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Related Concept Videos

Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

262
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...
262
Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

283
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...
283
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

154
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...
154
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

172
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
172
Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

322
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
322
Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

201
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
201

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Proposed treatment strategy for reactive hypoglycaemia.

Younes R Younes1, Nicholas Cron2, Benjamin C T Field1,3

  • 1Department of Diabetes & Endocrinology, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom.

Frontiers in Endocrinology
|February 19, 2024
PubMed
Summary

Managing reactive hypoglycaemia (RH) can be challenging. A stepwise approach using lifestyle changes, metformin, GLP-1 analogues, and flash glucose monitoring offers effective treatment options for RH.

Keywords:
GLP-1 analoguesfreeStyle libremetforminmixed meal tolerance testreactive hypoglycaemia

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Clinical Medicine

Background:

  • Reactive hypoglycaemia (RH) management presents significant challenges with limited effective treatments.
  • A case series approach was employed to investigate treatment strategies for recurrent RH symptoms.

Purpose of the Study:

  • To propose a stepwise treatment strategy for reactive hypoglycaemia.
  • To evaluate the efficacy of lifestyle modifications, metformin, GLP-1 analogues, and flash glucose monitoring in managing RH.

Main Methods:

  • Retrospective analysis of 11 patients with recurrent reactive hypoglycaemia symptoms.
  • Assessment of treatment outcomes including symptom resolution, pharmacological response, and glucose monitoring data.

Main Results:

  • Lifestyle modifications resolved symptoms in two patients.
  • Metformin was effective in seven of nine patients; two with prior GI surgery benefited from GLP-1 analogues.
  • Pharmacological interventions significantly reduced insulin and C-peptide levels (P<0.05).
  • Flash glucose monitoring aided in preventing hypoglycaemic episodes.

Conclusions:

  • Escalated treatment strategies, including metformin, GLP-1 analogues, and flash glucose monitoring, show potential efficacy for RH.
  • A stepwise approach may improve outcomes for patients with reactive hypoglycaemia.