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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...

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...

Complications of Diabetes Mellitus

Complications of Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.Acute ComplicationsAcute complications result from sudden metabolic imbalance.Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency,...

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 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...

Type I Diabetes III: Clinical Manifestations

Type I Diabetes III: Clinical Manifestations

Type 1 diabetes mellitus typically presents with rapid-onset symptoms due to the body’s inability to utilize glucose in the absence of insulin. Since insulin is required for glucose uptake into cells, its deficiency leads to hyperglycemia and cellular energy deprivation, resulting in characteristic clinical features.Polyuria and PolydipsiaOne of the earliest, most prominent symptoms is polyuria (excessive urination). When blood glucose concentrations rise above the renal threshold, the kidneys...

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Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Hypoglycemia is associated with intensive care unit mortality.

Jeroen Hermanides¹, Robert J Bosman, Titia M Vriesendorp

¹Academic Medical Center, Amsterdam, The Netherlands. J.Hermanides@amc.nl

Critical Care Medicine

|April 14, 2010

Summary

Intensive insulin therapy can increase hypoglycemia, which is linked to higher intensive care unit (ICU) mortality. This study found hypoglycemia significantly increases the risk of death in ICU patients, even after adjusting for disease severity.

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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 is common in intensive care units (ICUs).
Hypoglycemia (low blood glucose) is a known complication of intensive insulin therapy.
Previous evidence on the association between hypoglycemia and ICU mortality is conflicting.

Purpose of the Study:

To investigate the relationship between hypoglycemia and mortality in the intensive care unit.
To determine if hypoglycemia is an independent risk factor for ICU death.

Main Methods:

Retrospective database cohort study of 5961 patients admitted to a medical/surgical ICU from 2004 to 2007.
Patients treated with a computerized insulin algorithm targeting glucose levels of 72-126 mg/dL.
Hypoglycemia defined as glucose ≤45 mg/dL; mortality analyzed using Poisson regression, adjusting for disease severity, age, sex, surgery, sepsis, and diabetes.

Main Results:

288 patients (4.8%) experienced at least one episode of hypoglycemia.
The incidence rate of death was 40 per 1000 ICU days for patients with hypoglycemia versus 17 per 1000 ICU days for those without.
The adjusted incidence rate ratio for ICU death associated with hypoglycemia was 2.1 (95% CI, 1.6-2.8; p < .001).

Conclusions:

Hypoglycemia is significantly associated with increased intensive care unit mortality.
This association persists even after adjusting for disease severity, suggesting a potential causal relationship.
Findings highlight the importance of managing hypoglycemia in critically ill patients.