Research Paper on Hypoglycemia

Case finding/Risk Factors

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Hypoglycaemia is a common issue among patients who take a combination of sulfonylureas and insulin and is a frequent limiting factor in the management of diabetes. According to the American Diabetes Association, hypoglycemia is defined as plasma glucose of 79 mg/dL. (3.9 mmol/L) or less. The risk factors for hypoglycemia include incorrect dosing of the medications, including sulfonylureas and insulin. Besides, skipping meals, eating meals that are significantly smaller, as well as having irregular eating patterns have also been identified as risk factors. Furthermore, the increased physical activity can also cause increased insulin activity, thereby exacerbating hypoglycemia. Other factors that can be categorized as risk factors include alcohol and drug consumption, renal diseases, longer duration of diabetes, an older age, cognitive dysfunctions, obesity, as well as peripheral neuropathy. Medications, including ACE inhibitors and beta blockers, have a likelihood of masking hypoglycemia symptoms.

Usual Presenting History

Most people begin feeing symptoms of hypoglycemia when the concentration of glucose reaches 61mg/dl-64mg.dL or 3.4 to 3.6 mmol/L. Most of the episodes of hypoglycemia are usually reported on the basis of symptoms and not on the levels of glucose, and thus, the American Diabetes Association (ADA) Workgroup on Hypoglycaemia distinguished five hypoglycaemic subsets. These are: (1) severe hypoglycaemia, which demands outside assistance regardless of the levels of glucose; (2) documented symptomatic hypoglycaemia, where there are manifestation of hypoglycaemic symptoms as well as a confirmed glucose level of 3.9 mmol/L or even less; (3) asymptomatic hypoglycaemia, where there are absolutely no symptoms, but there is a confirmed glucose level of 3.9 mmol/L or even less; (4) probable symptomatic hypoglycaemia, where the symptoms have been confirmed but not the levels of glucose; and (5) relative hypoglycaemia, where the symptoms, as well as levels of glucose that surpass 3.9 mmol/L have been confirmed.

Presenting Signs and Symptoms

There are many symptoms associated with hypoglycaemia, and include seizures, slurred speech, loss of consciousness, tachycardia, tiredness, anxiety, headache, aggression, blurred vision, confusion, irritability, prickly skin, palpitation, shaking, sweating, drowsiness, hunger, dizziness, weakness, and trouble concentrating (Burson & Moran, 2014; Laurenius et al., 2014; Shriraam et al., 2017).

Laboratory/Diagnostic Studies Typically Performed and Diagnosis

For patients with type 2 diabetes, severe hypoglycemia is usually associated with adverse effects on their quality of life and economic impact (Lee et al., 2006; Lundkvist et al., 2006). For this reason, strict controls are being emphasized in the treatment of diabetes, especially after the DCCT studies (DCCT Research Group, 1993).

The doctor first looks into the symptoms, especially when the patient has type 2 diabetes. A diagnosis of hypoglycemia is not usually based on symptoms alone. A determination whether the patient has low blood sugar has to be conducted by utilizing a blood glucose meter, which is a small computerized device that can be used by medical practitioners to measure and display the blood sugar levels. Hypoglycaemia is diagnosed once the patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Besides it is important for the patient to record the time, date, dosage and medication, exercise, and diet information each time a doctor tests the blood for blood sugar levels and note any low blood sugar reactions as the doctor uses these records and looks into patterns to determine how lifestyle and medications affect the blood sugar.

Management strategies (pharmacological, educational, and otherwise)

A characteristic of the most successful care systems is making high-quality care a priority for healthcare providers. In regards to hypoglycemia, management of the condition requires therapy. Essentially, the mainstay of therapy for the condition is managing glucose levels. Providers can advise on dietary therapy, which improves the symptoms in patients with fasting hypoglycemia. Here, patients are advised of frequent meals and snacks, particularly a night with complex carbohydrates. If the therapy is inefficient in managing the condition, the therapy may be accompanied by intravenous glucose infusion. Intravenous octreotide is often effective in suppressing instances of endogenous insulin secretion; however, reactive hypoglycemia does not require medical care. Additionally, as exercise burns carbohydrates and increases insulin sensitivity, patients undergoing fasting hypoglycemia should avoid significant activity. On the other hand, patients with reactive hypoglycemia have their symptoms improve after embarking on exercise programs. Additionally, a definitive treatment for fasting hypoglycemia that is caused by a tumor is surgical resection where the success rate is high for benign tumors as opposed to malignant tumors.

Reactive hypoglycemia patients need to restrict carbohydrate intake and avoid simple sugars. They also need to increase the frequency of their meals and reduce the size of them. For instance, they need to have six small meals and 2-3 snacks daily. They need to increase protein and fiber intake. Besides, using alpha-glucosidase inhibitors, such as miglitol and acarbose may also be handy. The medications are important as they cause reversible inhibition of pancreatic alpha-amylase, as well as membrane-bound intestinal alpha-glucoside hydrolase enzymes.

Education is also an important strategy for hypoglycemia management. Educating carers and people help them avoid hypoglycemia in the future. These entail teaching them of warning symptoms, the frequency of hypoglycemic incidences and their reasons while checking the patients report on hypoglycemia occurrences. Education about the treatment of hypoglycemia is required, especially of friends, relatives, and carers in administering medication. Additionally, education on when to avoid hypoglycemia about exercise is also important. Patients should be educated on the effect of alcohol and other contra-drugs while managing the condition. Education should also cover mixing of insulin preparations, injection sites, needles and devices, and technique. Friends, relatives, and carers should also be taught insulin dosing about carbohydrate intake.

Follow up recommendations

It is recommended that the providers should ensure that the patient is taking the assigned medications, especially for the old. Other recommendations include frequent checking for glucose levels to ensure that they are normal.

Practicum Table

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Risk Factors Blood sugar level less than 79 mg/dL. (3.9 mmol/L Skipping meals.

Obesity and peripheral neuropathy.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L

Eating meals that are significantly smaller

Blood sugar level less than 79 mg/dL. (3.9 mmol/L

Having irregular eating patterns.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L Increased physical activity

Blood sugar level less than 79 mg/dL. (3.9 mmol/L Alcohol and drug consumption.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L Renal diseases.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L Longer duration of diabetes, an older age.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L Cognitive dysfunctions.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L Medications, including ACE inhibitors and beta-blockers.

Blood sugar level less than 79 mg/dL. (3.9 mmol/L

Usual Presenting History

Symptoms of hypoglycemia when the concentration of glucose reaches 61mg/dl-64mg.dL or 3.4 to 3.6 mmol/L. N/A Symptoms of hypoglycemia when the concentration of glucose reaches 61mg/dl-64mg.dL or 3.4 to 3.6 mmol/L N/A N/A N/A N/A Symptoms of hypoglycemia when the concentration of glucose reaches 61mg/dl-64mg.dL or 3.4 to 3.6 mmol/L. N/A symptoms of hypoglycemia when the concentration of glucose reaches 61mg/dl-64mg.dL or 3.4 to 3.6 mmol/L.

Diagnosis

Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL). Patients blood sugar level drops below 3.9 mmol/L (70 mg/dL).

Presenting Signs and Symptoms

Seizures, slurred speech, palpitation,

headache. Loss of consciousness,

anxiety,

hunger. Tachycardia, tiredness,

Hunger. A headache, aggression,

Seizures. Blurred vision, confusion,

Hunger. Irritability, prickly skin,

Seizures. Drowsiness, hunger, seizures. Weakness, and trouble concentrating

A headache. Shaking, sweating, dizziness. Slurred speech, palpitation,

headache,

seizures.

Management strategies Dietary therapy.

(Fasting hypoglycemia) Exercise (reactive hypoglycemia) Dietary therapy.

(Fasting hypoglycemia) Dietary therapy. (Fasting hypoglycemia) Dietary therapy.

(Fasting hypoglycemia) Exercise (reactive hypoglycemia) Dietary therapy.

(Fasting hypoglycemia) Dietary therapy. \(Fasting hypoglycemia) Exercise (reactive hypoglycemia) Dietary therapy.

(Fasting hypoglycemia)

Follow up recommendations

Check whether the patient is taking the assigned medication and frequent checking for glucose levels.

Findings

The guidelines were correct in that the fall of blood sugar level less than 79 mg/dL. (3.9 mmol/L predisposed the patients to hypoglycemia. It was the most common risk factor among the patients. Additionally, the usual presenting history that was most common was that the symptoms of hypoglycemia when the concentration of glucose reaches 61mg/dl-64mg.dL or 3.4 to 3.6 mmol/L. However, the guidelines were incorrect as some of the patients did not have this presenting history. As such, the guidelines in this instance were not accurate. Furthermore, the guidelines were accurate on hypoglycaemic diagnosis in that all the patients who had hypoglycemia had blood sugar level drops below 3.9 mmol/L (70 mg/dL).

The most common presenting signs and symptoms were headaches, hunger, and seizures. However, most of the patients had a combination of symptoms, and thus, the guidelines were correct. The management strategies that were applied were dietary therapy...