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Related Concept Videos

Hypoglycemia and Glucagon01:15

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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...
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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.
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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Oral Hypoglycemic Agents: Glinides01:06

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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...
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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...
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The pancreatic islets comprising only 1%-2% of the volume are highly vascularized and innervated mini-organs. They contain five endocrine cell types, including β cells that secrete insulin, which is synthesized as a single polypeptide chain, preproinsulin, processed to proinsulin, and finally to insulin and C-peptide. This process is complex and regulated, involving the Golgi complex, the endoplasmic reticulum, and the secretory granules of the β cell.
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Suspecting unwitnessed hypoglycaemia.

Danielle Lux1, Mark Edwards2, Liqun Zhang3

  • 1Department of Neurology and Stroke Medicine, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, Greater London, UK d.lux@nhs.net.

Practical Neurology
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Summary

Hypoglycaemic coma can mimic stroke with neurological symptoms. Even with normal blood sugar, specific brain MRI findings may indicate this condition, allowing for prompt treatment and recovery.

Keywords:
MRIendocrinologyimage analysisstroke

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Area of Science:

  • Neurology
  • Endocrinology
  • Radiology

Background:

  • Hypoglycaemic coma can cause acute neurological dysfunction that resembles stroke.
  • The Somogyi phenomenon, a physiological response, can mask hypoglycemia, leading to normoglycaemia despite low blood glucose levels.
  • Recurrent hypoglycemia increases the risk of misdiagnosis in acute neurological presentations.

Purpose of the Study:

  • To highlight the importance of considering hypoglycaemic coma in acute neurological dysfunction mimicking stroke.
  • To emphasize the diagnostic value of specific Magnetic Resonance (MR) brain scan findings.
  • To underscore the need for prompt identification and treatment of hypoglycemia, even when blood glucose levels are not low at presentation.

Main Methods:

  • Review of clinical presentations of hypoglycaemic coma.
  • Analysis of neuroimaging findings in patients with hypoglycemia.
  • Correlation of clinical symptoms, blood glucose levels, and radiological findings.

Main Results:

  • Hypoglycaemic coma can present with neurological symptoms indistinguishable from stroke.
  • Specific MR brain scan changes can suggest hypoglycemia as an alternative diagnosis.
  • Normoglycaemia at presentation does not rule out hypoglycaemic coma, especially in patients with a history of recurrent hypoglycemia.

Conclusions:

  • Clinicians should consider hypoglycaemic coma in patients with acute neurological dysfunction mimicking stroke, particularly those with a history of recurrent hypoglycemia.
  • Characteristic MR brain scan findings are crucial for early diagnosis.
  • Timely recognition and management of hypoglycemia can lead to a favorable prognosis and radiological resolution.