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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...

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...

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are typically...

Oral Hypoglycemic Agents: Glinides

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...

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Glucose transporters facilitate the transport of glucose across the cell membrane. In addition to glucose, some glucose transporters can also aid the movement of other hexoses such as fructose, mannose, and galactose.
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Updated: Jun 25, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Unrecognized hypoglycemia due to maltodextrin interference with bedside glucometry.

Barbara M Kirrane¹, Elizabeth A Duthie, Lewis S Nelson

¹Department of Surgery, Section of Emergency Medicine. Yale University School of Medicine, New Haven, CT 06511, USA. bmkirrane@gmail.com

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology

|February 5, 2009

Summary

Certain glucometers may inaccurately read high blood glucose levels when patients consume maltodextrin. This can lead to dangerous insulin dosing errors and missed hypoglycemia, impacting patient safety.

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Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

Published on: January 26, 2024

Area of Science:

Clinical Chemistry
Medical Diagnostics
Biochemistry

Background:

Point-of-care glucometry is essential for diagnosing hypoglycemia.
Non-glucose sugars can interfere with glucometer readings, causing falsely elevated blood glucose levels.
This interference poses a risk of missed clinical hypoglycemia due to inappropriate treatment decisions.

Observation:

A case report details a 79-year-old male patient receiving enteral nutrition containing maltodextrin.
The patient exhibited persistently high blood glucose readings on a glucometer.
Standard laboratory blood glucose analysis revealed normal glucose levels, highlighting a discrepancy.

Findings:

Maltodextrin, a glucose polymer, was identified as the cause of falsely elevated glucometer readings.
This false elevation occurred despite normal blood glucose levels confirmed by laboratory testing.
The study indicates a potential for glucometer inaccuracy with enteral maltodextrin administration.

Implications:

Falsely high glucometer readings can lead to excessive insulin administration.
This can result in unrecognized and potentially fatal clinical hypoglycemia.
Further research is needed to validate the impact of maltodextrin on glucometry and patient management.