treatment, causes, Symptoms, diagnosis, preventions, functions, mechanism of action, insulin regulation & control of secretion

2. Topic:
Hypoglycemia
Group members:
Nouman Mughal BDP02171003
Syed Muhammad Saif Ali BPD02171021
Hafiz Muhammad Mohsin Rasheed BPD02171019
Hafiz Mohsin Shahbaz Butt BPD02171013
Mohsin Mehmood BPD02171100
Instructor:

3. ➢Hypoglycemia was first discovered by James Collip while
working on insulin purification with Frederick Banting in
1922.
➢Hypoglycemia, also known as low blood sugar, is when
blood sugar decreases to below normal levels.
➢Hypoglycemia is the blood glucose concentration of less
than 2.8mmol/L.

4. Diabetes is a disease in which blood glucose level are too
high. It is often treated with insulin or with medication that
increase your body’s insulin production. If these treatments
are raise, you insulin level too high and your blood glucose
level drop too low.

7. There are two types of hypoglycemia:
➢ Reactive Hypoglycemia
➢ Non-Reactive Hypoglycemia

8. ➢Reactive hypoglycemia occurs within a few hours after a meal. An over production
of insulin causes reactive hypoglycemia.
➢Having reactive hypoglycemia means that you are at risk for diabetes mellitus.
CAUSES:-
The characteristics clinical features or causes of acute hypoglycemia:
➢Ataxia
➢Coma
➢Hunger
➢Anxiety
➢Diplopia
➢Dizziness
➢Palpitation
➢Convulsions
➢Tachycardia
➢Facial flushing

9. Ataxia
➢ Ataxia is a neurological sign consisting
of lack of voluntary coordination of
muscle movements that includes gait
abnormality.
➢ Ataxia is a non-specific clinical
manifestation implying dysfunction of
the parts of the nervous system that
coordinate movement, such as the
cerebellum.

10. Diplopia
➢ Diplopia, commonly known as double
vision, is the simultaneous perception of
two images of a single object that may be
displaced horizontally, vertically,
diagonally (i.e., both vertically and
horizontally), or rotationally in relation to
each other.

11. Dizziness
➢ The most common causes of dizziness are
outlined below. Labyrinthitis – an inner ear
infection that affects your hearing and
balance, and can lead to a severe form
of dizziness called vertigo. Migraine –
dizziness may come on before or after the
headache, or even without the headache.

12. Palpitation
➢ Palpitations make you feel like your heart
is beating too hard or too fast, skipping a
beat, or fluttering. You may notice
heart palpitations in your chest, throat, or
neck. They can be bothersome or
frightening. They usually aren't serious or
harmful, though, and often go away on
their own.

13. convulsions
➢ A convulsion is a medical condition where
body muscles contract and relax rapidly
and repeatedly, resulting in an
uncontrolled shaking of the body. Because
epileptic seizure is often a symptom
ofconvulsion, the term convulsion is
sometimes used as a synonym for seizure.

14. Tachycardia
➢ Tachycardia, also called tachyarrhythmia,
is a heart rate that exceeds the normal
resting rate. In general, a resting heart
rate over 100 beats per minute is accepted
as tachycardia in adults.

15. facial Flushing
➢ Skin flushing or blushing describe feelings
of warmth and rapid reddening of your
neck, upper chest, orface. Blotchiness or
solid patches of redness are often visible
when blushing.

16. ➢Non-reactive hypoglycemia isn't necessarily related to meals and
may be due to an underlying disease. Causes of non-reactive, or
fasting, hypoglycemia can include:
➢Some medications, like those used in adults and children with
kidney failure
✓Excess amounts of alcohol , which can stop your liver from
producing glucose
✓Disorder that affects the liver, heart or kidneys
✓Eating disorders, such as anorexia
✓Pregnancy

17. Anorexia
➢ Anorexia nervosa, often referred to simply
as anorexia, is an eating disorder
characterized by low weight, fear of
gaining weight, and a strong desire to be
thin, resulting in food restriction. Many
people with anorexia see themselves as
overweight even though they are in fact
underweight.

18. ➢The most common cause of hypoglycemia is medications used to treat
diabetes mellitus such as insulin and sulfonylureas.
➢Risk is greater in diabetics who have eaten less than usual, exercised more
than usual, or have drunk alcohol.
➢Other causes of hypoglycemia include:
✓Kidney failure
✓Nesidioblastosis
✓Insulinoma
✓liver disease
✓Hypothyroidism
✓Anorexia Nervosa
✓inborn error of metabolism

19. ➢Symptoms of hypoglycemia tend to come on quickly and can vary from person to
person.
➢Severe hypoglycemia is when your blood glucose level becomes so low that you’re
unable to treat yourself and need help from another person. Severe hypoglycemia is
dangerous and needs to be treated right away. This condition is more common in
people with type 1 diabetes.
General Symptoms
➢Clumsiness
➢Anxiety
➢Confusion
➢Loss of consciousness
➢Seizures or death
➢A feeling of hunger
➢Sweating
➢Shakiness and weakness may also be present.

20. ➢ Sweaty
➢ Hungry
➢ Headachy
➢ Blurred vision
➢ Weakness and fatigue
➢ Tingling
➢ Dizzy or lightheaded
➢ Confused or disoriented
➢Looking pale

21. ➢ Unable to eat or drink
➢ Seizures or convulsions (jerky movements)
➢ Unconsciousness

22. ➢There are two stages in the diagnosis of hypoglycemia
1. Conformation of low blood glucose concentration
➢Hypoglycemia can occur in a fasting state, meaning you’ve gone for an extended
period without eating. Your doctor may ask you to take a fasting test. This test
can last as long as 72 hours. During the test, you’ll have your blood drawn at
different times to measure your blood glucose level.
➢Another test is a mixed-meal tolerance test. This test is for people experiencing
hypoglycemia after eating.
2. Elucidation of the cause
Both tests will involve a blood draw at your doctor's office. The results
are usually available within a day or two. If your blood sugar level is
lower than 50 to 70 milligrams per deciliter, you may have hypoglycemia.
That number can vary from one person to another. Some people's bodies
naturally have lower blood sugar levels. Your doctor will diagnose you
based on your blood sugar levels.

23. If you begin to feel one or more hypoglycemia symptoms,
check your blood glucose. If your blood glucose level is below
your target or less than 70, eat or drink 15 grams of
carbohydrates right away. Examples include:
Rule of 15
➢ Four glucose tablets or one tube of glucose gel
➢ 1/2 cup (4 ounces) of fruit juice, not low-calorie or reduced
sugar
➢ 1/2 can (4 to 6 ounces) of soda, not low-calorie or reduced
sugar
➢ 1 tablespoon of sugar, honey, or corn syrup

24. ➢ Check blood glucose levels
➢ Eat regular meals and snacks
➢ Be physically active safely
➢ Eat a balanced and stable diet that’s low in sugar and high in
protein, fiber, and complex carbohydrates.
➢Eat small meals every two hours to help keep your blood sugar
levels stable.
➢The risk of further episodes of diabetic hypoglycemia can often
(but not always) be reduced by lowering the dose of insulin or
other medications (meglitinide, sulfonylurea) , or by more
meticulous attention to blood sugar balance during unusual hours,
higher levels of exercise, or decreasing alcohol intake.

25. Glucagon is a hormone secreted by alpha cells of islets of
Langerhans causes the increase in the concentration of
glucose by the process of glycogenolysis & gluconeogenesis.
Glucagon is large polypeptide.
It has a molecular weight of 3485 & It is composed of a
chain of 29 amino acids.
Glucagon is also called as hyper glycemic hormone.

26. ➢In a normal person, the blood glucose concentration is
narrowly controlled, usually between 80 and 90mg/100ml
of blood in the fasting person each morning before
breakfast.
➢This concentration increases to 120 to 140mg/100ml
during the first hour or so after a meal.
➢the feedback systems control of blood glucose rapidly
return glucose concentration back to the control level,
usually within 2 hours after the last absorption of
carbohydrates.

27. ➢The liver functions as an important blood glucose buffer system.
➢Both insulin and glucagon function as important feedback control
systems for maintaining a normal blood glucose concentration.
➢In severe hypoglycemia, a direct effect of low blood glucose on the
hypothalamus also stimulates the sympathetic nervous system.
➢The epinephrine secreted by the adrenal glands further increases
release of glucose from the liver, which is also helps protect against
severe hypoglycemia.
➢Growth hormone and cortisol are secreted in response to
prolonged hypoglycemia.
➢They both decrease the rate of glucose utilization by most cells of
the body, converting instead to greater amounts of fat utilization.

30. ➢Breakdown of liver glycogen (glycogenolysis)
➢Gluconeogenesis

31. Glycogenolysis occur in cascade system.
Glycogenolysis steps are following:
1. Glucagon activates adenylyl cyclase in the hepatic cell membrane.
2. Which causes the formation of cyclic adenosine monophosphate.
3. Which activates protein kinase regulator protein.
4. Which activates protein kinase.
5. Which activates phosphorylase b kinase.
6. Which converts phosphorylase b into phosphorylase a.
7. Which promotes the degradation of glycogen into glucose-1-phosphate.
8. Which is then dephosphorylated, and the glucose is released from the liver
cells.

32. Cascade system:
It is a system in which a succeeding product is produce in
greater quantity than the preceding product.
Due to the cascade system the few micrograms of glucagon
can cause the blood glucose level to double within a few
minutes.

33. ➢Inhibit the storage of triglyceride in the liver.
➢Activates adipose cell lipase.
➢Enhances the strength of heart.
➢Increases the blood flow in some tissues.

34. Factors which increases the glucagon secretion
1. Presence of amino acid in blood stream.
2. Exercise
Factors which decreases the glucagon secretion.
1. Increase blood glucose level.

35. ➢Insulin
➢Glucagon
➢Somatostatin
➢Epinephrine
➢Cortisol
➢ACTH
➢Growth Hormone
➢Thyroxin

37. ➢Blood sugar regulation is the process by which the levels of blood
sugar, primarily glucose, are maintained by the body within a
narrow range. This phenomenon of tight regulation is referred to
as glucose homeostasis.
➢Pancreas has four type of cells.
➢Alpha Cells
➢Beta Cells
➢Delta Cells ( It produces somatostatin)
➢PP Cells(Polypeptide cells):(It produces pancreatic polypeptide)
➢Alpha cells secrete glucagon which raises the blood sugar.
➢Beta cells secrete insulin which lowers the blood sugar.

38. ➢Insulin is synthesized in significant quantities only in beta cells.
Synthesis
➢Prepro insulin synthesis.
➢Pro insulin synthesis
➢The insulin mRNA is translated as a single chain precursor called pre
pro insulin and removal of single peptide during insertion in
endoplasmic reticulum generates pro insulin.
➢There are three chains of pro insulin
➢B chain
➢A chain
➢C chain
➢Pro insulin is exposed to several specific endopeptidase which cut the C
chain in mature form of insulin (A chain and B chain).

41. ➢Insulin secreted in response to elevated blood concentration
glucose
➢There are following steps involving in glucose entrance in beta cell
1. Glucose is transported by facilitated diffusion through a
glucose transporter thus glucose level is increased in beta
cells.
2. Elevated glucose in beta cell causes depolarization of
membrane of beta cell and influx of calcium ions which
trigger the exocytosis on insulin-containing secretory
granules.

43. Drugs which blocks potassium channel
1. Sulphonylureas
These are oral hypoglymic agent
a) Tol-butamide
b) Glyburide
2. Meglitinide
a) Repaglinide
b) Nateglinide

44. Insulinoma is treated by potassium channel activator or opener by
Diazoxide drug.
Causes of Insulinemia
Impaired glucose tolerance.
Insulin resistance.
Pancreatic Cancer.
Symptoms
Often there is no visible symptoms unless hypoglycemia is present.

45. Keep Calm &
Thank You
For Your
Attention