Hypoglycaemia treatment

Q100 The patient returns to the pharmacy complaining of very frequent attacks of hypoglycaemia, especially during the night. When contacted by the prescriber, v/hich alternative treatment may be recommended ... 

Recombinant glucagon Insulin-induced hypoglycaemia emergency treatment for severe hypogycaemic reactions... 

Blockade of /32-adrenoceptors by non-selective /3-blockers causes side-effects such as bronchoconstriction, vasoconstriction and hypoglycaemia. /32-Adrenoceptor blockade is sometimes used in the treatment of migraine or particular forms of tremor. 

Diagnosis of hypoglycaemia requires that blood glucose concentration be measured before treatment. If the cause is uncertain, samples can be taken to measure the concentrations of insulin, insulin antibodies, and pancreatic C-peptide before the administration of glucose. 

The treatment of uncomplicated hypoglycaemia is to administer sufficient glucose by mouth or intravenously to restore blood glucose concentration to normal values. 

Exercise is an essential yet neglected aspect of treatment for type 2 diabetes especially in its early stages where insulin resistance may predominate. Accumulation of at least 30 0 minutes of moderate physical activity on most days of the week is recommended. For type 1 diabetes the emphasis must be on adjusting the therapeutic regimen to allow safe sports participation to prevent precipitation of ketoacidosis or hypoglycaemia. Extra care is required in cases with known complications like proliferative retinopathy, nephropathy, foot ulcers and cardiac or peripheral vascular disease. 

Matyka KA, Wigg L, Pramming S, Stores G, Dunger DB. Cognitive function and mood after profound nocturnal hypoglycaemia in prepubertal children with conventional insulin treatment for diabetes. Arch Dis Child 1999 81(2) 138-42. 

Holm G, Herlitz J, Smith U. Severe hypoglycaemia during physical exercise and treatment with beta-blockers. BMJ (Clin Res Ed) 1981 282(6273) 1360. 

The treatment aims at reducing the plasma glucose to minimize the risk of these serious complications the lower the better. But on the other side of the coin is the risk of severe hypoglycaemia here and now. The result is a subtle balance, where an understanding of the mutual interaction between the different processes is sine qua non. 

Other considerations can influence the selection of the highest dose level. Rats and mice are relatively insensitive to sulfo-ureas used for the treatment of diabetes. Rats counteract the hypoglycaemic effect of these drags by secretion of glucagon and 25-hydroxy-cortisol and no hypoglycaemia occurs at the maximum dose level (> 5 000 mg/kg). In one case of a novel antidiabetic sulfonylurea it was demonstrated that absorption becomes saturated at relatively low oral dose (ca. 1000 mg/kg). This observation convinced the FDA that testing of the maximum tolerated dose (probably not determinable) is not necessary. By that the demand of test material could be reduced at least by a factor of 5. 

CM is a 27-year-old white woman with type 1 diabetes diagnosed at age 14 when she presented with diabetic ketoacidosis. Her initial insulin treatment was complicated by poor glycaemic control, frequent hypoglycaemia and weight gain. 

The adrenal cortex secretes steroid hormones, primarily glucocorticoids and mineralocorticoids. Deficiency of these steroids results in Addison s disease, characterized by hypoglycaemia, lethargy and weight loss, anorexia and nausea and hypotension, which can be severe and may result in cardiovascular collapse. Treatment includes replacement of the missing steroids. 

INSULIN VASODILATOR ANTIHYPERTENSIVES-DIAZOXIDE May t insulin requirement Diazoxide causes hyperglycaemia by inhibiting insulin release and probably by a catecholamine-induced extrahepatic effect. Used in the treatment of hypoglycaemia due to insulinomas Larger doses of insulin are often required, and there is a need to monitor blood sugar until adequate control of blood sugar is achieved... 

Mechanism uncertain. ACE inhibitors possibly t insulin sensitivity and glucose utilization. Altered renal function may also be factor. ACE inhibitors may t bradykinin levels, which i production of glucose by the liver. Hypoglycaemia is reported as a (rare) side-effect of ACE inhibitors. Suggested that occurrence of hypoglycaemia is greater with captopril than enalapril. Captopril and enalapril are used in the treatment of diabetic nephropathy... 

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