Hypoglycemia, diabetes mellitus

Insulin and the oral antidiabetic dmgi, alongwith diet and exercise are die cornerstones of treatment for diabetes mellitus. They are used to prevent episodes of hypoglycemia and to normalize carbohydrate metabolism. 

The answer is a. (Hardman, p 1510.) Although the mechanism of action of metformin and other biguanicies is unclear, biguanides virtually never cause hypoglycemia They operate independently of pancreatic p cells but are not useful in insulin-dependent diabetes mellitus (IDDM). Some possible mechanisms of action are direct stimulation of glycolysis in peripheral tissues, increased sensitivity to insulin, and reduction of glucagon levels. 

For pentamidine, side effects include hypotension, tachycardia, nausea, vomiting, severe hypoglycemia or hyperglycemia, pancreatitis, irreversible diabetes mellitus, elevated transaminases, nephrotoxicity, leukopenia, and cardiac arrhythmias. 

Diabetes mellitus Recurrent episodes of hypoglycemia (low blood sugar)... 

Adverse reactions that occurred in at least 3% of patients included the following Aggravated diabetes mellitus, edema, headache, hypoglycemia, myalgia, pharyngitis, sinusitis, tooth disorder, upper respiratory tract infection. 

Diabetes mellitus and hypoglycemia -blockade may prevent the appearance of premonitory signs and symptoms of acute hypoglycemia. -blockade also reduces insulin release it may be necessary to adjust antidiabetic drug dose. 

Endocrine disorders Peginterferon alfa-2a causes or aggravates hypothyroidism and hyperthyroidism. Hyperglycemia, hypoglycemia, and diabetes mellitus have developed in patients treated with peginterferon alfa-2a. 

Adverse reactions occur frequently. Rapid drug infusion may produce tachycardia, vomiting, shortness of breath, headache, and a fall in blood pressure. Changes in blood sugar (hypoglycemia or hyperglycemia) necessitate caution in its use, particularly in patients with diabetes mellitus. Renal function should be monitored and blood counts checked for dyscrasias. 

Chelliah A, Burge MR. Hypoglycemia in elderly patients with diabetes mellitus. Causes and strategies for prevention. Drugs Aging 2004 2 i 5 i i-530. 

Hypoglycemia may occur in patients with previously controlled diabetes mellitus. 

Diabetes mellitus, combination therapy PO With insulin Initially, 15-30 mg once a day. Initially, continue current insulin dosage then decrease insulin dosage by 10% to 25% if hypoglycemia occurs or plasma glucose level decreases to less than 100 mg/dl. Maximum 45 mg/day. With sulfonylureas Initially, 15-30 mg/day. Decrease sulfonylurea dosage if hypoglycemia occurs. With metformin Initially, 15-30 mg/day. As monotherapy Monotherapy is not to be used if patient is well controlled with diet and exercise alone. Initially, 15-30 mg/day. May increase dosage in increments until 45 mg/day is reached. 

For many years, there has been concern by medical professionals and nutritionists over the effects of dietary sugar on human health. Sucrose has been implicated as a cause of juvenile hyperactivity, tooth decay, diabetes mellitus, obesity, atherosclerosis, hypoglycemia, and nutrient deficiencies. 

Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Kebbi IM. Hypoglycemia in patients with type 2 diabetes mellitus. Arch Intern Med 2001 161(13) 1653-9. 

Burge MR, Schmitz-Fiorentino K, Fischette C, Qualls CR, Schade DS. A prospective trial of risk factors for sulfonylurea-induced hypoglycemia in type 2 diabetes mellitus. JAMA I998 279(2) l 37 13. 

Daneman D, Frank M, Perlman K, Tamm J, Ehrlich R. Severe hypoglycemia in children with insulin-dependent diabetes mellitus frequency and predisposing factors. J Pediatr 1989 115(5 Pt l) 681-5. 

Ovalle F, Fanelli CG, Paramore DS, Hershey T, Craft S, Cryer PE. Brief twice-weekly episodes of hypoglycemia reduce detection of clinical hypoglycemia in type 1 diabetes mellitus. Diabetes 1998 47(9) 1472-9. 

Sulli N, Shashaj B. Continuous subcutaneous insulin infusion in children and adolescents with diabetes mellitus decreased HbAlc with low risk of hypoglycemia. J Pediatr Endocrinol Metab 2003 16 393-9. 

Jeha GS, Karaviti LP, Anderson B, O Brian Smith E, Donaldson S, McGirk TS, Haymond MW. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther 2005 7 876-84. 

Severe hypoglycemia occurred in two elderly men with type 2 diabetes mellitus and mild to moderate impaired renal function, who took clarithromycin 1000 mg/day for respiratory infections, in addition to a sulfonylurea (glibenclamide 5 mg/day in one case and glipizide 15 mg/day in the other) (168). Both developed severe hypoglycemia within 48 hours of starting clarithromycin. 

Ibuprofen (150 mg, 3 doses) for arthralgias was associated with hypoglycemia in a 72-year-old man who was taking glibenclamide 2.5 mg/day for type 2 diabetes mellitus ... 

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