Abstract
Hypoglycemia is a condition of blood glucose deficit that occurs in association with type 1 diabetes in most cases. This disorder is believed to be manifested by several clinical signs. Infants and children are more susceptible to this illness, although significant proportions of adults are affected. It occurs when blood sugar levels typically achieve a low concentration range of 40-70 mg/dL in contrast to the normal range of 70-150 mg/dL.
Extreme low birth weight and the associated neurological complaints are reportedly connected to morbidity in pediatric cases. Gastroenteritis or diarrheal illness in young children and drug induced adverse reactions in adults are connected to hypoglycemia. There is a need to review about the available prevention strategies of hypoglycemia. Biomedical databases were searched to retrieve pertinent literature on hypoglycemia.
Articles other that English were excluded. Conventional glucose tests that require fasting blood, urine and oral glucose tolerance test (OGTT) are some of the well known methods. Other tests may include determination of c-peptide and microalbumins. Since hypoglycemia is reported to occur in diabetic individuals, they are the prime suspects of complications that pose a relevant threat.
Experiments have been carried out largely on these groups of patients. Several reliable approaches with better implications have been identified. These comprise real-time continuous glucose monitoring (RT-CGM) for controlling frequent glucose fluctuation.
islet cell transplantation, for restoring the awareness of hypoglycemia and, lowering the incidence of type 1 diabetes, and the combination of drug Pramlinitide and insulin therapy for reducing the incidence of hypoglycemia and controlling postprandial blood glucose fluctuations. It seems that hypoglycemia has potential treatment strategies due to its association with the metabolic disorder diabetes mellitus. Hence, it is reasonable to consider hypoglycemia as one of the important clinical conditions and emphasize on the reliable treatment practices.
Discussion
Metabolic disorders have become a serious health concern worldwide due to their life threatening complications that may start during the childhood and continue till the old age.
The present description deals with a disorder known as Hypoglycemia that induces metabolic defects. It is an abnormal condition that occurs due to a fall in the glucose levels from the normal range of 70-150 mg/dL or 3.9 -7.8 mmol/L.The values mostly considered during clinical conditions are typically below 40, 50, 60, or 70 mg/dL. Hence, this disorder is better regarded as low blood sugar.The clinical symptoms of this disorder are hunger, shakiness, dizziness, confusion, difficulty in speaking and anxiety. It was widely believed that hypoglycemia occurs usually as a side effect of diabetic drugs. Therefore there is a need to connect this description with diabetes. It was reported that hypoglycemia occurs commonly in pediatric patients born with severe low birthweight and type 1 diabetes (Kaufman, etal. 2002).
The use of continuous glucose monitoring system (CGMS) would be beneficial to determine whether bedtime blood glucose levels were associated with the occurrence of nocturnal hypoglycemia in children with type 1 diabetes (Kaufman, etal. 2002). This is because nocturnal hypoglycemia is frequent and in of long duration was found to be associated with bedtime glucose values </=100 to 150 mg/dL, in the early part of the night.
Research has revealed that neonates with previous exposure to the problem of asphyxia and who are offspring of diabetic mothers, or who are low birthweight for gestational age are more susceptible to hypoglycemia with fatal neuropathologic manifestations (Vannucci and Vannucci 2008). In a study on children with type 1 diabetes it was found that pediatric diabetes is associated with mild lower cognitive scores indicating that cognitive effects are most pronounced and pervasive for early onset diabetes(EOD) with moderately lower cognitive performance in contrast to the healthy individuals(Gaudieri, et al.2008).
Hypoglycemia in young children is characterized by diarrheal illness, Idiopathic ketotic hypoglycemia, isolated growth hormone deficiency, hypopituitarism. In young adults, the common cause this disorder is type 1 diabetes and congenital metabolic defects. In adults, it occurs due to the drug interactions which involve oral hypoglycemic agents and insulin for diabetes. In addition tumors are also reported to contribute to this disorder like Insulin-secreting pancreatic tumor.
Further, the other recommended standard approach for maintaining near-normal glycaemia in all patients with diabetes mellitus (DM) is Real-time continuous glucose monitoring (RT-CGM) (Battelino and Bolinder 2008).This may be due to the reason that many individuals with DM could not achieve their clinical goal because of hypoglycemia and the associated glycaemic fluctuations. Therefore, the introduction of RT-CGM into the recent clinical practice might offer better knowledge about current glucose concentration and enable people with DM to prevent unnecessary glucose fluctuations by appropriate interventions (Battelino and Bolinder 2008).
The tests to detect hypoglycemia mostly include blood glucose, fasting blood glucose, urine glucose tests, oral glucose tolerance tests (OGTT), c-peptide, hemoglobin A1c and microalbumin. In a recent study it was described that islet transplantation (ITx) in patients with unstable type 1 diabetes mellitus was found to restore hypoglycemia awareness even after islet Graft failure (Leitão, etal.2008).
This strategy could be considered as another approach of lowering the incidence of hypoglycemia in patients with type 1 diabetes. Drugs therapy may also appear influential. Pramlintide in combination with insulin therapy was reported to reduce the risk of hypoglycemia by lowering the rate and magnitude of postprandial blood glucose fluctuations in patients with type 1 diabetes (Kovatchev, Crean and McCall, 2008). Therefore, in view of the above information it can be concluded that hypoglycemia is accompanied by severe metabolic complications that need great attention in people of all ages, especially children.
References
- Kaufman, F.R., Austin, J., Neinstein, A., Jeng, L., Halvorson, M., Devoe, D.J., Pitukcheewanont, P.2002. Nocturnal hypoglycemia detected with the Continuous Glucose Monitoring System in pediatric patients with type 1 diabetes. J Pediatr 141(5):625-30.
- Vannucci, R.C. and Vannucci, S.J. 2001. Hypoglycemic brain injury. Semin Neonatol 6(2):147-55.
- Gaudieri, P.A., Chen, R., Greer, T. F., Holmes, C.S. 2008. Cognitive function in children with type 1 diabetes: a meta-analysis. Diabetes Care 31(9):1892-7.
- Leitão, C.B., Tharavanij, T., Cure, P., Pileggi, A., Baidal, D.A., Ricordi, C., Alejandro, R. 2008. Restoration of Hypoglycemia Awareness after Islet Transplantation. Diabetes Care. [Epub ahead of print]. Web.
- Battelino, T and Bolinder, J.2008. Clinical use of real-time continuous glucose monitoring. Curr Diabetes Rev 4(3):218-22.
- Kovatchev, B.P., Crean, J and McCall A. 2008. Pramlintide reduces the risks associated with glucose variability in type 1 diabetes. Diabetes Technol Ther 10(5):391-6.
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