Hypoglycemia management

During an acute adrenal crisis, the immediate treatment goals are to correct volume depletion, manage hypoglycemia, and provide glucocorticoid replacement. 

Patient management Monitor long-term efficacy by measurement of HbA- c levels approximately every 3 months. When hypoglycemia occurs in patients taking a combination of repaglinide and a thiazolidinedione or repaglinide and metformin, reduce the dose of repaglinide. 

Green HL, Ghishan FK, Brown (1988) Hypoglycemia in type IV glycogenosis hepatic improvement in two patients with nutritional management. J Pediatr 112 55-58... 

A 25-year-old woman and a 52-year-old woman injected lispro instead of insulin glargine (29). The first realized her mistake and managed to prevent severe hypoglycemia by eating continuously, despite a fall in blood glucose to 3.7 mmol/1. The other had a blood glucose of 3.1 mmol/1 and recovered after intravenous dextrose. 

The most desired outcome of a glucose sensor system is to prevent the occurrence of hyper- and hypoglycemia or, at least, reduce the severity of hypoglycemia. For a stand-alone monitor system, all it needs to do is to sound an alarm accurately and in a timely fashion. This, in concept, is an open-loop system. It requires the patient to decide how to manage the monitoring process. In reality, however, this seemingly simple task has been very difficult. Sensitivity and specificity are usually used to evaluate the effectiveness of the alarm methodology as well as the usefulness of the device. 

Because all the myriad consequences to the infant of a diabetic mother arise from maternal hyperglycemia, the therapy of hyperglycemia for the infant should begin before birth. Careful management of the maternal diabetes to prevent both hypoglycemia and hyperglycemia will lessen the likelihood to fetal death or neonatal hypoglycemia. In the present case, economic hardship (the husband s layoff and... 

In summary, HMG-CoA lyase deficiency is a unique inborn error of metabolism with profound effects on both amino acid catabolism and metabolic homeostasis in the fasted state. Management of these patients is difficult and requires constant attention to daily nutrition and timely intervention during acute illness. Fortunately, nutritional therapy treatment that provides a diet adequate for growth but with limited intake of leucine and prevents fasting and hypoglycemia enables individuals with HMG-CoA lyase deficiency to live normal active lives. 

Prompt referral for liver transplantation is the therapy of choice for most patients with fulminant hepatic failure. Transplantation should be considered in all cases in which the patient demonstrates progressive clinical deterioration (encephalopathy, hypoglycemia, metabolic acidosis, renal failure, and coagulation defects)." Patients should be transferred at the first sign of altered mental status, because these patients often worsen very rapidly. One-year smvival rates with liver transplantation for fulminant hepatitis are 50% to 80% (as compared to <20% with medical management alone)."... 

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