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Hypoglycemia and Glucagon

Hypoglycemia and Glucagon

Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...

Hypoglycemia

Hypoglycemia

Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...

Diabetic Ketoacidosis l: Introduction

Diabetic Ketoacidosis l: Introduction

DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic ketone production, and...

SBAR II: Application of SBAR

SBAR II: Application of SBAR

SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...

Hyperglycemia

Hyperglycemia

Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...

Diabetic Ketoacidosis ll: Pathophysiology

Diabetic Ketoacidosis ll: Pathophysiology

Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...

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Updated: Jul 17, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Hypoglycemia in the intensive care unit.

Jeffrey I Mechanick¹, Yehuda Handelsman, Zachary T Bloomgarden

¹Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, New York, New York 10128, USA. jmechanick@aol.com

Current Opinion in Clinical Nutrition and Metabolic Care

|February 8, 2007

Summary

Intensive insulin therapy can cause hypoglycemia, a serious complication in critical care. Careful glucose monitoring and advanced technology are needed to mitigate risks and improve patient outcomes.

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Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

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Improving IV Insulin Administration in a Community Hospital

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Published on: June 11, 2012

Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

Published on: January 26, 2024

Area of Science:

Critical care medicine
Endocrinology
Clinical research

Background:

Intensive insulin therapy (IIT) in surgical intensive care units (ICUs) has been studied since 2001.
IIT aims to improve clinical outcomes but carries the risk of hypoglycemia.
Hypoglycemia is a significant concern in critically ill patients receiving IIT.

Purpose of the Study:

To review recent literature on hypoglycemia as a complication of IIT.
To evaluate the impact of hypoglycemia in intensive care settings.
To anticipate data from ongoing clinical studies on IIT.

Main Methods:

Literature review of recent articles on intensive insulin therapy and hypoglycemia.
Analysis of studies evaluating clinical outcomes and hypoglycemia incidence.
Identification of risk factors associated with hypoglycemia in the ICU.

Main Results:

Hypoglycemia incidence in IIT can reach 25% in prospective studies with comparator groups (RR 5.0).
Incidence is lower (<7%) in studies lacking a comparator group.
Identified risk factors include diabetes, octreotide, nutrition support, hemofiltration, sepsis, and inotropic support.

Conclusions:

Hypoglycemia is linked to adverse outcomes in ICU patients on IIT.
Causality between IIT-induced hypoglycemia and adverse outcomes requires further investigation.
Managing hypoglycemia risk necessitates frequent glucose monitoring, readily available dextrose, improved nursing training, and technological advancements.