Hypoglycaemia, or low blood glucose, can cause brain damage or death in newborns. It is defined as a blood glucose level below 2.0 mmol/L. Infants at highest risk include preterm infants, underweight infants, and infants of diabetic mothers. Clinical signs of hypoglycaemia are non-specific but may include depression or overstimulation of brain function. Mild hypoglycaemia can be treated with milk feeds while severe hypoglycaemia below 1.5 mmol/L requires immediate intravenous glucose therapy. Preventing hypothermia and early feeding helps reduce the risk of hypoglycaemia.
The document discusses homeostasis and the regulation of blood glucose levels. It explains that glucose levels are normally maintained between 5-5.5 mmol/dm3. If levels rise too high or fall too low, issues can occur. Insulin allows glucose to enter cells, while lack of insulin causes high blood sugar. Type 1 diabetes is caused by immune destruction of beta cells, while Type 2 diabetes is associated with aging and obesity. Glucose levels are regulated through a negative feedback loop involving the liver, alpha and beta cells, insulin, and glucagon.
The document summarizes how the body controls blood glucose levels. Glucose from food is absorbed into the bloodstream and transported throughout the body. The pancreas releases insulin in response to rising blood glucose levels, which allows cells to absorb glucose for energy or storage. The normal blood glucose range is listed, as well as classifications for different blood glucose levels and potential causes of hyperglycemia. A brief case study describes a patient with elevated blood glucose possibly due to liver disease and recommendations for nursing assessments.
The document discusses hormonal communication and the control of blood glucose concentration. It focuses on the pancreas, which is both an exocrine and endocrine gland. The pancreas' exocrine role is to secrete pancreatic juices into the duodenum. Its endocrine role is carried out by the islets of Langerhans, which contain alpha and beta cells. Alpha cells secrete glucagon to stimulate glucose release, while beta cells secrete insulin to stimulate glucose uptake. The pancreas detects changes in blood glucose and releases the appropriate hormone, insulin or glucagon, to regulate glucose levels.
1. The pancreas contains clusters of cells called islets of Langerhans that secrete hormones like insulin and glucagon to regulate blood glucose levels. Insulin allows cells to take in glucose from the bloodstream and lowers blood glucose levels, while glucagon has the opposite effect.
2. In diabetes, the pancreas either produces little or no insulin (type 1 diabetes) or the body develops a resistance to insulin's effects (type 2 diabetes), disrupting the body's ability to regulate blood glucose levels and maintain homeostasis. This leads to high blood glucose levels (hyperglycemia).
3. Without enough insulin to allow cells to take in glucose, the body begins to breakdown proteins and fats
This document provides an overview of blood glucose regulation and diabetes. It begins with definitions of key terms like blood sugar, normal glucose levels, and hyperglycemia and hypoglycemia. The document then discusses the history of diabetes research and discoveries. It explains the normal physiology of glucose regulation including the roles of insulin, glucagon, and other hormones. It also covers alterations in blood glucose levels and the public health impacts of diabetes.
This document discusses glucose homeostasis and diabetic emergencies from an emergency perspective. It provides guidance on assessing altered mental status, including checking a blood sugar level. It describes insulin and its role in glucose metabolism. Diabetic ketoacidosis and hyperglycemic hyperosmolar state are life-threatening disorders that can result from lack of insulin or inability to use insulin properly. Proper treatment involves fluid resuscitation and insulin therapy while closely monitoring electrolytes. Hypoglycemia is also covered, noting it can result if insulin levels are too high.
Glucose homeostasis involves maintaining blood glucose levels within a normal range of 70-100 mg/dl. This is regulated by hormones like insulin and glucagon, as well as metabolic processes in the liver, muscles and other tissues. When blood glucose rises after a meal, insulin is secreted which promotes glucose uptake and storage. When blood glucose falls, glucagon is secreted which breaks down glycogen to release glucose. Other hormones like epinephrine and cortisol also help raise blood glucose levels. The kidneys play a role by filtering out excess glucose to prevent hyperglycemia. Tests are done to monitor blood glucose levels and diagnose conditions like diabetes that disrupt normal homeostasis.
The document discusses alternation between anabolism and catabolism in the human body. Anabolism involves building complex molecules from simpler ones and supports growth, while catabolism breaks down large molecules into smaller ones and produces ATP through cellular respiration. Insulin promotes anabolic activities that store glucose, while glucagon stimulates catabolic activities. The liver plays a key role in maintaining blood glucose levels between meals by breaking down glycogen or converting other substrates into glucose. Insulin and glucagon work to regulate glucose uptake and output from the liver to keep blood glucose within a normal range. Diabetes mellitus occurs when there is insufficient or ineffective insulin to properly regulate blood glucose.
The document discusses homeostasis and the regulation of blood glucose levels. It explains that glucose levels are normally maintained between 5-5.5 mmol/dm3. If levels rise too high or fall too low, issues can occur. Insulin allows glucose to enter cells, while lack of insulin causes high blood sugar. Type 1 diabetes is caused by immune destruction of beta cells, while Type 2 diabetes is associated with aging and obesity. Glucose levels are regulated through a negative feedback loop involving the liver, alpha and beta cells, insulin, and glucagon.
The document summarizes how the body controls blood glucose levels. Glucose from food is absorbed into the bloodstream and transported throughout the body. The pancreas releases insulin in response to rising blood glucose levels, which allows cells to absorb glucose for energy or storage. The normal blood glucose range is listed, as well as classifications for different blood glucose levels and potential causes of hyperglycemia. A brief case study describes a patient with elevated blood glucose possibly due to liver disease and recommendations for nursing assessments.
The document discusses hormonal communication and the control of blood glucose concentration. It focuses on the pancreas, which is both an exocrine and endocrine gland. The pancreas' exocrine role is to secrete pancreatic juices into the duodenum. Its endocrine role is carried out by the islets of Langerhans, which contain alpha and beta cells. Alpha cells secrete glucagon to stimulate glucose release, while beta cells secrete insulin to stimulate glucose uptake. The pancreas detects changes in blood glucose and releases the appropriate hormone, insulin or glucagon, to regulate glucose levels.
1. The pancreas contains clusters of cells called islets of Langerhans that secrete hormones like insulin and glucagon to regulate blood glucose levels. Insulin allows cells to take in glucose from the bloodstream and lowers blood glucose levels, while glucagon has the opposite effect.
2. In diabetes, the pancreas either produces little or no insulin (type 1 diabetes) or the body develops a resistance to insulin's effects (type 2 diabetes), disrupting the body's ability to regulate blood glucose levels and maintain homeostasis. This leads to high blood glucose levels (hyperglycemia).
3. Without enough insulin to allow cells to take in glucose, the body begins to breakdown proteins and fats
This document provides an overview of blood glucose regulation and diabetes. It begins with definitions of key terms like blood sugar, normal glucose levels, and hyperglycemia and hypoglycemia. The document then discusses the history of diabetes research and discoveries. It explains the normal physiology of glucose regulation including the roles of insulin, glucagon, and other hormones. It also covers alterations in blood glucose levels and the public health impacts of diabetes.
This document discusses glucose homeostasis and diabetic emergencies from an emergency perspective. It provides guidance on assessing altered mental status, including checking a blood sugar level. It describes insulin and its role in glucose metabolism. Diabetic ketoacidosis and hyperglycemic hyperosmolar state are life-threatening disorders that can result from lack of insulin or inability to use insulin properly. Proper treatment involves fluid resuscitation and insulin therapy while closely monitoring electrolytes. Hypoglycemia is also covered, noting it can result if insulin levels are too high.
Glucose homeostasis involves maintaining blood glucose levels within a normal range of 70-100 mg/dl. This is regulated by hormones like insulin and glucagon, as well as metabolic processes in the liver, muscles and other tissues. When blood glucose rises after a meal, insulin is secreted which promotes glucose uptake and storage. When blood glucose falls, glucagon is secreted which breaks down glycogen to release glucose. Other hormones like epinephrine and cortisol also help raise blood glucose levels. The kidneys play a role by filtering out excess glucose to prevent hyperglycemia. Tests are done to monitor blood glucose levels and diagnose conditions like diabetes that disrupt normal homeostasis.
The document discusses alternation between anabolism and catabolism in the human body. Anabolism involves building complex molecules from simpler ones and supports growth, while catabolism breaks down large molecules into smaller ones and produces ATP through cellular respiration. Insulin promotes anabolic activities that store glucose, while glucagon stimulates catabolic activities. The liver plays a key role in maintaining blood glucose levels between meals by breaking down glycogen or converting other substrates into glucose. Insulin and glucagon work to regulate glucose uptake and output from the liver to keep blood glucose within a normal range. Diabetes mellitus occurs when there is insufficient or ineffective insulin to properly regulate blood glucose.
This document summarizes blood glucose regulation and diabetes. It explains that insulin decreases blood glucose by stimulating glucose uptake and glycogenesis, while glucagon and epinephrine increase it by stimulating glycogenolysis and gluconeogenesis. The oral glucose tolerance test (OGTT) measures blood glucose levels after consuming glucose to diagnose diabetes, where abnormally high post-meal levels indicate the condition. Fasting plasma glucose levels between 100-125 mg/dL signal impaired fasting glucose, and over 126 mg/dL indicate diabetes.
Galactosemia is a genetic disorder where the body cannot break down galactose, a sugar found in milk. This causes galactose to build up and potentially damage the brain, eyes, liver and kidneys. The only treatment is a lifelong galactose-restricted diet that avoids foods containing lactose or milk products. Strict adherence to the diet can prevent complications, which may include speech delays, movement problems and eye cataracts.
This document summarizes key aspects of insulin and glucagon regulation of blood glucose levels. It discusses that insulin and glucagon are polypeptide hormones secreted by the pancreas that have opposing functions. Insulin is produced in response to high blood glucose to promote glucose uptake and storage. Glucagon is produced in response to low blood glucose to promote glucose release from stores. The document also summarizes the different types of diabetes, their causes and treatments.
Diabetes Mellitus Type-II is a lifelong disease where the body does not properly use insulin to regulate blood sugar levels. Over time, high blood sugar can damage organs like the heart, kidneys, eyes, and nerves. Type-2 diabetes is usually caused by a combination of genetic and lifestyle factors like weight and diet. It is diagnosed through blood tests measuring glycated hemoglobin and fasting plasma glucose levels. Treatment involves medications, lifestyle changes like diet and exercise, and possibly surgery, to manage blood sugar and prevent complications.
This document discusses the regulation of blood sugar levels and diabetes mellitus. It explains that blood glucose is tightly regulated by factors that control glucose entry into and depletion from the bloodstream. In fasting state, glycogenolysis and gluconeogenesis maintain blood glucose levels. After eating, insulin helps regulate levels by promoting glucose uptake and storage. Diabetes occurs when this regulation breaks down, and is classified into type 1 (insulin deficiency) and type 2 (insulin resistance). The document outlines symptoms, treatments, and oral manifestations of diabetes.
This document summarizes blood glucose homeostasis. It defines normal fasting and post-prandial blood glucose levels. It describes the main sources of blood glucose and the factors that regulate blood glucose levels, including gastrointestinal, hepatic, renal, and hormonal factors. Specifically, it outlines the roles of insulin and glucagon in maintaining blood glucose within a narrow range.
Diabetes mellitus is characterized by hyperglycemia due to insufficient insulin production or ineffective insulin. There are two main types - type 1 diabetes results from autoimmune destruction of insulin-producing pancreatic beta cells, while type 2 diabetes involves insulin resistance along with relative insulin deficiency. Insulin regulates carbohydrate, fat, and protein metabolism, maintaining blood glucose levels. Glucagon has opposing effects, promoting gluconeogenesis and glycolysis to increase glucose levels. Tight regulation of insulin and glucagon secretion is needed to keep glucose within its narrow physiological range.
This document discusses neonatal hypoglycemia and hyperglycemia. It begins by explaining the physiology of glucose homeostasis in newborns, including their dependence on maternal glucose prenatally and the body's response to low blood sugar through gluconeogenesis and ketone production. It then defines hypoglycemia, discusses its incidence in high-risk newborns, and identifies potential etiologies like hyperinsulinism. Clinical features and diagnostic methods are outlined, along with treatment approaches focused on early feeding and prevention in at-risk infants.
Some additional things to ask in the history:
- Family history of similar episodes or endocrine disorders
- Dietary history, including any changes in appetite/food intake
- Growth pattern and any slowing of growth
- Pubertal development
Some additional things to examine:
- Vital signs - check for signs of dehydration, shock
- Detailed physical exam looking for signs of other endocrine abnormalities
- Developmental assessment
- Nutritional status
Investigations to consider:
- Electrolytes, liver/renal function tests
- Cortisol, ACTH to check for primary adrenal insufficiency
- Thyroid function tests
- Growth hormone stimulation test
- Blood glucose curve/
Diabetic ketoacidosis occurs due to severe insulin deficiency and excess counter-regulatory hormones like epinephrine, glucagon, cortisol, and growth hormone. Without insulin, glucose accumulates in the blood while the liver uses amino acids and fatty acids to produce ketone bodies like acetone, acetoacetate, and beta-hydroxybutyrate. The counter-regulatory hormones increase insulin resistance, glycogenolysis, gluconeogenesis, and lipolysis while inhibiting insulin secretion.
Homeostasis refers to the maintenance of stable internal conditions in the body. Glucose homeostasis specifically reflects a balance between hepatic glucose production and peripheral glucose uptake, regulated by insulin and glucagon. In the fasting state, low insulin and high glucagon promote gluconeogenesis and glycogenolysis in the liver to produce glucose for tissues like the brain that require it. Postprandially, high insulin and low glucagon stimulate glucose uptake in tissues and inhibit hepatic glucose production. Gluconeogenesis allows the conversion of substrates like lactate, glycerol, and amino acids into glucose, especially in the liver. It bypasses three irreversible glycolytic steps through key enzymes. The Cori and Alanine cycles shuttle lact
This document summarizes neonatal hyperglycemia. It defines hyperglycemia in newborns as a blood glucose level >125 mg/dL or plasma glucose >150 mg/dL. The main causes of neonatal hyperglycemia are high rates of parenteral glucose infusion, prematurity, stress, sepsis, drugs like glucocorticoids and phenytoin, and rare cases of neonatal diabetes mellitus. Management involves monitoring blood glucose levels and administering insulin therapy if levels exceed 180-200 mg/dL to prevent risks like increased mortality and intraventricular hemorrhage in extremely premature infants.
This document provides information about the glucose tolerance test (GTT), also known as the oral glucose tolerance test (OGTT). It defines the GTT as a standardized test used to diagnose diabetes mellitus in doubtful cases. The document outlines the indications for an OGTT as having symptoms of diabetes, inconclusive fasting blood sugar levels, pregnancy with excessive weight gain or history of large or miscarried babies. Contraindications are a confirmed diabetes diagnosis or using it for follow-up. Preparation involves a high carbohydrate diet before the test and fasting overnight. The test involves collecting fasting and 2-hour blood and urine samples after a glucose drink. Diagnosis of diabetes is made if fasting blood sugar is over 126 mg/dl or
This document discusses glucose homeostasis and diabetes. It covers:
- The roles of insulin, glucagon, and other hormones in regulating blood glucose levels. Insulin lowers glucose while glucagon raises it.
- The differences between type 1 and type 2 diabetes, including causes and treatments. Type 1 is an autoimmune disease treated with insulin, while type 2 is due to insulin resistance and may be treated with diet, exercise, or oral medication.
- How insulin works by binding receptors on cells and increasing glucose uptake, utilization, and storage. This lowers blood glucose levels.
This document discusses glucose regulation and hypoglycemia in infants. It notes that hypoglycemia is defined as 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.
This document discusses neonatal hypoglycemia in a newborn baby referred from another hospital. It provides details on the baby's condition, history, treatment and monitoring. It also includes an overview of neonatal glucose homeostasis, the definition of hypoglycemia, classification of neonatal hypoglycemia, special considerations for preterm infants, SGA infants and infants of diabetic mothers. It outlines who should be screened for hypoglycemia and the recommended frequency of blood glucose monitoring based on risk factors.
1. Beta cells in the pancreas produce the hormone insulin which regulates blood sugar levels. Impairment of beta cells leads to diabetes. Studying beta cell development in zebrafish can provide insights into treating diabetes in humans.
2. Zebrafish have similarities to humans in genes associated with disease and drug responses, making them a useful model for studying beta cell development. Their pancreas contains beta cells clustered in islets as well as single beta cells in the tail.
3. Transcription factors like Pdx1 and Ptf1a are involved in early beta cell differentiation and maturation. Understanding their roles and how to generate new beta cells could lead to strategies for treating diabetes.
Neonatal hypoglycemia can occur in high-risk infants such as those born to diabetic mothers or who are preterm/small for gestational age. Symptoms may include jitteriness, apnea, or seizures. Management involves early feeding and glucose monitoring to prevent and detect hypoglycemia. For levels under 1.5 mmol/L, IV dextrose is given with frequent monitoring until levels rise above 2.6 mmol/L. Persistent hypoglycemia may require increased dextrose concentration or addition of medications like glucagon or hydrocortisone. Recurrent hypoglycemia suggests underlying conditions like hyperinsulinemia which require additional investigation and treatment with drugs to reduce insulin secretion.
This document provides an overview of carbohydrate metabolism and associated disorders. It discusses the regulation of glycolysis and phosphofructokinase, the significance of glycolysis in meeting energy demands, and disorders associated with deficiencies in glycolysis enzymes. It also covers topics like the Rapoport-Leubering cycle, effects of altitude on hemoglobin, and the importance of gluconeogenesis during fasting.
Galactosemia is a rare genetic metabolic disorder caused by a deficiency of the enzyme galactose-1-phosphate uridyltransferase, which is necessary for galactose metabolism. There are three main types depending on the specific enzyme deficiency. It is inherited in an autosomal recessive pattern and causes an inability to properly break down and use the sugar galactose. If left untreated, it can cause serious issues such as liver damage, cataracts, intellectual disabilities and more. Treatment involves a strict lifelong galactose-restricted diet.
Newborn Care: Skills workshop Glucose control and hypoglycaemiaSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, communication with parents
A Mathematical Model for the Enhancement of Stress Induced Hypoglycaemia by A...IJRES Journal
The normal distribution is a very commonly occurring continuous probability distribution. In this paper the Multivariate Normal distribution is used for finding the mgf of the curve for the enhancement of stress induced Hypoglycaemia with consideration of the variablesProlactin, ACTH, Growth Hormone, Blood Pressure, Plasma Glucose, Plasma Renin, Epinephrine, Cortisol. These variables are treated with the drugs (citalopram and tianeptine) and the joint moment generating function for the variables in Citalopram, Tianeptineand Placebo casesare found out and are given as curves in the Mathematical Results
This document summarizes blood glucose regulation and diabetes. It explains that insulin decreases blood glucose by stimulating glucose uptake and glycogenesis, while glucagon and epinephrine increase it by stimulating glycogenolysis and gluconeogenesis. The oral glucose tolerance test (OGTT) measures blood glucose levels after consuming glucose to diagnose diabetes, where abnormally high post-meal levels indicate the condition. Fasting plasma glucose levels between 100-125 mg/dL signal impaired fasting glucose, and over 126 mg/dL indicate diabetes.
Galactosemia is a genetic disorder where the body cannot break down galactose, a sugar found in milk. This causes galactose to build up and potentially damage the brain, eyes, liver and kidneys. The only treatment is a lifelong galactose-restricted diet that avoids foods containing lactose or milk products. Strict adherence to the diet can prevent complications, which may include speech delays, movement problems and eye cataracts.
This document summarizes key aspects of insulin and glucagon regulation of blood glucose levels. It discusses that insulin and glucagon are polypeptide hormones secreted by the pancreas that have opposing functions. Insulin is produced in response to high blood glucose to promote glucose uptake and storage. Glucagon is produced in response to low blood glucose to promote glucose release from stores. The document also summarizes the different types of diabetes, their causes and treatments.
Diabetes Mellitus Type-II is a lifelong disease where the body does not properly use insulin to regulate blood sugar levels. Over time, high blood sugar can damage organs like the heart, kidneys, eyes, and nerves. Type-2 diabetes is usually caused by a combination of genetic and lifestyle factors like weight and diet. It is diagnosed through blood tests measuring glycated hemoglobin and fasting plasma glucose levels. Treatment involves medications, lifestyle changes like diet and exercise, and possibly surgery, to manage blood sugar and prevent complications.
This document discusses the regulation of blood sugar levels and diabetes mellitus. It explains that blood glucose is tightly regulated by factors that control glucose entry into and depletion from the bloodstream. In fasting state, glycogenolysis and gluconeogenesis maintain blood glucose levels. After eating, insulin helps regulate levels by promoting glucose uptake and storage. Diabetes occurs when this regulation breaks down, and is classified into type 1 (insulin deficiency) and type 2 (insulin resistance). The document outlines symptoms, treatments, and oral manifestations of diabetes.
This document summarizes blood glucose homeostasis. It defines normal fasting and post-prandial blood glucose levels. It describes the main sources of blood glucose and the factors that regulate blood glucose levels, including gastrointestinal, hepatic, renal, and hormonal factors. Specifically, it outlines the roles of insulin and glucagon in maintaining blood glucose within a narrow range.
Diabetes mellitus is characterized by hyperglycemia due to insufficient insulin production or ineffective insulin. There are two main types - type 1 diabetes results from autoimmune destruction of insulin-producing pancreatic beta cells, while type 2 diabetes involves insulin resistance along with relative insulin deficiency. Insulin regulates carbohydrate, fat, and protein metabolism, maintaining blood glucose levels. Glucagon has opposing effects, promoting gluconeogenesis and glycolysis to increase glucose levels. Tight regulation of insulin and glucagon secretion is needed to keep glucose within its narrow physiological range.
This document discusses neonatal hypoglycemia and hyperglycemia. It begins by explaining the physiology of glucose homeostasis in newborns, including their dependence on maternal glucose prenatally and the body's response to low blood sugar through gluconeogenesis and ketone production. It then defines hypoglycemia, discusses its incidence in high-risk newborns, and identifies potential etiologies like hyperinsulinism. Clinical features and diagnostic methods are outlined, along with treatment approaches focused on early feeding and prevention in at-risk infants.
Some additional things to ask in the history:
- Family history of similar episodes or endocrine disorders
- Dietary history, including any changes in appetite/food intake
- Growth pattern and any slowing of growth
- Pubertal development
Some additional things to examine:
- Vital signs - check for signs of dehydration, shock
- Detailed physical exam looking for signs of other endocrine abnormalities
- Developmental assessment
- Nutritional status
Investigations to consider:
- Electrolytes, liver/renal function tests
- Cortisol, ACTH to check for primary adrenal insufficiency
- Thyroid function tests
- Growth hormone stimulation test
- Blood glucose curve/
Diabetic ketoacidosis occurs due to severe insulin deficiency and excess counter-regulatory hormones like epinephrine, glucagon, cortisol, and growth hormone. Without insulin, glucose accumulates in the blood while the liver uses amino acids and fatty acids to produce ketone bodies like acetone, acetoacetate, and beta-hydroxybutyrate. The counter-regulatory hormones increase insulin resistance, glycogenolysis, gluconeogenesis, and lipolysis while inhibiting insulin secretion.
Homeostasis refers to the maintenance of stable internal conditions in the body. Glucose homeostasis specifically reflects a balance between hepatic glucose production and peripheral glucose uptake, regulated by insulin and glucagon. In the fasting state, low insulin and high glucagon promote gluconeogenesis and glycogenolysis in the liver to produce glucose for tissues like the brain that require it. Postprandially, high insulin and low glucagon stimulate glucose uptake in tissues and inhibit hepatic glucose production. Gluconeogenesis allows the conversion of substrates like lactate, glycerol, and amino acids into glucose, especially in the liver. It bypasses three irreversible glycolytic steps through key enzymes. The Cori and Alanine cycles shuttle lact
This document summarizes neonatal hyperglycemia. It defines hyperglycemia in newborns as a blood glucose level >125 mg/dL or plasma glucose >150 mg/dL. The main causes of neonatal hyperglycemia are high rates of parenteral glucose infusion, prematurity, stress, sepsis, drugs like glucocorticoids and phenytoin, and rare cases of neonatal diabetes mellitus. Management involves monitoring blood glucose levels and administering insulin therapy if levels exceed 180-200 mg/dL to prevent risks like increased mortality and intraventricular hemorrhage in extremely premature infants.
This document provides information about the glucose tolerance test (GTT), also known as the oral glucose tolerance test (OGTT). It defines the GTT as a standardized test used to diagnose diabetes mellitus in doubtful cases. The document outlines the indications for an OGTT as having symptoms of diabetes, inconclusive fasting blood sugar levels, pregnancy with excessive weight gain or history of large or miscarried babies. Contraindications are a confirmed diabetes diagnosis or using it for follow-up. Preparation involves a high carbohydrate diet before the test and fasting overnight. The test involves collecting fasting and 2-hour blood and urine samples after a glucose drink. Diagnosis of diabetes is made if fasting blood sugar is over 126 mg/dl or
This document discusses glucose homeostasis and diabetes. It covers:
- The roles of insulin, glucagon, and other hormones in regulating blood glucose levels. Insulin lowers glucose while glucagon raises it.
- The differences between type 1 and type 2 diabetes, including causes and treatments. Type 1 is an autoimmune disease treated with insulin, while type 2 is due to insulin resistance and may be treated with diet, exercise, or oral medication.
- How insulin works by binding receptors on cells and increasing glucose uptake, utilization, and storage. This lowers blood glucose levels.
This document discusses glucose regulation and hypoglycemia in infants. It notes that hypoglycemia is defined as 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.
This document discusses neonatal hypoglycemia in a newborn baby referred from another hospital. It provides details on the baby's condition, history, treatment and monitoring. It also includes an overview of neonatal glucose homeostasis, the definition of hypoglycemia, classification of neonatal hypoglycemia, special considerations for preterm infants, SGA infants and infants of diabetic mothers. It outlines who should be screened for hypoglycemia and the recommended frequency of blood glucose monitoring based on risk factors.
1. Beta cells in the pancreas produce the hormone insulin which regulates blood sugar levels. Impairment of beta cells leads to diabetes. Studying beta cell development in zebrafish can provide insights into treating diabetes in humans.
2. Zebrafish have similarities to humans in genes associated with disease and drug responses, making them a useful model for studying beta cell development. Their pancreas contains beta cells clustered in islets as well as single beta cells in the tail.
3. Transcription factors like Pdx1 and Ptf1a are involved in early beta cell differentiation and maturation. Understanding their roles and how to generate new beta cells could lead to strategies for treating diabetes.
Neonatal hypoglycemia can occur in high-risk infants such as those born to diabetic mothers or who are preterm/small for gestational age. Symptoms may include jitteriness, apnea, or seizures. Management involves early feeding and glucose monitoring to prevent and detect hypoglycemia. For levels under 1.5 mmol/L, IV dextrose is given with frequent monitoring until levels rise above 2.6 mmol/L. Persistent hypoglycemia may require increased dextrose concentration or addition of medications like glucagon or hydrocortisone. Recurrent hypoglycemia suggests underlying conditions like hyperinsulinemia which require additional investigation and treatment with drugs to reduce insulin secretion.
This document provides an overview of carbohydrate metabolism and associated disorders. It discusses the regulation of glycolysis and phosphofructokinase, the significance of glycolysis in meeting energy demands, and disorders associated with deficiencies in glycolysis enzymes. It also covers topics like the Rapoport-Leubering cycle, effects of altitude on hemoglobin, and the importance of gluconeogenesis during fasting.
Galactosemia is a rare genetic metabolic disorder caused by a deficiency of the enzyme galactose-1-phosphate uridyltransferase, which is necessary for galactose metabolism. There are three main types depending on the specific enzyme deficiency. It is inherited in an autosomal recessive pattern and causes an inability to properly break down and use the sugar galactose. If left untreated, it can cause serious issues such as liver damage, cataracts, intellectual disabilities and more. Treatment involves a strict lifelong galactose-restricted diet.
Newborn Care: Skills workshop Glucose control and hypoglycaemiaSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, communication with parents
A Mathematical Model for the Enhancement of Stress Induced Hypoglycaemia by A...IJRES Journal
The normal distribution is a very commonly occurring continuous probability distribution. In this paper the Multivariate Normal distribution is used for finding the mgf of the curve for the enhancement of stress induced Hypoglycaemia with consideration of the variablesProlactin, ACTH, Growth Hormone, Blood Pressure, Plasma Glucose, Plasma Renin, Epinephrine, Cortisol. These variables are treated with the drugs (citalopram and tianeptine) and the joint moment generating function for the variables in Citalopram, Tianeptineand Placebo casesare found out and are given as curves in the Mathematical Results
Aspire in home study-hypo protection plan learning modulemedtronicdiab
The ASPIRE In-Home Study evaluated the effect of the MiniMed VEO pump with Low Glucose Suspend (LGS) feature compared to Sensor Augmented Pump (SAP) therapy alone on nocturnal hypoglycemia and A1c in patients experiencing nocturnal hypos. The study found that LGS significantly reduced the duration and severity of nocturnal hypos by 38% and the frequency of nocturnal hypos by 31.8%, without increasing A1c. LGS also reduced the frequency of hypos throughout the 24-hour period by 30% and the number of mild, moderate, and severe hypos, without causing rebound hyperglycemia.
An insightful presentation on issue of Hypoglycaemia in patients of Diabetes Mellitus with focus on causes, symptoms and management. Also find included experience based inputs on issue of vehicle driving and hypoglycaemia
The document discusses various endocrine emergencies including diabetic ketoacidosis (DKA), hypoglycemia, and thyroid storm. It provides details on the causes, symptoms, diagnostic criteria and treatment approaches for each condition. DKA results from lack of insulin and needs urgent treatment including rehydration, insulin administration, and electrolyte correction. Hypoglycemia can be caused by too much insulin or too little food intake and requires glucose administration. Thyroid storm is a life-threatening exacerbation of hyperthyroidism that requires treatments to correct the hyperthyroidism and address any precipitating factors.
Growth of the fetus begins soon after fertilization, when the first cell division occurs.
Cell division, hypertrophy, and differentiation are highly coordinated events that result in the growth and development of specialized organ systems.
The fetus, fetal membranes, and placenta develop and function as a unit throughout pregnancy, and their development is interdependent or symbiotic.
The growth trajectory of fetal mass is relatively flat during the first trimester, increases linearly at the beginning of the second trimester, and rises rapidly during the third trimester.
The document discusses various types of insulin and insulin delivery methods for managing diabetes. It describes a 37-year-old man with type 1 diabetes of 18 years whose HbA1c is consistently high at 9.0-10.5% despite different insulin regimens. It then discusses options like Glargine insulin and education programs that can help improve blood sugar control and reduce hypoglycemia for patients.
Hypoglycemia is a potentially devastating metabolic emergency in children. It can cause cognitive impairment, seizures, cerebral palsy, and other neurological issues if severe and prolonged. The document discusses the various causes and classifications of hypoglycemia in infants and children, including transient neonatal hypoglycemia, persistent hypoglycemia due to conditions like hyperinsulinism, counterregulatory hormone deficiencies, and disorders of glycogenolysis and gluconeogenesis. Clinical features and key cases are also presented.
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.
Neonatal hypoglycemia and hyperglycemia Dr vijitha ASVijitha A S
Neonatal hypoglycemia and hyperglycemia BY Dr VIJITHA A S
Hypoglycemia is most common metabolic problem seen in newborns
No universally accepted definition ; Hypoglycemia cut off variable
This document provides an overview of hypoglycemia, including its definition, causes, symptoms, diagnosis, and treatment. It describes how iridology can be used to gain information about organ function and capacity in relation to hypoglycemia. Case studies are presented of three clients whose iris analyses revealed weaknesses in organs involved in blood sugar regulation like the pancreas and liver, as well as stress, all contributing factors in hypoglycemia. Recommendations focus on diet, herbal remedies, and supporting organ function to prevent and alleviate hypoglycemia symptoms.
Approach to Hypoglycemia in Children.pptxJwan AlSofi
Introduction
DEFINITION
Symptoms and Signs of Hypoglycemia
Sequelae of Hypoglycemia
Hormonal Signal
Regulation of serum glucose
Disorders of Hypoglycemia
Classification of Hypoglycemia in Infants and Children
DIAGNOSIS
EMERGENCY MANAGEMENT
This document provides information on clinical chemistry and biochemistry topics related to blood sugar regulation and glucose testing. It discusses how glucose levels are tightly regulated in the body and the hormones involved. Normal ranges for blood glucose are provided. Causes of high and low blood sugar are explained. Several blood tests for measuring glucose are outlined, including their purposes and normal ranges. Regulation of calcium, phosphates and lipids are also summarized.
Guidelines For Glucose Monitoring And Treatment Of Hypoglycemia In Breastfed ...Biblioteca Virtual
This document provides guidelines for monitoring and treating hypoglycemia in breastfed neonates. It summarizes that transient hypoglycemia is common in healthy newborns and usually resolves on its own without treatment. Routine glucose monitoring is unnecessary for healthy term infants and could harm breastfeeding. The guidelines define hypoglycemia, recommend thresholds for plasma glucose levels by infant age, and identify at-risk infants that may require monitoring. Clinical signs of hypoglycemia are also outlined.
This document summarizes key aspects of glucose homeostasis and diabetes mellitus. It discusses how glucose levels are tightly regulated within the physiological range through a balance of intake, utilization, storage and excretion across organs like the liver, muscle and adipose tissue. Insulin and glucagon are the main hormones that regulate glucose levels by facilitating glucose uptake and storage or promoting gluconeogenesis and glycogenolysis. The diagnosis of diabetes is based on tests measuring fasting glucose, oral glucose tolerance, and HbA1c levels according to defined criteria. Type 1 diabetes involves autoimmune destruction of beta cells while type 2 diabetes ranges from insulin resistance to deficient insulin secretion.
Hypoglycemia in infants and children can have potentially devastating consequences if not properly managed. It is defined as a blood glucose level below 55 mg/dL. The brain relies heavily on glucose for energy in early life. Persistent hypoglycemia can impair brain growth and development. Causes include decreased glucose production, increased glucose utilization, infections, metabolic disorders, and others. Symptoms range from autonomic activation to neurological changes like seizures. Management involves identifying the cause, treating any underlying condition, monitoring blood glucose closely, and administering intravenous glucose to prevent hypoglycemia.
This document summarizes glucose homeostasis and diabetes mellitus. It discusses how glucose levels are tightly regulated in the blood and maintained within a narrow range through the actions of various organs like the liver, muscles, and adipose tissue. Insulin and glucagon are the main hormones that regulate glucose levels by facilitating glucose uptake and breakdown of glycogen stores. The document classifies diabetes into types 1 and 2 and discusses the mechanisms of hyperglycemia in diabetes through insulin resistance and beta cell dysfunction. It also outlines the diagnostic criteria and tests used to diagnose diabetes.
Control of blood glucose concentration.pptxHalaAlabdullah
MAYBE I USED SLIDES GO POWERPOINT AND SOME APPLICATION LIKE BITESIZE
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This document summarizes key aspects of glucose homeostasis and diabetes. It discusses how glucose levels are tightly regulated in the body within a normal range through a balance of intake, utilization, storage and excretion across organs like the liver, muscle and adipose tissue. Diabetes occurs when there is a defect in insulin production or action leading to hyperglycemia. The main tests used to diagnose diabetes are fasting plasma glucose, oral glucose tolerance test, and HbA1c levels. Gestational diabetes involves glucose intolerance diagnosed during pregnancy.
This document summarizes key aspects of glucose homeostasis and diabetes. It discusses how blood glucose levels are tightly regulated within a narrow range through the coordinated actions of various organs like the liver, muscles and adipose tissue. Insulin plays a central role in facilitating glucose uptake into cells after meals to maintain homeostasis. The diagnosis of diabetes is based on tests measuring fasting plasma glucose levels, HbA1c levels, or plasma glucose levels 2 hours after an oral glucose tolerance test.
The document discusses glucose homeostasis and type 2 diabetes. It introduces key players like glucose, insulin, glucagon, the pancreas, liver, muscles and fat cells. It explains how these systems normally work together to maintain balanced blood glucose levels. However, insulin resistance can develop if receptors do not bind insulin as well, overworking the pancreas and potentially leading to beta cell damage and type 2 diabetes. The stages from prediabetes to full diabetes are outlined based on blood glucose levels.
This document summarizes key aspects of glucose homeostasis and diabetes. It discusses how glucose levels are tightly regulated in the body and maintained within a narrow range. It describes the roles of organs like the liver, muscles and adipose tissue in glucose metabolism and storage. It also outlines the diagnostic criteria and tests used to diagnose diabetes, including fasting plasma glucose, oral glucose tolerance tests and HbA1c levels. The document compares types 1 and 2 diabetes and discusses gestational diabetes as well.
This document summarizes glucose homeostasis and diabetes. It discusses how the liver, muscles, adipose tissue, and kidneys work to regulate blood glucose levels. Insulin and glucagon are described as the main hormones that increase and decrease blood glucose. The mechanisms of hyperglycemia in diabetes are explained as insulin resistance and beta cell dysfunction in Type 1 and 2 diabetes. Methods for diagnosing diabetes include fasting plasma glucose, oral glucose tolerance tests, and measuring HbA1c levels.
Neonatal Hypoglycemia approach and Management .pptxAzad Haleem
Dr. Azad Haleem provides an overview of neonatal hypoglycemia. Key points include:
1) Neonates are susceptible to hypoglycemia due to their high brain glucose needs and immature defenses against low blood sugar. Transitional hypoglycemia is common in the first 48 hours while persistent low blood sugar beyond 48 hours requires investigation.
2) Causes of persistent hypoglycemia include hyperinsulinism, hypopituitarism, inborn errors of metabolism, and rarely other conditions. Diagnostic testing aims to identify the underlying etiology.
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This document discusses glucose homeostasis and the tightly regulated process of maintaining blood glucose levels within a narrow range. It describes the various sources of blood glucose, including dietary carbohydrates and the body's ability to produce glucose through glycogenolysis and gluconeogenesis when needed. Key hormones involved in regulating glucose include insulin, released after meals to lower blood glucose levels, and glucagon, released during fasting to raise blood glucose levels and promote glycogen breakdown and glucose production. Precise control of these opposing hormones is critical for metabolic health.
This document discusses neonatal hypoglycemia, including its definition, causes, signs and symptoms, and treatment. It defines neonatal hypoglycemia as a plasma glucose level below 40 mg/dL. Causes include increased glucose utilization, decreased substrate availability, or both. Signs are non-specific and include jitteriness, apnea, and seizures. Treatment involves oral feeds, IV dextrose if needed, and medications like hydrocortisone or diazoxide for persistent hypoglycemia. Close monitoring of at-risk infants is important to prevent neurological damage from prolonged hypoglycemia.
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Newborn Care: Glucose control and hypoglycaemia
1. 8
Glucose
control and
hypoglycaemia
can also be converted by the liver into glucose.
Objectives Glucose is an essential source of energy to
many cells of the body, especially the brain.
Glucose is absorbed from the gut and stored in
When you have completed this unit you the body as:
should be able to:
1. Glycogen in the liver
• Explain why the body needs glucose. 2. Protein in muscles
• Define hypoglycaemia. 3. Fat under the skin
• List the dangers of hypoglycaemia.
Glycogen, protein and fat form the body’s
• Diagnose hypoglycaemia. energy stores. They can all be converted back
• Identify infants at risk of hypoglycaemia. into glucose by the liver if needed.
• Prevent and treat hypoglycaemia.
The amount of glucose available to the
• Discuss the causes and management of cells can be assessed by measuring the
hyperglycaemia. concentration of glucose in the blood. Glucose
is the same as dextrose.
NOTE The fetus gets most of its energy from the
mother in the form of glucose which crosses the
GLUCOSE CONTROL placenta. The higher the mother’s blood glucose
concentration, the more glucose the fetus will
receive.
8-1 What is glucose?
Glucose is a simple sugar. It is obtained from 8-2 How is glucose measured in the blood?
the diet by the breakdown of more complex The concentration of blood glucose can be
carbohydrates (such as starch) and from the measured by different methods:
conversion of other dietary sugars (such as
lactose in milk). Fat and protein in the diet 1. The quickest, cheapest and easiest method
in the nursery to measure the blood
2. 148 NEWBORN CARE
glucose concentration is to use a reagent is 0.5 mmol/l lower than the serum glucose
strip such as Haemo-Glukotest (Dextrostix concentration, as measured in the laboratory.
is no longer available). The colour of the
reagent strip is then compared to the
colour range on the bottle to determine the
The normal range of blood glucose concentration
blood glucose concentration. Unfortunately in newborn infants is 2.0 mmol/l to 7.0 mmol/l
reading the result by eye is not reliable
while reagent strips may give a false low NOTE One mmol/l of glucose equals 18 mg/dl.
reading if the method is not done correctly.
2. A more accurate method to screen for 8-4 What is hypoglycaemia?
hypoglycaemia is to use a glucose meter (a A blood glucose concentration below
reflectance meter) such as reading Haemo- 2.0 mmol/l (35 mg/dl) is abnormal and,
Glukotest strips with a Reflolux meter or therefore, defined as hypoglycaemia (hypo
AccuChek Active strips with a Glucotrend = low; glycaemia = blood glucose). Mild
meter or AccuChek Active meter. This hypoglycaemia is defined as a blood glucose
is much better than simply reading the concentration between 1.5 to 2.0 mmol/l while
reagent strip by eye. It is essential that severe hypoglycaemia is defined as a blood
the correct meter is used with the reagent glucose concentration of less than 1.5 mmol/l
strips designed for that meter. (25 mg/dl). Whenever a reagent strip gives a
3. In a laboratory the serum glucose reading below 1.5 mmol/l, a sample of blood
concentration can be measured using a should be taken, if possible, to confirm the
more complicated method. The laboratory diagnosis of hypoglycaemia by a laboratory
method is more accurate than reagent measurement. The definition of hypoglycaemia
strips but takes longer, is more expensive when serum is sent to the laboratory is a
and requires more blood. concentration below 2.5 mmol/l (blood glucose
is lower than serum glucose concentrations).
The blood glucose concentration in the nursery NOTE The definition of hypoglycaemia in newborn
is usually measured with a reagent strip and a infants remains debatable with textbooks often
glucose meter giving different cut-off points.
Hypoglycaemia is defined as a blood glucose
8-3 What is the normal concentration of
glucose in the blood?
concentration below 2.0 mmol/l
The normal concentration of glucose in
the blood of newborn infants is 2.0 mmol/l 8-5 What are the dangers of hypoglycaemia?
(35 mg/dl) to 7.0 mmol/l (120 mg/dl). This
Hypoglycaemia is extremely dangerous
is called normoglycaemia (normo = normal;
especially when the blood glucose concen-
glycaemia = blood glucose). Most newborn
tration is below 1.5 mmol/l. When the blood
infants have a blood glucose concentration
glucose concentration is low the cells of the
in the middle of the normal range, about 3 to
body, particularly the brain, do not receive
5 mmol/l. The normal range for older children
enough glucose and cannot produce energy
and adults is higher than this. It is preferable
for their metabolism. As a result the brain cells
to use the metric units of mmol/l rather than
can be damaged or die, causing cerebral palsy,
the old units of mg/dl.
mental retardation or death.
Note that the normal blood glucose
concentration, as measured with reagent strips,
Hypoglycaemia may cause brain damage or death
3. GLUCOSE CONTROL AND HYPOGLYCAEMIA 149
8-6 When are infants at risk of developing 1. Infants with respiratory distress. Their
hypoglycaemia? respiratory muscles are doing a lot of work
and require large amounts of glucose to
Infants are at an increased risk of developing
provide the energy needed for respiration.
hypoglycaemia when:
2. Hypothermic infants. These infants
1. They have reduced energy stores. use large amounts of glucose and fat to
2. They have increased energy needs. produce heat in an attempt to correct their
body temperature.
8-7 Which infants have reduced energy 3. Infants of diabetic mothers. Before
stores? delivery these infants receive excess
glucose across the placenta, especially if the
The supply of glucose into the blood is maternal diabetes is poorly controlled. The
reduced when the body’s energy stores are low, higher the maternal glucose concentration,
such as reduced glycogen in the liver, protein the more glucose the infant receives. This
in muscles, and fat under the skin. large supply of glucose makes the fetus
The following newborn infants do not have obese and stimulates the fetal pancreas to
adequate energy stores to convert into glucose: secrete extra insulin. At delivery the supply
of glucose from the mother suddenly
1. Preterm infants. They are born before
stops when the umbilical cord is clamped.
adequate amounts of glycogen, protein and
However, the stimulated fetal pancreas
fat are stored in their tissues. The fetus gets
continues to secrete excessive amounts of
most of its energy stores in the last 6 weeks
insulin after delivery, and the high insulin
of pregnancy. Therefore, most preterm
concentration in the blood of the newborn
infants have very small energy stores.
infant causes hypoglycaemia.
2. Underweight for gestational age or
4. Overweight for gestational age infants.
wasted infants. They have either not built
Some of the mothers of these infants
up energy stores or have used up most of
may be undiagnosed diabetics. Think of
their energy stores before delivery because
maternal diabetes in all obese infants.
they have not been getting enough glucose
5. Polycythaemic infants. Their increased
from their mother.
number of red cells use a lot of glucose.
3. Starved infants. Infants that are not fed,
either orally or intravenously soon after
delivery, rapidly use up their energy stores. Hypothermia causes hypoglycaemia
4. Stressed infants, such as infants who are
infected or who have suffered hypoxia, may NOTE With maternal diabetes, the mother is
be unable to convert their energy stores diabetic but the infant is not. In fact the problem
into glucose. This includes infants who in the infant is exactly the opposite to that in
need active resuscitation at birth. the mother. While the mother secretes too little
5. Infants with liver damage, such as insulin and, therefore, has a high blood glucose,
the newborn infant secretes too much insulin
hepatitis, often have low stores of liver
and, therefore, becomes hypoglycaemic. Insulin
glycogen and also are unable to convert acts as a fetal growth hormone. Excess fetal
other energy stores into glucose. insulin, therefore, results in macrosomia.
8-8 Which infants have increased energy
needs?
The following infants have increased energy
needs and, therefore, rapidly use up their
energy stores:
4. 150 NEWBORN CARE
HYPOGLYCAEMIA Often an infant has some signs of brain
stimulation (such as jitteriness )and other
signs of brain depression (such as poor
8-9 Which infants have an increased risk of feeding) at the same time. Therefore,
hypoglycaemia? while some parts of the brain may be
stimulated other parts may be depressed
Those infants with a decreased supply of by hypoglycaemia. As a result, the clinical
glucose or an increased demand for glucose presentation of hypoglycaemia is very
(i.e. infants with small energy stores or large variable, making the clinical diagnosis of
energy needs): hypoglycaemia very unreliable.
1. Low birth weight infants (either preterm or
underweight for gestational age)
Hypoglycaemic infants may have no abnormal
2. Wasted infants
3. Infants where there is a delay in the onset
clinical signs
of feeding (infants who have not been fed)
4. Hypoxic infants and infants who need
8-11 How can you diagnose hypoglycaemia?
active resuscitation at birth
5. Infected infants The clinical diagnosis is difficult and often
6. Infants with liver disease missed. Therefore, it is essential that all
7. Infants with respiratory distress infants at risk of hypoglycaemia, and infants
8. Hypothermic infants with clinical signs that may be caused by
9. Infants of diabetic mothers hypoglycaemia, be screened with reagent
10. Overweight for gestational age infants strips. Whenever possible, use a reflectance
11. Polycythaemic infants meter such as an Accu-chek or Glucotrend
meter rather than reading the reagent strip
by eye. Ideally a diagnosis of hypoglycaemia
Low birth weight infants and starved infants are made with reagent strips should be confirmed
at high risk for hypoglycaemia with a laboratory serum glucose measurement.
An infant’s blood glucose concentration will
8-10 What are the clinical signs of fall into one of the following groups:
hypoglycaemia? 1. 2.0 mmol/l or more. Remember that the
Hypoglycaemia may produce no clinical signs normal range of blood glucose in newborn
or present with non-specific signs only. This infants is 2.0 mmol/l to 7.0 mmol/l.
makes the clinical diagnosis of hypoglycaemia 2. Between 1.5 mmol/l and 2.0 mmol/l. This is
very difficult. When present, the signs of mild hypoglycaemia. These infants’ blood
hypoglycaemia are: glucose concentration is abnormally low
and they are at high risk of developing
1. Depression of brain function. The infant severe hypoglycaemia.
may be lethargic and hypotonic, feed 3. Less than 1.5 mmol/l. This is the definition
poorly, have a weak cry, apnoea, cyanosis of severe hypoglycaemia, which is very
or an absent Moro reflex. dangerous.
2. Overstimulation of brain function. The
infant may be jittery with a high-pitched
8-12 How can you prevent hypoglycaemia?
cry, a fixed stare and fisting, have abnormal
eye movements or convulsions. The following steps must be taken to prevent
3. Excessive sweating. This sign may not be hypoglycaemia:
present, however, especially in preterm
1. Identify all infants at high risk of
infants.
developing hypoglycaemia.
5. GLUCOSE CONTROL AND HYPOGLYCAEMIA 151
2. Monitor the blood glucose concentration despite 2 milk feeds, start an intravenous
of these infants with reagent strips so that infusion.
a falling blood glucose can be detected 4. If the blood glucose concentration falls
before hypoglycaemic levels are reached. below 1.5 mmol/l at any time, treat for
3. Feed all infants as soon as possible after severe hypoglycaemia.
delivery, especially preterm, underweight 5. If the infant is too small or too ill to tolerate
for gestational age and wasted infants, as milk feeds, start a 10% intravenous infusion
well as infants of diabetic women. (e.g. Neonatalyte). Monitor the blood
4. Whenever possible, milk feeds should glucose concentration with reagent strips
be given. Both clear feeds orally and oral and start milk feeds as soon as possible.
dextrose feeds should not be used in
Remember that mild hypoglycaemia may
newborn infants as they are low in energy
rapidly progress to severe hypoglycaemia if
and may result in hypoglycaemia.
not correctly treated.
5. If milk feeds cannot be given, then an
intravenous infusion of 10% glucose
(e.g. Neonatalyte) should be started. Mild hypoglycaemia can usually be corrected
6. Prevent hypothermia. with milk feeds
Early feeding with milk helps to prevent
8-14 How should you treat an infant with
hypoglycaemia severe hypoglycaemia?
All infants with a blood glucose concentration
8-13 How should you treat an infant with below 1.5 mmol/l have severe hypoglycaemia.
mild hypoglycaemia? This is a medical emergency and must be
treated immediately. Do not wait for the
These infants, with a blood glucose concen-
result of the laboratory measurement before
tration between 1.5 mmol/l and 2.0 mmol/l,
starting treatment. The management of severe
need milk feeds or intravenous glucose urgently
hypoglycaemia consists of the following steps:
to prevent severe hypoglycaemia:
1. The treatment of choice is to start an
1. If they tolerate oral or nasogastric feeds,
intravenous infusion of 10% dextrose (or
give 10 ml/kg breast milk or milk formula
Neonatalyte) at a drip rate calculated to
immediately. Do not give 5% or 10%
give 60 ml/kg in the first 24 hours. Infants
dextrose orally as the energy content is less
older than 24 hours can be given a larger
than that of breast milk or milk formula.
volume calculated for their age.
2. Repeat the blood glucose measurement
30 minutes after the feed to determine NOTE A 10% dextrose infusion at 60 ml/kg/24
whether the blood glucose concentration hours will provide 0.22 mmol (4 mg) glucose/
has returned to the normal range. If it kg/minute which will meet most infants’ energy
needs. To increase a 5% to a 10% glucose solution,
is still in the mild hypoglycaemia range,
add 10 ml of 50% dextrose to 100 ml 5% dextrose.
repeat the feed with an added 5 ml sugar Some infants will need a 15% glucose solution,
(one teaspoon) per 30 ml milk and repeat however, to maintain a normal blood glucose
the blood glucose measurement after a concentration.
further 30 minutes.
3. When the blood glucose concentration has 2. If you cannot rapidly establish a peripheral
returned to normal, continue with regular intravenous line, insert an umbilical vein
milk feeds and continue to monitor with catheter so that intravenous fluids can be
reagent strips hourly for 3 hours. If the given.
blood glucose concentration remains low
6. 152 NEWBORN CARE
3. Once an intravenous line has been estab-
The treatment of severe hypoglycaemia is an
lished, give 2 ml/kg of 10% glucose as a
intravenous infusion of 10% dextrose
bolus. It is not advisable to inject a bolus
of 25% or 50% dextrose as it is extremely
hypertonic.
8-15 How frequently should you measure
4. If the blood glucose concentration still has
the blood glucose concentration?
not returned to normal within a further
15 minutes, give 5 mg hydrocortisone The blood glucose concentration should
intravenously. be closely monitored in infants at risk of
hypoglycaemia and in infants who have had
NOTE Take 5 ml of blood from these infants for
glucose and insulin estimation before giving the hypoglycaemia:
hydrocortisone. This is very important in identifying 1. In most infants at high risk of hypogly-
the correct cause of the hypoglycaemia. Glucagon caemia, the blood glucose concentration
0.3 mg/kg IM or IV can be used if hydrocortisone
should be measured hourly with for the
fails to correct the blood glucose concentration.
first 3 hours, then 2 hourly for the next 3
hours. Thereafter the blood glucose should
5. In an emergency, if you are unable to
be monitored every 3 hours until 100 ml/
give intravenous dextrose, give the infant
kg/day milk feeds have been established
10 ml/kg breast milk or formula (or cow’s
which is usually in 24 to 48 hours.
milk if neither is available) by mouth or
2. Infants with mild hypoglycaemia should
via a nasogastric tube. You can add 5 ml
be monitored every 30 minutes until the
(a teaspoon) of sugar, or 5 ml of 50%
blood glucose concentration has returned
dextrose, per 10 ml feed to increase the
to the normal range. Readings should then
energy concentration. Do not give pure
be made hourly for 3 hours to ensure that
50% dextrose as it will cause vomiting.
the blood glucose concentration does not
6. Start regular milk feeds as soon as possible.
fall again. Thereafter, measure the blood
Extra sugar can be added to the milk feeds
glucose concentration every 2 hours until
if necessary.
100 ml/kg milk feeds are established.
7. As the volume of milk feeds are increased
3. Infants with severe hypoglycaemia should
the rate of the intravenous infusion can
have their blood glucose concentration
be reduced. Never suddenly withdraw
measured every 15 minutes until it has
intravenous dextrose as this may precipitate
increased above 1.5 mmol/l. Then measure
hypoglycaemia, as commonly happens if
the blood glucose concentration as for
the drip infiltrates the tissues. Reduce the
infants with mild hypoglycaemia.
drip rate gradually when oral feeds are
introduced. The greater the risk of hypoglycaemia
8. Keep the infant warm. the more frequently the blood glucose
9. Once the blood glucose concentration has concentration should be monitored.
returned to normal, monitor the blood
glucose concentration hourly until full
volume feeds have been established. 8-16 What is the prognosis after
hypoglycaemia?
NOTE Repeated or unresponsive hypoglycaemia
may be due to a rare metabolic cause and The risk of brain damage depends on
urgent specialist medical advice must be sought. the severity, duration and number of
A sample of venous blood should be taken for hypoglycaemic attacks. The prognosis is worst
further investigations. if the hypoglycaemia has produced clinical
signs, especially convulsions. The risk of
permanent brain damage is probably low if
the hypoglycaemia is asymptomatic. However,
7. GLUCOSE CONTROL AND HYPOGLYCAEMIA 153
asymptomatic hypoglycaemia remains simply changing the intravenous solution from
dangerous and must be treated urgently as Neonatalyte or 10% dextrose to a 5% dextrose
clinical signs may suddenly develop. solution. Once milk feeds are established,
hyperglycaemia usually returns to normal.
HYPERGLYCAEMIA
CASE STUDY 1
8-17 What is hyperglycaemia? A term infant is brought to a rural clinic
Hyperglycaemia (hyper = high; glycaemia after having been born at home. The infant is
= blood glucose) is defined as a blood cold and wasted but otherwise appears well.
glucose concentration above 7.0 mmol/l A reagent strip reading is between 1.5 and
(120 mg/dl). Usually hyperglycaemia does 2.0 mmol/l when the colour is matched against
not cause problems until the blood glucose the container.
concentration increases above 10 mmol/l.
1. What is your interpretation of the blood
8-18 What is the cause of hyperglycaemia? glucose concentration?
1. Hyperglycaemia is usually due to a 10% The infant has mild hypoglycaemia. This
dextrose or Neonatalyte infusion given to a should be confirmed with a reflectance meter
preterm infant during the first few days of if possible as reading a reagent strip by eye is
life. Some immature infants are not able to not very accurate.
remove glucose fast enough from the blood
stream. 2. What is the danger of mild hypo-
2. Hyperglycaemia may be caused by a severe glycaemia?
intraventricular haemorrhage.
The infant is at high risk of developing severe
3. The stress of hypoxia or infection may
hypoglycaemia.
increase or decrease the blood glucose
concentration.
3. Why does this term infant have a low
NOTE Transient or permanent neonatal diabetes is blood glucose concentration?
a rare cause of hyperglycaemia.
Because the infant is cold. Hypothermic
8-19 What are the dangers of hyper- infants increase the rate at which they break
glycaemia? down glucose in order to produce heat.
Eventually the energy stores become depleted
1. A high blood glucose concentration results and hypoglycaemia may result. In addition this
in a lot of glucose being excreted in the infant is wasted and, therefore, has reduced
urine (glycosuria), which in turn may energy stores.
cause polyuria and lead to dehydration.
Mild glycosuria is common in preterm 4. Why is this infant at risk of brain damage?
infants and does not require treatment.
2. Severe hyperglycaemia increases the risk of Because the infant has mild hypoglycaemia.
intraventricular haemorrhage in preterm This may progress to severe hypoglycaemia if
infants. not correctly managed. Remember that even
without clinical signs, hypoglycaemia is still
8-20 How should you treat hyperglycaemia? dangerous.
The raised blood glucose concentration usually
can be lowered into the normal range by
8. 154 NEWBORN CARE
5. How would you treat this infant at the normal functioning of the brain and may cause
clinic? both depression of brain function resulting in
a poor Moro reflex and overstimulation of the
Give the infant a feed of breast milk, formula
brain resulting in jitteriness.
milk or sweetened cow’s milk. The infant
must also be warmed. The blood glucose
concentration should have returned to 4. How would you treat this infant?
normal in 30 minutes. If not, repeat the An intravenous infusion of 10% dextrose or
feed and arrange urgent transport to the Neonatalyte must be started immediately at
nearest hospital. If the infant develops severe a rate to give 60 ml/kg/day. Add 2 ml/kg of
hypoglycaemia, or is to be transported, an 10% dextrose as a bolus. Repeat the reagent
infusion with Neonatalyte or 10% dextrose strip measurement after 15 minutes. If it is
must be started. It is very important to start still low give a dose of 5 mg hydrocortisone
treatment before referring the infant to intravenously. Start milk feeds every 2 hours as
hospital. The blood glucose concentration soon as possible. If the milk feeds are tolerated
must be carefully monitored during transport. and the blood glucose concentration returns
to normal, then the rate of the 10% dextrose
infusion can be slowly reduced. Monitor the
CASE STUDY 2 blood glucose concentration carefully.
A preterm infant of 1500 g is born in a level 5. Why could this infant not be treated with
I hospital. The infant is nursed in a closed 5% dextrose orally?
incubator but no feed is given for 2 hours.
Because 5% dextrose does not contain enough
At 1 hour after birth the Haemo-Glukotest
glucose to rapidly correct hypoglycaemia.
reading with a Reflolux meter is normal but at
2 hours after birth the reading indicates severe
hypoglycaemia. The infant is jittery with a 6. Has this infant already suffered brain
poor Moro reflex. damage?
It is possible as the infant has symptomatic
1. Why is this infant hypoglycaemic? hypoglycaemia. With immediate treatment
there is a good chance that this infant will not
The infant is preterm and, therefore, has
suffer permanent brain damage.
little energy store. In addition the infant
has not been fed for 2 hours after birth. The
normal blood glucose concentration at 1 hour
indicates that the infant had energy stores to CASE STUDY 3
last 1 but not 2 hours.
An infant weighing 4500 g is born to a patient
2. How could the hypoglycaemia have been whose diabetes was poorly controlled during
prevented? pregnancy. The infant is sweating a lot and has
a convulsion. The blood glucose concentration
Breast or formula feeds via a nasogastric tube is 0 mmol/l. Attempts to give 10% dextrose
or an intravenous infusion should have been water via a scalp vein needle fail as the staff
started within an hour of delivery. cannot find a suitable vein.
3. Could the hypoglycaemia have caused 1. Why is this infant hypoglycaemic?
the jitteriness and poor Moro reflex?
Because the mother is a poorly controlled
Yes. The brain uses glucose to obtain energy. diabetic. Excessive glucose crosses the placenta
Therefore, hypoglycaemia interferes with the to the fetus and this stimulates the fetal
9. GLUCOSE CONTROL AND HYPOGLYCAEMIA 155
pancreas to secrete excessive insulin. Soon 4. What should be done if the
after birth the infant becomes hypoglycaemic hypoglycaemia cannot be corrected with
as a result of the large amount of insulin still an infusion of 10% dextrose?
being secreted by the infant’s pancreas.
Give 5 mg hydrocortisone intravenously.
2. Can hypoglycaemia cause sweating and
5. How could the hypoglycaemia have been
convulsions?
prevented?
Yes, in both infants and adults hypoglycaemia
The maternal diabetes should have been well
may present with sweating and convulsions.
controlled. As this infant is at very high risk
The convulsions are worrying as they suggest
of hypoglycaemia due to the poor diabetic
that the function of the brain has been severely
control and high birth weight, milk feeds
affected.
should have been given straight away and a
10% dextrose or Neonatalyte infusion started.
3. What should the staff do if they cannot Once feeds are tolerated and the reagent
find a suitable vein? strip readings are normal, the infusion can
Give 10% dextrose or Neonatalyte via an gradually be slowed.
umbilical vein catheter.
Blood glucose
less than 2.0 mmol/l
Blood glucose Blood glucose less than
1.5–2.0 mmol/l (mild 1.5 mmol/l (severe
hypoglycaemia) hypoglycaemia)
• Give 10 ml/kg milk feed Normal Normal • 10% dextrose infusion
• Measure blood glucose in • Measure blood glucose in
30 minutes 15 minutes
Low Low
• Milk feed with
Normal Normal • 5 ml 30% dextrose bolus
added sugar
• Measure blood glucose in
• Measure blood glucose in
15 minutes
30 minutes
Low Low
Treat as • Normal feeds • Start milk feeds Give 5 mg
for severe • Measure blood • Measure blood hydrocortisone
hypoglycaemia glucose 3 hourly glucose hourly intravenously
Flow diagram 8.1: The acute management of an infant with hypoglycaemia.