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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...

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...

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...

Diabetes Mellitus: Type 2 and Gestational

Diabetes Mellitus: Type 2 and Gestational

Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...

Diabetes: Management and Pharmacotherapy

Diabetes: Management and Pharmacotherapy

The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...

Oral Hypoglycemic Agents: Glinides

Oral Hypoglycemic Agents: Glinides

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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Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Hyperglycemia and perioperative glucose management.

Andra E Duncan¹

¹Cleveland Clinic Lerner College of Medicine, OH, USA. duncana@ccf.org

Current Pharmaceutical Design

|July 6, 2012

Summary

Managing blood sugar in critically ill patients is complex. While high blood sugar (hyperglycemia) is risky, aggressive insulin treatment offers no consistent benefits and may increase mortality. Mild hyperglycemia may be better tolerated.

Area of Science:

Critical care medicine
Endocrinology
Surgical patient management

Background:

Hyperglycemia is common in critically ill surgical patients due to stress response, leading to insulin resistance.
While hyperglycemia correlates with adverse outcomes, intensive insulin therapy for "tight" glucose control has yielded inconsistent and sometimes harmful results.
Optimal glucose targets for critically ill patients remain undetermined, but hypoglycemia and glucose variability must be avoided.

Purpose of the Study:

To review the current understanding of hyperglycemia management in critically ill patients.
To discuss the risks and benefits of intensive glucose control versus mild hyperglycemia.
To address perioperative glucose management in patients with diabetes mellitus.

Main Methods:

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Last Updated: May 20, 2026

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

Characterization of Metabolic Status in Nonhuman Primates with the Intravenous Glucose Tolerance Test

Characterization of Metabolic Status in Nonhuman Primates with the Intravenous Glucose Tolerance Test

Published on: November 13, 2016

Review of existing literature on hyperglycemia and glucose control in critical care and surgical settings.
Analysis of studies investigating "tight" versus conventional glucose control strategies.
Examination of current clinical practice guidelines and recommendations.

Main Results:

Intensive insulin therapy for tight glucose control has not consistently improved outcomes and may increase mortality.
Hypoglycemia and increased glucose variability are associated with worse patient outcomes.
Mild hyperglycemia appears to be well-tolerated in many critically ill patients, and current guidelines are varied.
Diabetic patients require special consideration for perioperative glucose management, including oral hypoglycemic agents.

Conclusions:

The optimal glucose concentration for critically ill patients is unknown.
Aggressive "tight" glucose control is not recommended due to lack of benefit and potential harm.
Avoiding hypoglycemia and excessive glucose variability is crucial, while mild hyperglycemia may be acceptable.