This document discusses glucose regulation and hypoglycemia in infants. It notes that hypoglycemia is a blood glucose level below 40 mg/dL and can cause long term neurological damage if prolonged. The mechanisms that control blood glucose levels like insulin and glucagon are described. Causes, signs, and treatments of hypoglycemia in infants are provided, including feeding, intravenous dextrose infusions, and medications if needed to stabilize blood glucose. Screening and monitoring of at-risk infants is recommended.

2.  Usual rate of glucose utilization is 4-8 mg per
kg/min.
 Glucose regulatory mechanism is sluggish at birth
 When glucose demand is increase / when
exogenous/ endogenous glucose supply is limited .
 Prolonged hypoglycemia may result in long term
neurologic damage.

3.  Hypoglycemia in the first few days after
birth is defined as “blood glucose levels
below 40 mg/dl.”
 In preterm infants, repeated blood glucose
level below 50 mg / dl maybe associated
with neurodevelopment delay.

4.  Insulin and glucagon hormones control the blood
glucose level.
 Blood glucose level increases → rate of insulin
secretion increases → stimulates liver to store
glucose as glycogen → when liver and muscle cells
are saturated with glycogen additional glucose is
stored as fat.

5.  Blood glucose level falls → glucagon level
increases → it promotes conversion of
glycogen in liver back into glucose
(glycogenolysis) → this glucose released in
blood.
 During starvation liver maintain glucose level
by gluconeogenesis i.e formation of glucose
from amino acids and fat.

6.  Hypothalamus stimulate epinephrine secretion from
adrenal, causing further glucose release from liver.
 After prolong hypoglycemia growth hormone and
cortisol secreted that the decrease the rate of glucose
utilization by body cells.

7. Hypoglycemia
Insulin
↑
Glucagon ↑ Epinephri
ne ↑
Growth
Hormo
ne ↑
Cortisol ↑
Protein
breakdow
n ↑
Insulin
sensitivi
ty ↓
Fat break
down ↑
Hepatic
glucose
output ↑
Gluconeoge
nesis ↑
Glucose
utilizatio
n ↓
Ketones ↑
Glucose ↑

8. Decreased substrate availability
•Intrauterine growth retardation
•Inborn errors (fructose intolerance)
•Prolonged fasting without iv glucose
•Glycogen storage disease
•Prematurity

9.  Infant of diabetic mother
 Erythroblast sis fetalis
 High umbilical arterial catheter
 Islet cell hyperplasia
 Exchange transfusion
 Maternal beta mimetic tocolytic agents
 Abrupt cessation of iv glucose
 Beckwith-wiedemann syndrome

10.  Cold stress
 Sepsis
 Increase work of breathing
 Prenatal asphyxia

11.  Pan-hypopituitarism
 Adrenal insufficiency
 Hypo thyroidism

12.  Polycythemia
 CNS abnormalities
 Congenital heart diseases

13.  Cyanosis
 Breathing problems
 Hypotonia
 Grunting
 Listlessness
 Irritability or lethargy
 Restlessness
 Altered sensorium
 Twitching and trenmors
 seizures

14.  Specimen for measurement of glucose should be
obtained from heel stick, venipuncture , or from and
indwelling catheter that does not have glucose
infusing in it

15.  Infants at risk for hypoglycemia should be screened
by measuring blood sugar by glucometer at ages 1,
2, 4, 6, 9 and 12th. Less frequent measurement are
appropriate if blood glucose is stable.
 Continue surveillance and more frequent
measurement may be needed until blood glucose is
stable > 14mg/ dl or > 50 mg/ dl in very preterm
infants

16.  Glucometer reading > 40 mg/dl and infant is feeding
normally:
Follow usual nursery protocol
 Glucometer reading 20-40 mg/dl, infant is term and
is able to feed:
 Draw blood for stat blood glucose measurement
 Feed 5 ml/kg of 5%/ dextrose
 Repeat blood glucose 20 min after feeding

17.  Glucometer reading :
a) < 20 mg/dl
b) < 40 mg/dl and NPO or preterm
c) < 40 mg/dl after feeding
d) < 40 mg/dl and symptomatic
 Draw blood for stat glucose measurement
 Give iv bolus of 2-3 ml/kg of D10W
 Begin continuous infusion of D10W at 4-6 mg/kg per
min

18.  If infant of diabetic mother begin D10W at 8-10
mg/kg/min
 Repeat blood glucose in 20 min and pursue
treatment until blood sugar < 40 mg/dl

19.  Increase rate of glucose infusion stepwise in
2mg/kg/min increments upto 12-15
mg/kg/min glucose.

20.  If hypoglycemia is not controlled with
dextrose infusion then further management
include glucocorticoid,dizoxide,somatostatin
or pancreactectomy.

21.  When blood glucose is stable for 12-24 hrs,
begin decreasing iv infusion by 1-2 ml/hr if
blood glucose remain >60 mg/dl

22.  Occipital lobe damage
 Developmental delay
 Heart failure