Pathway hipoglikemia

pathway hipoglikemia

Medical condition Hypoglycemia Other names Hypoglycaemia, hypoglycæmia, low blood glucose, low pathway hipoglikemia sugar Glucose meter Specialty Endocrinology Symptoms Headache, blurred vision, shakiness, dizziness, weakness, tiredness, sweating, clamminess, fast heart rate, pounding heartbeat, pathway hipoglikemia or anxiety, hunger, nausea, pins and needles sensation, difficulty talking, confusion, loss of consciousness, unusual behavior, lightheadedness, pale skin color, seizures, death [1] [2] [3] [4] [5] Usual onset Rapid [1] Causes Medications ( insulin, glinides and sulfonylureas), sepsis, kidney failure, certain tumors, liver disease [1] [6] Diagnostic method Whipple's triad: Symptoms of hypoglycemia, serum blood glucose level <70 mg/dL (3.9 mmol/L), and resolution of symptoms when blood glucose returns to normal [2] Treatment Eating foods high in simple sugars, dextrose, glucagon [1] Frequency In type 1 diabetics, mild hypoglycemia occurs twice per week on average, and severe hypoglycemia occurs one per year.

[3] Deaths In type 1 diabetics, 6-10% will die of hypoglycemia. [3] Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). [1] [3] Whipple's triad pathway hipoglikemia used to properly identify hypoglycemic episodes. [2] It is defined as blood glucose below 70 mg/dL (3.9 mmol/L), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal. [2] Hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death.

[1] [3] [2] Symptoms typically come on quickly. [1] The most common pathway hipoglikemia of hypoglycemia is medications used to treat diabetes such as insulin, sulfonylureas, and biguanides.

[3] [2] [6] Risk is greater in diabetics who have eaten less than usual, recently exercised, or consumed alcohol. [1] [3] [2] Other causes of hypoglycemia include severe illness, sepsis, kidney failure, liver disease, hormone deficiency, tumors such as insulinomas or pathway hipoglikemia cell tumors, inborn errors of metabolism, several medications, and alcohol.

[1] [3] [2] Low blood sugar may occur in otherwise healthy newborns who have not eaten for a few hours. [7] Hypoglycemia is treated by eating a sugary food or drink, for example glucose tabs or gel, apple juice, soda, or candy. [1] [3] [2] The person must be conscious and able to swallow.

[1] [3] The goal is to consume 10-20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L). [3] [2] If a person is not pathway hipoglikemia to take food by mouth, glucagon by injection or in the nose may help. [1] [3] [8] The treatment of hypoglycemia unrelated to diabetes includes treating the underlying problem. [3] [2] Among people with diabetes, prevention starts with learning the signs and symptoms of hypoglycemia.

[3] [2] Diabetes medications, like insulin, sulfonylureas, and biguanides can also be adjusted or stopped to prevent hypoglycemia. [3] [2] Frequent and routine blood glucose testing is recommended. [1] [3] Some may find continuous glucose montiors with insulin pumps to be helpful in the management of diabetes and prevention of hypoglycemia. [3] Contents • 1 Definition • 1.1 Whipple's triad • 1.2 Age • 2 Differential diagnosis • 3 Signs and symptoms • 4 Pathophysiology • 5 Causes • 5.1 Diabetics • 5.1.1 Medications • 5.1.2 Hypoglycemic unawareness • 5.1.3 Other causes • 5.2 Non-diabetics • 5.2.1 Serious illness • 5.2.2 Drugs • 5.2.3 Surreptitious insulin use • 5.2.4 Alcohol misuse • 5.2.5 Hormone deficiency • 5.2.6 Inborn errors of metabolism • 5.2.7 Insulinomas • 5.2.8 Non-B cell tumors • 5.2.9 Post-gastric bypass postprandial hypoglycemia • 5.2.10 Autoimmune hypoglycemia • 5.2.11 Neonatal hypoglycemia • 6 Diagnostic approach • 7 Treatment • 7.1 Self-treatment pathway hipoglikemia 7.1.1 Education • 7.2 Treatment by family, friends, or co-workers • pathway hipoglikemia Treatment by medical professionals • 7.4 Other treatments • 8 Prevention • 8.1 Diabetics • 8.2 Non-diabetics • 9 Epidemiology • 10 History • 11 Etymology • 12 See also • 13 References • 14 External links Definition [ edit ] Blood sugar levels naturally fluctuate throughout the day, however hypoglycemia, also called low blood sugar or low blood glucose, is when blood sugar levels drop below 70 mg/dL (3.9 mmol/L).

[3] [5] Blood sugar levels are generally maintained between 70 and 110 mg/dL (3.9-6.1 mmol/L). [3] [2] Although 70 mg/dL (3.9 mmol/L) is the lower limit of normal glucose, symptoms of hypoglycemia usually do not occur until 55 mg/dL (3.0 mmol/L) or lower. [3] [2] The blood glucose level at which symptoms of hypoglycemia develop in someone with several prior episodes of hypoglycemia may be even lower.

[2] Whipple's triad [ edit ] The symptoms of low blood sugar alone are not specific enough to characterize a pathway hipoglikemia episode. [2] A single blood sugar reading below 70 mg/dL is also not specific enough characterize a hypoglycemic episode. [2] Whipple's triad is a set of three conditions that need to be met in order to accurately characterize a hypoglycemic episode. [2] The three conditions are the following: • The signs and symptoms of hypoglycemia are present (see section below on Signs and Symptoms) [2] • A low blood glucose measurement is present, typically less than 70 mg/dL (3.9 mmol/L) [2] • The signs and symptoms of hypoglycemia resolve after blood glucose levels have returned to normal [2] Age [ edit ] The biggest difference in blood glucose levels between the adult and pediatric population occurs in newborns during the first 48 hours of life.

[7] After the first 48 hours of life, the Pediatric Endocrine Society cites that there is little difference in blood glucose level and the use of glucose between adults and children. [7] During the 48 hour neonatal period, the neonate adjusts glucagon and epinephrine levels following birth, which may cause temporary hypoglycemia.

[7] As a result, there has been difficulty in developing guidelines on interpretation and treatment of low blood glucose in neonates aged less than 48 hours. [7] Following a data review, the Pediatric Endocrine Society concluded that neonates aged less than 48 hours begin to respond to hypoglycemia at serum glucose levels of 55–65 mg/dL (3.0-3.6 mmol/L).

[7] This is contrasted by the value in adults, children, and older infants, which is approximately 80–85 mg/dL (4.4-4.7 mmol/L). [7] In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dL (3.9-5.5 mmol/L), similar to adults. [7] Whipple's triad is used to identify hypoglycemia in children who can communicate their symptoms.

[7] Differential diagnosis [ edit ] Other conditions that may present similarly to hypoglycemia include the following: • Alcohol or drug intoxication [2] [9] • Cardiac arrhythmia [2] [9] • Valvular heart disease [2] [9] • Postprandial syndrome [9] • Hyperthyroidism [9] • Pheochromocytoma [9] • Post-gastric bypass hypoglycemia [2] [9] • Generalized anxiety disorder [9] • Surreptitious insulin use [2] [9] • Lab or blood draw error (lack of antiglycolytic agent in collection tube or during processing) [9] Signs and symptoms [ edit ] Hypoglycemic symptoms are divided into two main categories.

[3] The first category is symptoms caused by low glucose in the brain, called neuroglycopenic symptoms. [3] The second category of symptoms is caused by the body's reaction to low glucose in the brain, called adrenergic symptoms.

[3] Neuroglycopenic symptoms Adrenergic symptoms • Headache • Blurred vision • Tiredness (also called Fatigue) • Unusual behavior • Confusion • Lightheadedness • Difficulty speaking or slurred speech • Seizures • Loss of consciousness (sometimes called passing out) • Death, if severe hypoglycemia • Fast heart rate • Pounding heartbeat (also called Pathway hipoglikemia • Sweating • Clamminess • Shakiness or tremulousness • Nervousness (also called Anxiety) • Hunger • Nausea • Pins and needles sensation • Pale skin color References: [1] [3] [2] [5] [4] Everyone experiences different symptoms of hypoglycemia, so someone with hypoglycemia may not have all of the symptoms listed above.

[3] [5] [4] Symptoms also tend to have quick onset. [5] It is important to quickly obtain a blood glucose measurement in someone presenting with symptoms of hypoglycemia to properly identify the hypoglycemic episode. [5] [2] Pathophysiology [ edit ] Glucose is the main source of energy for the brain, and a number of mechanisms are in place to prevent hypoglycemia and protect energy supply to the brain.

[3] [10] The body can adjust insulin production and release, adjust glucose production by the liver, and adjust glucose use by the body. [3] [10] The body naturally produces the hormone insulin, in an organ called the pancreas. [3] Insulin helps to regulate the amount of glucose in the body, especially after meals.

[3] Glucagon is another hormone involved in regulating blood glucose levels, and can be thought of as the opposite of insulin. [3] Glucagon helps to increase blood glucose levels, especially in states of hunger. [3] When blood sugar levels fall to the low-normal range, the first line of defense against hypoglycemia is decreasing insulin release by the pancreas.

[3] [10] This drop in insulin allows the liver to increase glycogenolysis. [3] [10] Glycogenolysis is the process of glycogen breakdown that results in the production of glucose. [3] [10] Glycogen can be thought of as the inactive, storage form of glucose. [3] Decreased insulin also allows pathway hipoglikemia increased gluconeogenesis in the liver and kidneys.

[3] [10] Gluconeogenesis is the process of glucose production from non- carbohydrate sources, supplied from muscles and fat. [3] [10] Once blood glucose levels fall out of the normal range, additional protective mechanisms work to prevent hypoglycemia. [3] [10] The pancreas is signaled to release glucagon, a hormone that increases glucose production by the liver and kidneys, and increases muscle and fat breakdown to supply gluconeogenesis.

[3] [11] If increased glucagon does not raise blood sugar levels to normal, the adrenal glands release epinephrine. [3] [10] Pathway hipoglikemia works to also increase gluconeogenesis and glycogenolysis, while also decreasing the use of glucose by organs, protecting the brain's glucose supply. [3] [10] After hypoglycemia has been prolonged, cortisol and growth hormone are released to continue gluconeogenesis and glycogenolysis, while also preventing the use of glucose by other organs.

[3] [10] The effects of cortisol and growth hormone are far less effective than epinephrine. [3] [10] In a state of hypoglycemia, the brain also signals a sense of hunger and drives the person to eat, in an attempt to increase glucose. [3] [10] Causes [ pathway hipoglikemia ] Main article: List of causes of hypoglycemia Hypoglycemia is most common in those with diabetes treated by insulin, glinides, and sulfonylureas.

[3] [2] Hypoglycemia is rare in those without diabetes, because there are many regulatory mechanisms in place to appropriately balance glucose, insulin, and glucagon. [3] [2] Please refer to Pathophysiology section (above) for more information on glucose, insulin, and glucagon. Diabetics [ edit ] Medications [ edit ] The most common cause of hypoglycemia in diabetics is medications used to treat diabetes such as insulin, sulfonylureas, and biguanides.

[3] [2] [6] This pathway hipoglikemia often due to excessive doses or poorly timed doses. [3] Sometimes diabetics may pathway hipoglikemia insulin pathway hipoglikemia anticipation of a meal or snack, and missing or forgetting that meal will lead to hypoglycemia. [3] This is due to increased insulin without the presence of glucose from the planned meal.

[3] Hypoglycemic unawareness [ edit ] Recurrent episodes of hypoglycemia can lead to hypoglycemic unawareness, or the decreased ability to recognize hypoglycemia. [12] [13] [14] As diabetics experience more episodes of hypoglycemia, the blood glucose level which triggers symptoms of hypoglycemia decreases.

[12] [13] [14] In other words, people without hypoglycemic unawareness experience symptoms of hypoglycemia at a blood glucose of about 55 mg/dL (3.0 mmol/L). [3] [2] Those with hypoglycemic unawareness experience the symptoms of hypoglycemia at far lower levels of blood glucose. [12] [13] [14] This is dangerous for a number of reasons. [12] [13] [14] The hypoglycemic person not only gains awareness of hypoglycemia at very low blood glucose levels, but they also require high levels of carbohydrates or glucagon to recover their blood glucose to normal levels.

[12] [13] [14] These individuals are also at far greater risk of severe hypoglycemia. [12] [13] [14] While the exact cause of hypoglycemic unawarenss is still under research, it is thought that these individuals progressively begin to develop fewer adrenergic-type symptoms, resulting in the loss of neuroglycopenic-type symptoms. [13] [14] Neuroglycopenic pathway hipoglikemia are caused by low glucose in the brain, and can result in tiredness, confusion, difficulty with speech, pathway hipoglikemia, and loss of consciousness.

[3] Adrenergic symptoms are caused by pathway hipoglikemia body's reaction to low glucose in the brain, and can result in fast heart rate, sweating, nervousness, and hunger. [3] See section above on Signs and Symptoms for further explanation of neuroglycopenic symptoms and adrenergic symptoms. In terms of epidemiology, hypoglycemic pathway hipoglikemia occurs in 20-40% of type 1 diabetics. [12] [14] [15] Other causes [ edit ] Other causes of hypoglycemia in diabetics include the following: • Fasting, whether it be a planned fast or overnight fast, as there is a long period of time without glucose intake [1] [3] • Exercising more than usual as it leads to more use of glucose, especially by the muscles [1] [3] • Drinking alcohol, especially when combined with diabetic medications, pathway hipoglikemia alcohol inhibits glucose production [1] [3] • Kidney disease, as insulin cannot be cleared out of circulation well [3] Non-diabetics [ edit ] Serious illness [ edit ] Serious illness may result in low blood sugar.

[1] [3] [2] [10] Severe disease of many organ systems can cause hypoglycemia as a secondary problem. [3] [2] Hypoglycemia is especially common in those in the intensive care unit or those in whom food and drink is withheld as a part of their treatment plan. [3] [10] Sepsis, a common cause pathway hipoglikemia hypoglycemia in serious illness, can lead to hypoglycemia through many ways.

[3] [10] In a state of sepsis, the body uses large amounts of glucose for energy. [3] [10] Glucose use is further increased by cytokine production. [3] Cytokines are a protein produced by the body in a state of stress, particularly when fighting an infection. [3] Cytokines may inhibit glucose production, further decreasing the body's energy stores. [3] Finally, the liver and kidneys are sites of glucose production, and in a state of sepsis those organs may not receive enough oxygen, leading to decreased glucose production due to organ damage.

[3] Other causes of serious illness that may cause hypoglycemia include liver failure pathway hipoglikemia kidney failure. [3] [10] The liver is the main site of glucose production in the body, and any liver failure or damage will lead to decreased glucose production.

pathway hipoglikemia

{INSERTKEYS} [3] [10] While the kidneys are also sites of glucose production, their failure of glucose production is not significant enough to cause hypoglycemia . [3] Instead, the kidneys are responsible for removing insulin from the body, and when this function is impaired in kidney failure, the insulin stays in circulation longer, leading to hypoglycemia.

[3] Drugs [ edit ] A number of medications have been identified which may cause hypoglycemia, through a variety of ways. [3] [2] [16] Moderate quality evidence implicates the non-steroidal anti-inflammatory drug indomethacin and the anti-malarial quinine. [3] [2] [16] Low quality evidence implicates lithium, used for bipolar disorder. [2] [16] Finally, very low quality evidence implicates a number of hypertension medications including angiotensin converting enzyme inhibitors (also called ACE-inhibitors), angiotensin receptor blockers (also called ARBs), and β-adrenergic blockers (also called beta blockers).

[3] [2] [16] Other medications with very low quality evidence include the antibiotics levofloxacin and trimethoprim-sulfamethoxazole, progesterone blocker mifepristone, anti-arrhythmic disopyramide, anti-coagulant heparin, and chemotherapeutic mercaptopurine.

[2] [16] If a person without diabetes accidentally takes medications that are traditionally used to treat diabetes, this may also cause hypoglycemia. [3] [2] These medications include insulin, glinides, and sulfonylureas.

[3] [2] This may occur through medical errors in a healthcare setting or through pharmacy errors, also called iatrogenic hypoglycemia.

[3] Surreptitious insulin use [ edit ] When individuals take insulin without needing it, to purposefully induce hypoglycemia, this is referred to as surreptitious insulin use or factitious hypoglycemia. [3] [2] [17] Some people may use insulin to induce weight loss, whereas for others this may be due to malingering or factitious disorder, which is a psychiatric disorder. [17] Demographics affected by factitious hypoglycemia include women aged 30–40, particularly those with diabetes, relatives with diabetes, healthcare workers, or those with history of a psychiatric disorder.

[3] [17] The classic way to identify surreptitious insulin use is through blood work revealing high insulin levels with low C-peptide and proinsulin. [3] [17] Alcohol misuse [ edit ] The production of glucose is blocked by alcohol. [3] In those who misuse alcohol, hypoglycemia may be brought on by a several-day alcohol binge associated with little to no food intake. [1] [3] The cause of hypoglycemia is multifactorial, where glycogen becomes depleted in a state of starvation.

[3] Glycogen stores are then unable to be repleted due to the lack of food intake, all compounded the inhibition of glucose production by alcohol.

[3] Hormone deficiency [ edit ] Children with primary adrenal failure, also called Addison's disease, may experience hypoglycemia after long periods of fasting. [3] Addison's disease is associated with chronically low levels of the stress hormone cortisol, which leads to decreased glucose production.

[3] Hypopituitarism, leading to decreased growth hormone, is another cause of hypoglycemia in children, particularly with long periods of fasting or increased exercise. [3] Inborn errors of metabolism [ edit ] Briefly, inborn errors of metabolism are a group rare of genetic disorders that are associated with the improper breakdown or storage of proteins, carbohydrates, or fatty acids.

[18] Inborn errors of metabolism may cause infant hypoglycemia, and much less commonly adult hypoglycemia. [18] Disorders that are related to the breakdown of glycogen, called glycogen storage diseases, may cause hypoglycemia.

[3] [18] Normally, breakdown of glycogen leads to increased glucose levels, particularly in a fasting state. [3] In glycogen storage diseases however, glycogen cannot be properly broken-down, leading to inappropriately decreased glucose levels in a fasting state, and thus hypoglycemia.

[3] The glycogen storage diseases associated with hypoglycemia include type 0, type I, type III, and type IV, as well as Fanconi syndrome.

[3] Insulinomas [ edit ] A primary B-cell tumor, such as an insulinoma, is associated with hypoglycemia. [3] This is a tumor located in the pancreas. [3] An insulinoma produces insulin, which in turn decreases glucose levels, causing hypoglycemia. [3] Normal regulatory mechanisms are not in place, which prevent insulin levels from falling during states of low blood glucose. [3] During an episode of hypoglycemia, plasma insulin, C-peptide, and proinsulin will be inappropriately high.

[3] Non-B cell tumors [ edit ] Hypoglycemia may occur in people with non-B cell tumors such as hepatomas, adrenocorticoid carcinomas, and carcinoid tumors. [3] These tumors lead to a state of increased insulin, specifically increased insulin-like growth factor II, which decreases glucose levels.

[3] Post-gastric bypass postprandial hypoglycemia [ edit ] The Roux-en-Y gastric bypass, is a weight-loss surgery performed on the stomach, and has been associated with hypoglycemia, called post-gastric bypass postprandial hypoglycemia.

[3] Although the entire mechanism of hypoglycemia following this surgery is not fully understood, it is thought that meals cause very high levels of glucagon-like peptide-1 (also called GLP-1), a hormone that increases insulin, causing glucose levels to drop.

[3] Autoimmune hypoglycemia [ edit ] Antibodies can be formed against insulin, leading to autoimmune hypoglycemia. [3] [19] Antibodies are immune cells produced by the body, that normally attack bacteria and viruses, but sometimes can attack normal human cells, leading to an autoimmune disorder. {/INSERTKEYS}

pathway hipoglikemia

{INSERTKEYS} [20] In autoimmune hypoglycemia, there are two possible mechanisms. [3] [19] In one instance, antibodies bind to insulin following its release associated with a meal, resulting in insulin being non-functional. [3] [19] At a later time, the antibodies fall off insulin, causing insulin to be functional again leading late hypoglycemia after a meal, called late postprandial hypoglycemia.

[3] [19] Another mechanism causing hypoglycemia is due to antibodies formed against insulin receptors, called insulin receptor antibodies. [3] [19] The antibodies attach to insulin receptors and prevent insulin breakdown, or degradation, leading to inappropriately high insulin levels and low glucose levels.

[3] [19] Neonatal hypoglycemia [ edit ] Low blood sugar may occur in healthy neonates aged less than 48 hours who have not eaten for a few hours. [7] During the 48 hour neonatal period, the neonate adjusts glucagon and epinephrine levels following birth, which may trigger transient hypoglycemia. [7] In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dL (3.9-5.5 mmol/L), similar to adults, with hypoglycemia being far less common.

[7] Diagnostic approach [ edit ] The most reliable method of identifying hypoglycemia is through identifying Whipple's triad. [3] [2] The components of Whipple's triad are a blood sugar level below 70 mg/dL (3.9 mmol/L), symptoms related to low blood sugar, and improvement of symptoms when blood sugar is restored to normal.

[3] [2] Identifying Whipple's triad in a patient helps to avoid unnecessary diagnostic testing and decreases healthcare costs. [2] In those with a history of diabetes treated with insulin, glinides, or sulfonylurea, who demonstrate Whipple's triad, it is reasonable to assume the cause of hypoglycemia is due to insulin, glinides, or sulfonylurea use.

[2] In those without a history of diabetes with hypoglycemia, further diagnostic testing is necessary to identify the cause. [2] Testing, during an episode of hypoglycemia, should include the following: • Plasma glucose level, not point-of-care measurement [3] [2] • Insulin level [3] [2] • C-peptide level [3] [2] • Proinsulin level [3] [2] • Beta-hydroxybutyrate level [3] [2] • Oral hypoglycemic agent screen [2] • Response of blood glucose level to glucagon [2] • Insulin antibodies [2] If necessary, a diagnostic hypoglycemic episode can be produced in an inpatient or outpatient setting.

[3] This is called a diagnostic fast, in which a patient undergoes an observed fast to cause a hypoglyemic episode, allowing for appropriate blood work to be drawn.

[3] In some, the hypoglycemic episode may be reproduced simply after a mixed meal, whereas in others a fast may last up to 72 hours. [3] [2] In those with a suspected insulinoma, imaging is the most reliable diagnostic technique, including ultrasound, computed tomography imaging (also called CT imaging), and magnetic resonsance imaging (also called MRI). [3] [2] Treatment [ edit ] After hypoglycemia in a person is identified, rapid treatment is necessary and can be life-saving.

[1] The main goal of treatment is to raise blood glucose back to normal levels, which is done through various ways of administering glucose, depending on the severity of the hypoglycemia, what is on-hand to treat, and who is administering the treatment. [1] [3] A general rule used by the American Diabetes Association is the "15-15 Rule," which suggests consuming or administering 15 grams of a carbohydrate, followed by a 15-minute wait and re-measurement of blood glucose level to assess if blood glucose has returned to normal levels.

[5] Self-treatment [ edit ] If an individual recognizes the symptoms of hypoglycemia coming on, blood sugar should promptly be measured, and a sugary food or drink should be consumed. [1] The person must be conscious and able to swallow. {/INSERTKEYS}

pathway hipoglikemia

{INSERTKEYS} [1] [3] The goal is to consume 10-20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L). [3] [2] Examples of products to consume are: • Glucose tabs or gel (refer to instructions on packet) [1] [2] • Juice containing sugar like apple, grape, or cranberry juice, 4 ounces or 1/2 cup [1] [2] • Soda or a soft-drink, 4 ounces or 1/2 cup (not diet soda) [2] • Candy [2] • Table sugar or honey, 1 tablespoon [1] Improvement in blood sugar levels and symptoms are expected to occur in 15–20 minutes, at which point blood sugar should be measured again.

[3] [2] If the repeat blood sugar level is not above 70 mg/dL (3.9 mmol/L), consume another 10-20 grams of a carbohydrate and remeasure blood sugar levels after 15–20 minutes. [3] [2] Repeat until blood glucose levels have returned to normal levels. [3] [2] The greatest improvements in blood glucose will be seen if the carbohydrate chewed or drunk, and then swallowed.

[21] This results in the greatest bioavaliablity of glucose, meaning the greatest amount of glucose enters the body producing the best possible improvements in blood glucose levels.

[21] The second best way to consume a carbohydrate it to allow it to dissolve under the tongue, also referred to as sublingual administration. [21] For example, a hard candy can be dissolved under the tongue, however the best improvements in blood glucose will occur if the hard candy is chewed and crushed, then swallowed.

[21] After correcting blood glucose levels, people may consume a full meal within one hour in order to replenish glucagon stores. [2] Education [ edit ] Family, friends, and co-workers of a person with diabetes may provide life-saving treatment in the case of a hypoglycemic episode [1] It is important for these people to receive training on how to recognize hypoglycemia, what foods to help the hypoglycemic eat, how to administer injectable or intra-nasal glucagon, and how use a glucose meter.

[1] A glucagon kit used to treat severe hypoglycemia. Treatment by family, friends, or co-workers [ edit ] Family, friends, and co-workers of those with hypoglycemia are often first to identify hypoglycemic episodes, and may offer help. [3] Upon recognizing the signs and symptoms of hypoglycemia in a diabetic, a blood sugar level should first be measured using a glucose meter.

[1] If blood glucose is below 70 mg/dL (3.9 mmol/L), treatment will depend on whether the person is conscious and can swallow safely. [3] [2] If the person is conscious and able to swallow, the family, friend, or co-worker can help the hypoglycemic consume 10-20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L).

[2] Improvement in blood sugar level and symptoms is expected to occur in 15–20 minutes, at which point blood sugar is measured again. [3] [2] If the repeat blood sugar level is not above 70 mg/dL (3.9 mmol/L), the hypoglycemic should consume another 10-20 grams of a carbohydrate and with remeasurement of blood sugar levels after 15–20 minutes.

[3] [2] Repeat until blood glucose levels have returned to normal levels, or call emergency services for further assistance. [2] If the person is unconscious, a glucagon kit may be used to treat severe hypoglycemia, which delivers glucagon either by injection into a muscle or through nasal inhalation.

[2] [3] [10] In the United States, glucacon kits are available by prescription for diabetic patients to carry in case of an episode of severe hypoglycemia. [22] [23] Emergency services should be called for further assitance. [2] Treatment by medical professionals [ edit ] In a healthcare setting, treatment depends on the severity of symptoms and intravenous access.

[24] If a patient is conscious and able to swallow safely, food or drink may be administered, as well as glucose tabs or gel. [24] In those with intravenous access, 25 grams of 50% dextrose is commonly administered. [24] When there is no intravenous access, intramuscular or intra-nasal glucagon may be administered. [24] Other treatments [ edit ] While the treatment of hypoglycemia is typically managed with carbohydrate consumption, glucagon injection, or dextrose administration, there are some other treatments available.

[3] Medications like diazoxide and octreotide decrease insulin levels, increasing blood glucose levels. [3] Dasiglucagon was approved for medical use in the United States in March 2021, to treat severe hypoglycemia.

[25] Dasiglucagon (brand name Zegalogue) is unique because it is glucagon in a prefilled syringe or auto-injector pen, as opposed to traditional glucagon kits that require mixing powdered glucagon with a liquid.

[25] The soft drink Lucozade has been used for hypoglycemia in the United Kingdom, but it has recently replaced much of its glucose with artificial sweeteners, which do not treat hypoglycemia.

[26] Prevention [ edit ] An insulin pump used to deliver appropriate levels of insulin. Diabetics [ edit ] The prevention of hypoglycemia depends on the cause. [1] [3] [2] In those with diabetes treated by insulin, glinides, or sulfonylurea, the prevention of hypoglycemia has a large focus on patient education and medication adjustments.

[1] [3] [2] The foundation of diabetes education is learning how to recognize the signs and symptoms of hypoglycemia, as well as learning how to act quickly to prevent worsening of an episode.

[2] Another cornerstone of prevention is strong self-monitoring of blood glucose, with consistent and frequent measurements. [2] Research has shown that patients with type 1 diabetes who use continuous glucose monitoring systems with insulin pumps significantly improve blood glucose control. [27] [28] [29] Insulin pumps help to prevent high glucose spikes, and help prevent inappropriate insulin dosing.

[28] [29] [30] Continuous glucose monitors can sound alarms when blood glucose is too low or too high, especially helping those with nocturnal hypoglycemia or hypoglycemic unawareness. [28] [29] [30] In terms of medication adjustments, medication doses and timing can be adjusted in order to prevent hypoglycemia, or a medication can be stopped altogether. [3] [2] Non-diabetics [ edit ] In those with hypoglycemia who do not have diabetes, there are a number of preventative measures dependent on the cause.

[1] [3] [2] Hypoglycemia caused by hormonal dysfunction like lack of cortisol in Addison's disease or lack of growth hormone in hypopituitarism can be prevented with appropriate hormone replacement. [3] [2] The hypoglycemic episodes associated with non-B cell tumors can be decreased following surgical removal of the tumor, as well as following radiotherapy or chemotherapy to reduce the size of the tumor.

[3] [2] In some cases, those with non-B cell tumors may have hormone therapy with growth hormone, glucocorticoid, or octreotide to also lessen hypoglycemic episodes. [3] [2] Post-gastric bypass hypoglycemia can be prevented by eating smaller, more frequent meals, avoiding sugar-filled foods, as well as medical treatment with an alpha-glucosidase inhibitor, diazoxide, or octreotide. [3] [2] Some causes of hypoglycemia require treatment of the underlying cause to best prevent hypoglycemia.

[2] This is the case for insulinomas which often require surgical removal of the tumor in order for hypoglycemia to remit. [2] In patients who cannot undergo surgery for removal of the insulinoma, diazoxide or octreotide may be used.

[2] Epidemiology [ edit ] Hypoglycemia is common in people with type 1 diabetes, especially in those taking insulin, glinides, or sulfonylurea. [1] [3] It is estimated that type 1 diabetics experience two mild, symptomatic episodes of hypoglycemia per week. [3] Additionally, type 1 diabetics suffer from at one severe hypoglyemic episode per year, requiring treatment assistance. [3] In terms of mortality, hypoglycemia causes death in 6-10% of type 1 diabetics.

[3] In those with type 2 diabetes, hypoglycemia is less common compared to type 1 diabetics, because medications that treat type 2 diabetes like metformin, glitazones, alpha-glucosidase inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase IV inhibitors, do not cause hypoglycemia. [1] [3] Hypoglycemia is common in type 2 diabetics who take insulin, glinides, or sulfonylurea. [1] [3] Insulin use remains a key risk factor in developing hypoglycemia, regardless of diabetes type.

[1] [3] History [ edit ] Hypoglycemia was first discovered by James Collip when he was working with Frederick Banting on purifying insulin in 1922. [31] Collip was asked to develop an assay to measure the activity of insulin. [31] He first injected insulin into a rabbit, and then measured the reduction in blood-glucose levels. [31] Measuring blood glucose was a time-consuming step. [31] Collip observed that if he injected rabbits with a too large a dose of insulin, the rabbits began convulsing, went into a coma, and then died.

[31] This observation simplified his assay. [31] He defined one unit of insulin as the amount necessary to induce this convulsing hypoglycemic reaction in a rabbit. [31] Collip later found he could save money, and rabbits, by injecting them with glucose once they were convulsing. [31] Etymology [ edit ] The word hypoglycemia is also spelled hypoglycaemia or hypoglycæmia. The term means 'low blood sugar' from Greek ὑπογλυκαιμία, from ὑπο- hypo- 'under' + γλυκύς glykys 'sweet' + αἷμᾰ haima 'blood'.

See also [ edit ] • Diabetic Hypoglycemia (journal) • Idiopathic hypoglycemia • Neonatal hypoglycemia References [ edit ] • ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "Low Blood Glucose (Hypoglycemia)". NIDDK.nih.gov. Archived from the original on 28 July 2017 . Retrieved 12 January 2022. • ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch ci Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ (March 2009).

"Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism.

94 (3): 709–728. doi: 10.1210/jc.2008-1410. PMID 19088155. • ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch ci cj ck cl cm cn co cp cq cr cs ct cu cv cw cx cy cz da db dc dd de df dg dh di dj dk dl dm dn do dp dq dr ds dt du dv dw dx dy dz ea eb ec ed ee ef eg eh ei ej ek el em en Jameson JL, Kasper DL, Longo DL, Fauci AS, Hauser SL, Loscalzo J (2018).

Harrison's principles of internal medicine (20th ed.). New York. ISBN 978-1-259-64403-0. OCLC 1029074059. Archived from the original on 29 August 2021 . Retrieved 12 January 2022. • ^ a b c Young VB (2016). Blueprints medicine. William A. Kormos, Davoren A. Chick (6th ed.). Philadelphia. ISBN 978-1-4698-6415-0. OCLC 909025539. Archived from the original on 26 January 2022 .

Retrieved 12 January 2022. • ^ a b c d e f g American Diabetes Association (ADA). "Hypoglycemia (Low Blood Glucose)". www.diabetes.org.

Archived from the original on 13 January 2022 . Retrieved 12 January 2022. • ^ a b c Yanai H, Adachi H, Katsuyama H, Moriyama S, Hamasaki H, Sako A (February 2015).

"Causative anti-diabetic drugs and the underlying clinical factors for hypoglycemia in patients with diabetes". World Journal of Diabetes.

6 (1): 30–36. doi: 10.4239/wjd.v6.i1.30. PMC 4317315. PMID 25685276. • ^ a b c d e f g h i j k l Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, et al. (August 2015). "Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children".

The Journal of Pediatrics. 167 (2): 238–245. doi: 10.1016/j.jpeds.2015.03.057. PMID 25957977. • ^ "FDA approves first treatment for severe hypoglycemia that can be administered without an injection". FDA. 11 September 2019.

Archived from the original on 17 May 2020 . Retrieved 11 November 2019. • ^ a b c d e f g h i j Vella A. "Hypoglycemia in adults without diabetes mellitus: Clinical manifestations, diagnosis, and causes". www.uptodate.com. Archived from the original on 26 January 2022 . Retrieved 14 January 2022. • ^ a b c d e f g h i j k l m n o p q r s t Mathew P, Thoppil D (2022). "Hypoglycemia". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30521262.

Archived from the original on 30 August 2021 . Retrieved 24 January 2022. • ^ Rix, Iben; Nexøe-Larsen, Christina; Bergmann, Natasha C.; Lund, Asger; Knop, Filip K. (2000), Feingold, Kenneth R.; Anawalt, Bradley; Boyce, Alison; Chrousos, George (eds.), "Glucagon Physiology", Endotext, South Dartmouth (MA): MDText.com, Inc., PMID 25905350, archived from the original on 15 January 2021 , retrieved 26 January 2022 • ^ a b c d e f g Johnson‐Rabbett, Brianna; Seaquist, Elizabeth R.

(September 2019). "Hypoglycemia in diabetes: The dark side of diabetes treatment. A patient‐centered review". Journal of Diabetes. 11 (9): 711–718. doi: 10.1111/1753-0407.12933. ISSN 1753-0393. PMID 30983138. S2CID 115202581.

• ^ a b c d e f g Ibrahim, Mahmoud; Baker, Jason; Cahn, Avivit; Eckel, Robert H.; El Sayed, Nuha Ali; Fischl, Amy Hess; Gaede, Peter; Leslie, R. David; Pieralice, Silvia; Tuccinardi, Dario; Pozzilli, Paolo (November 2020). "Hypoglycaemia and its management in primary care setting". Diabetes/Metabolism Research and Reviews. 36 (8): e3332. doi: 10.1002/dmrr.3332. ISSN 1520-7552. PMID 32343474. S2CID 216594548.

• ^ a b c d e f g h Martín-Timón, Iciar (2015). "Mechanisms of hypoglycemia unawareness and implications in diabetic patients". World Journal of Diabetes.

6 (7): 912–926. doi: 10.4239/wjd.v6.i7.912. ISSN 1948-9358. PMC 4499525. PMID 26185599. • ^ Lucidi, Paola; Porcellati, Francesca; Bolli, Geremia B.; Fanelli, Carmine G. (18 August 2018). "Prevention and Management of Severe Hypoglycemia and Hypoglycemia Unawareness: Incorporating Sensor Technology".

Current Diabetes Reports. 18 (10): 83. doi: 10.1007/s11892-018-1065-6. ISSN 1539-0829. PMID 30121746. S2CID 52039366. • ^ a b c d e Murad MH, Coto-Yglesias F, Wang AT, Sheidaee N, Mullan RJ, Elamin MB, et al.

(March 2009). "Clinical review: Drug-induced hypoglycemia: a systematic review". The Journal of Clinical Endocrinology and Metabolism. 94 (3): 741–745. doi: 10.1210/jc.2008-1416. PMID 19088166. • ^ a b c d Awad DH, Gokarakonda SB, Ilahi M (2022). "Factitious Hypoglycemia". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 31194450. Archived from the original on 26 January 2022 . Retrieved 21 January 2022. {/INSERTKEYS}

pathway hipoglikemia

• ^ a b c Jeanmonod R, Asuka E, Jeanmonod D (2022). "Inborn Errors Of Metabolism". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 29083820. Archived from the original on 13 October 2021. Retrieved 24 January 2022. • ^ a b c d e f Pathway hipoglikemia BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P (May 2009). "Autoimmune forms of hypoglycemia". Pathway hipoglikemia. 88 (3): 141–153. doi: 10.1097/MD.0b013e3181a5b42e. PMID 19440117. S2CID 34429211.

• ^ "Antibody". Genome.gov. Archived from the original on 9 October 2020. Retrieved 24 January 2022. • ^ a b c d De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T (April 2019).

"First aid glucose administration routes for symptomatic hypoglycaemia". The Cochrane Database of Systematic Reviews. 4: CD013283. doi: 10.1002/14651858.cd013283.pub2. PMC 6459163.

pathway hipoglikemia

PMID 30973639. • ^ "Severe Low Blood Sugar (Hypoglycemia) Treatment - Lilly GLUCAGON". www.lillyglucagon.com. Archived from the original on 24 January 2022. Retrieved 24 January 2022. • ^ "Glucacon Emergency Kit". Glucagon Emergency Kit. Archived from the original on 24 January 2022. Retrieved 24 January 2022.

• ^ a b c d Pasala S, Dendy JA, Chockalingam V, Meadows RY (2013). "An inpatient hypoglycemia committee: development, successful implementation, and impact on patient safety". The Ochsner Journal. 13 (3): 407–412. PMC 3776519. PMID 24052773. • ^ a b "HIGHLIGHTS OF PRESCRIBING INFORMATION. These highlights do not include all the information needed to use ZEGALOGUE® safely and effectively. See full prescribing information for ZEGALOGUE. ZEGALOGUE (dasiglucagon) injection, pathway hipoglikemia subcutaneous use" (PDF).

Accessdate.fsa.gov. Archived (PDF) from the original on 15 May 2021. Retrieved 10 Pathway hipoglikemia 2021. • ^ Harrold A. "Diabetic patients should be warned about changes to Lucozade glucose content".

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Nursing in Practice. Archived from the original on 28 February 2019. Retrieved 27 Pathway hipoglikemia 2019. • ^ Langendam, Miranda; Luijf, Yoeri M; Hooft, Lotty; DeVries, J Hans; Mudde, Aart H; Scholten, Rob JPM (18 January 2012). "Continuous glucose monitoring systems for type 1 diabetes mellitus". Cochrane Database of Systematic Reviews. 1: CD008101. doi: 10.1002/14651858.cd008101.pub2. ISSN 1465-1858. PMC 6486112. PMID 22258980. • ^ a b c Azhar, Anam; Gillani, Syed W.; Mohiuddin, Ghasna; Majeed, Rukhsar A.

(2020). "A systematic review on clinical implication of continuous glucose monitoring in diabetes management". Journal of Pharmacy & Bioallied Sciences. 12 (2): 102–111. doi: 10.4103/jpbs.JPBS_7_20. ISSN 0976-4879. PMC 7373113. PMID 32742108. • ^ a b c Mian, Zainab; Hermayer, Kathie L.; Jenkins, Alicia (2019).

pathway hipoglikemia Glucose Monitoring: Review of an Innovation in Diabetes Management". The American Journal of the Medical Sciences. 358 (5): 332–339. doi: 10.1016/j.amjms.2019.07.003. PMID 31402042. S2CID 199047204. • ^ a b "Continuous Glucose Monitoring - NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases.

Archived from the original on 12 January 2022. Retrieved 25 January 2022. • ^ a b c d e f g h "Collip discovers hypoglycemia". Treating Diabetes. Archived from the original on 8 September 2017. Retrieved 18 June 2017. External links [ edit ] • MedlinePlus: 000386 • eMedicine: emerg/272 med/1123 med/1939 ped/1117 • Patient UK: Hypoglycemia • The National Diabetes Information Clearinghouse Archived 8 February 2015 at the Wayback Machine • Hypoglycemia at the Mayo Clinic • American Diabetes Association • "Hypoglycemia".

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pathway hipoglikemia

"ASKEP HIPOGLIKEMIK", Assalamualaikum Kami dari kelompok 3 Kelas 6A Sarjana Keperawatan Universitas Aisyiyah Surakarta Semoga bermanfaat .
Hipoglikemia ialah suatu penurunan abnormal kadar gula darah.

Terdapat teknik baru untuk menguji keadaan hipoglikemi, seperti menggunakan penganalisa oksidase glukosa atau optical bedside glucose analyzer (mis One Touch). Teknik ini lebih bermakna untuk tujuan skrining di ruang rawat karena interpretasi warna terkadang tidak subjektif. Pada praktik klinik, bayi dengan kadar glukosa kurang dari 40 mg/dL memerlukan intervensi. Juga untuk menilai glukosa plasma < 20 hingga 25 mg/dL harus diterapi dengan pemberian glukosa per parenteral tanpa mempertimbangkan usia pathway hipoglikemia masa gestasi.

Munculnya gejala dan kadar glukosa sangat bervariasi pada setiap bagi. Gejala biasanya muncul bila kadar glukosa < 40 mg/dL dan tampak antara 24 dan 72 jam setelah kelahiran atau dalam 6 jam setelah suatu kelahiran bayi mengalami stress berat. Saat bayi berusia 72 jam, pencapaian kadar glukosa sebesar 45 mg/dL atau lebih adalah hasil yang diharapkan tanpa mempertimbangkan berat badan, usia gestasi atau faktor predisposisi lainnya.

Seperti sebagian besar jaringan lainnya, matabolisme otak terutama bergantung pada glukosa untuk digunakan sebagai bahan bakar. Saat jumlah glukosa terbatas, otak dapat memperoleh glukosa dari penyimpanan glikogen di astrosit, namun itu dipakai dalam beberapa menit saja.

Untuk melakukan kerja yang begitu banyak, otak sangat tergantung pada suplai glukosa secara terus menerus dari darah ke dalam jaringan pathway hipoglikemia dalam system saraf pusat dan saraf-saraf di dalam system saraf tersebut.

pathway hipoglikemia

Oleh karena itu, jika jumlah glukosa yang di suplai oleh darah menurun, maka akan mempengaruhi juga kerja otak.

Pada kebanyakan kasus, penurunan mental seseorang telah dapat dilihat ketika gula darahnya menurun hingga di bawah 65 mg/dl (3.6 mM). Saat kadar glukosa darah menurun hingga di bawah 10 mg/dl (0.55 mM), sebagian besar neuron menjadi tidak berfungsi sehingga dapat menghasilkan koma.

Patogenesis (Arif Masjoer, 2001), pada waktu makan cukup tersedia sumber energi yang diserap dari usus. Kelebihan energi disimpan sebagai makromolekul dan dinamakan fase anabotik. 60% dari glukosa yang pathway hipoglikemia serap usus dengan pengaruh insulin akan di simpan di hati sebagai glikogen, sebagian dari sisanya akan disimpan di jaringan lemak dan otot sebagai glikogen juga.

Sebagian lagi dari glukosa akan mengalami metabolisme anaerob maupun aerob untuk energi seluruh jaringan tubuh terutama otak sekitar 70% pemakaian glukosa berlangsung di otak tidak dapat menggunakan asam lemak bebas sebagai sumber energi.

Pencernaan dan penyerapan protein akan menimbulkan peningkatan asam amino di dalam darah yang dengan bantuan insulin akan disimpan di hati dan otak sebagai protein. Lemak diserap dari pathway hipoglikemia melalui saluran limfe dalam bentuk kilomikron yang kemudian akan dihidrolasi oleh lipoprotein lipase menjadi asam lemak. Asam lemak akan mengalami esterifikasi dengan gliserol membentuk trigliserida, yang akan disimpan di jaringan lemak.

Proses tersebut berlangsung dengan bantuan insulin. Pada waktu sesudah makan atau sesudah puasa 5-6 jam, kadar glukosa darah mulai turun keadaan ini menyebabkan sekresi insulin pathway hipoglikemia menurun, sedangkan hormon kontraregulator yaitu glukagon, epinefrin, kartisol, dan hormon pertumbuhan akan meningkat.

Terjadilah keadaan kortison sebaliknya (katabolik) yaitu sintetis glikogen, protein dan trigliserida menurun sedangkan pemecahan zat-zat tersebut akan meningkat.

Pada keadaan penurunan glukosa darah yang mendadak: glukogen dan epinefrilah yang sangat berperan.

pathway hipoglikemia

Kedua hormon tersebut akan memacu glikogenolisis, glukoneogenisis, dan proteolisis di otot dan lipolisis di jaringan lemak. Dengan demikian tersedia bahan untuk glukoneogenesis yaitu asam amino terutama alanin, asam laktat, piruvat, sedangkan hormon, kontraregulator yang lain berpengaruh sinergistk glukogen dan adrenalin tetapi perannya sangat lambat. Secara singkat dapat dikatakan dalam keadaan puasa terjadi penurunan insulin dan kenaikan hormon kontraregulator. Keadaan tersebut akan menyebabkan penggunaan glukosa hanya di jaringan insulin yang sensitif dan dengan demikian pathway hipoglikemia yang jumlahnya terbatas hanya disediakan untuk jaringan otak.

Walaupun metabolik rantai pendek asam lemak bebas, yaitu asam asetoasetat dan asam β hidroksi butiran (benda keton) dapat digunakan oleh otak untuk memperoleh energi tetapi pembentukan benda-benda keton tersebut memerlulan waktu beberapa jam pada manusia.

Karena itu ketogenesis bukan merupakan mekanisme protektif terhadap terjadinya hipoglikemia yang mendadak. b. Fase II : gejala-gejala yang terjadi akibat mulai terganggunya fungsi otak, karena itu dinamakan gejala neurologis. Pada awalnya tubuh memberikan respon terhadap rendahnya kadar gula darah dengan melepasakan epinefrin (adrenalin) dari kelenjar adrenal dan beberapa ujung saraf.

Epinefrin merangsang pelepasan gula dari cadangan tubuh tetapi jugamenyebabkan gejala yang menyerupai serangan kecemasan (berkeringat, kegelisahan, gemetaran, pingsan, jantung berdebar-debar dan kadang rasa lapar). Hipoglikemia yang lebih berat menyebabkan berkurangnya glukosa ke otak dan menyebabkan pusing, bingung, lelah, lemah, sakit kepala, perilaku pathway hipoglikemia tidak biasa, tidak mampu berkonsentrasi, gangguan penglihatan, kejang dan koma.

Hipoglikemia yang berlangsung lama bisa menyebabkan kerusakan otak yang permanen. Gejala yang menyerupai kecemasan maupun gangguan fungsi otak bisa terjadi secara perlahan maupun secara tiba-tiba. Hal ini paling sering terjadi pada orang yang memakai insulin atau obat hipoglikemik per-oral. Pada penderita tumor pankreas penghasil insulin, gejalanya terjadi pada pagi hari setelah puasa semalaman, terutama jika cadangan gula darah habis karena melakukan olah raga sebelum sarapan pagi.

Hipoglikemia merupakan salah satu kegawatan diabetic yang mengancam, sebagai akibat dari menurunnya kadar glukosa darah < 60 mg/dl. Munculnya gejala dan kadar glukosa sangat bervariasi pada setiap bagi. Gejala biasanya muncul bila kadar glukosa < 40 mg/dL dan tampak antara 24 dan 72 jam setelah kelahiran atau dalam 6 jam setelah suatu kelahiran bayi mengalami stress berat.

Saat bayi berusia 72 jam, pencapaian kadar glukosa sebesar 45 mg/dL atau lebih adalah hasil yang diharapkan tanpa mempertimbangkan berat badan, usia gestasi atau faktor predisposisi lainnya. gejala akibat aktivasi pusat autonom di hipotalamus sehingga hormon epinefrin di lepaskan.Gejala awal ini merupakan peringatan karna saat itu pasien masih sadar sehingga dapat di ambil tindakan yang perlu untuk mengatasi hipoglikemia lanjut.Fase II,gejala-gejala yang terjadi akibat mulai terganggunya pathway hipoglikemia otakkarna itu dinamakan gejala neurologis.

§ Hipoglikemia atau penurunan kadar gula darah merupakan keadaan dimana kadar glukosa darah berada di bawah normal, yang dapat terjadi karena ketidakseimbangan antara makanan yang dimakan, acara fisik dan obat-obatan yang digunakan.

Sindrom hipoglikemia ditandai dengan gejala klinis antara lain penderita merasa pusing, lemas, gemetar, pandangan menjadi kabur dan gelap, berkeringat dingin, detak jantung meningkat dan terkadang hingga hilang kesadaran (syok hipoglikemia). (Nabyl, 2009) § Hipoglikemia ialah suatu penurunan asing kadar gula darah atau kondisi ketidaknormalan kadar glukosa serum yang rendah.

Keadaan ini dapat didefinisikan sebagai kadar glukosa di bawah 40 mg/dL setelah kelahiran berlaku untuk seluruh bayi gres lahir atau pembacaan strip reagen oxidasi glukosa di bawah 45 mg/dL yang dikonfirmasi dengan uji glukose darah. § Hipoglikemi yakni kondisi ketidaknormalan kadar glokosa serum yang rendah. Keadaan ini dapat didefinisikan sebagai kadar glukosa dibawah 40 mg/dL setelah kelahiran berlaku untuk seluruh bayi gres lahir, atau pembacaan strip reagen oxidasi glukosa darah.

Hanya 20% hipoglikemia bersifat simptomatik, yaitu hipoglikemia yang disertai gejala neurologis dan gejala tersebut akan hilang setelah pemberian glukosa, tetapi kerusakan otak masih mungkin terjadi dan gejala akan terlihat kemudian. Pada hipoglikemia berat gejala pathway hipoglikemia asfiksia. Pada bai gres lahir dengan kejang atau jitteriness hendaknya dilakukan pemeriksaan Dextrostix berulang. Keadaan ini dapat terjadi jawaban pemberian insulin atau preparat oral yang berlebihan, konsumsi makanan yang terlalu sedikit atau karena acara fisik yang berat.

Pada pathway hipoglikemia berat (kadar glukosa darah hingga di bawah 10 mg/dl), dapat pathway hipoglikemia serangan kejang bahkan dapat terjadi koma (koma hipoglikemik).

Penurunan kadar glukosa dapat menyebabkan sel- sel otak tidak memperoleh materi bakar untuk bekerja dengan baik.

pathway hipoglikemia

Tanda- tanda gangguan fungsi pada sistem saraf pusat mencakup keetidakmampuan berkonsentrasi, sakit kepala, vertigo, konfusi, penurunan daya ingat, bicara pelo, gerakan tidak terkoordinasi, penglihatan ganda dan perasaan ingin pingsan. Saat menyuntikan obat insulin, anda harus tahu dan paham dosis obat yang anda suntik sesuai dengan kondisi gula darah ketika itu. Celakanya, terkadang pasien tidak dapat memantau kadar gula darahnya sebelum disuntik, sehingga dosis yang disuntikan tidak sesuai dengan kadar gula darah ketika pathway hipoglikemia.

Memang sebaiknya bila menggunakan insulin suntik, pasien harus memiliki monitor atau alat pemeriksa gula darah sendiri. Penderita diabetes sebaiknya mengkonsumsi obat insulin dengan kerja pathway hipoglikemia dua kali sehari dan obat yang kerja cepat sesaat sebelum makan.

Kadar insulin dalam darah harus seimbang dengan makanan yang dikonsumsi. Jika makanan yang anda konsumsi kurang maka keseimbangan ini terganggu dan terjadilah hipoglikemia. Olah raga atau aktifitas berat lainnya memiliki efek yang mirip dengan insulin. Saat anda berolah raga, anda akan menggunakan glukosa darah yang banyak sehingga kadar glukosa darah akan menurun.

Maka dari itu, olah raga merupakan cara terbaik untuk menurunkan kadar glukosa darah tanpa menggunakan insulin. Seperti sebagian besar jaringan lainnya, matabolisme otak terutama bergantung pada glukosa untuk digunakan sebagai materi bakar.

Saat jumlah glukosa terbatas, otak dapat memperoleh glukosa dari penyimpanan glikogen di astrosit, namun itu dipakai dalam beberapa menit saja. Untuk melaksanakan kerja yang begitu banyak, otak sangat tergantung pada suplai glukosa secara terus menerus dari darah ke dalam jaringan interstitial dalam system saraf pusat dan saraf-saraf di dalam system saraf tersebut. Oleh karena itu, bila jumlah glukosa yang di suplai oleh darah menurun, maka akan menghipnotis juga kerja otak.

Pada kebanyakan kasus, penurunan mental seseorang telah dapat dilihat ketika gula darahnya menurun hingga di bawah 65 mg/dl (3.6 mM). Saat kadar glukosa darah menurun hingga di bawah 10 mg/dl (0.55 mM), sebagian besar neuron menjadi tidak berfungsi sehingga dapat menghasilkan koma.

Apabila jumlah insulin berkurang jumlah glukosa yang memasuki sel akan berkurang pula, di samping itu produksi glukosa oleh hati menjadi tidak terkendali, kedua factor ini akan menimbulkan hipoglikemia. Dalam upaya untuk pathway hipoglikemia glukosa yang berlebihan dalam tubuh, ginjal akan mengekskresikan glukosa bahu-membahu air dan elektrolit (seperti natrium dan kalium).

Diuresis osmotic yang di tandai oleh urinaria berlebihan (poliuria) ini akan menyebabkan dehidrasi dan kehilangan elektrolit. penderita ketoasidosis pathway hipoglikemia yang berat dapat kehilangan kira-kira 6,5 liter air dan hingga 400 hingga mEq natrium, kalium serta klorida selama periode waktu 24 jam. Akibat defisiensi insulin yang lain yakni pemecahan lemak (liposis) menjadi asam-asam lemak bebas dan gliseral.asam lemak bebas akan di ubah menjadi tubuh keton oleh hati, pada keton asidosis diabetic terjadi produksi tubuh keton yang berlebihan sebagai jawaban dari kekurangan insulin yang secara normal akan mencegah timbulnya keadaan tersebut, tubuh keton bersifat asam, dan bila bertumpuk dalam sirkulasi darah, tubuh keton akan menimbulkan asidosis metabolic.

Pada hipoglikemia sedang, penurunan kadar glukosa darah menyebabkan sel-sel otak tidak memperoleh cukup materi bakar untuk bekerja dengan baik. Tanda-tanda gangguan fungsi pada sistem saraf pusat mencakup ketidak mampuan berkonsentrasi, sakit kepala,vertigo, konfusi, penurunan daya ingat, pati rasa di tempat bibir serta lidah, bicara pelo, gerakan tidak terkoordinasi, perubahan emosional, perilaku yang tidak rasional, penglihatan ganda dan perasaan ingin pingsan.

Kombinasi dari gejala ini (di samping gejala adrenergik) dapat terjadi pada hipoglikemia sedang. Pada hipoglikemia berat fungsi sistem saraf pusat mengalami gangguan yang sangat berat, sehingga pasien memerlukan pertolongan orang lain untuk mengatasi hipoglikemia yang di deritanya.

Pathway hipoglikemia dapat mencakup perilaku yang mengalami disorientasi, serangan kejang, pathway hipoglikemia di bangunkan dari tidur atau bahkan kehilangan kesadaran (Smeltzer. 2001). Pada awalnya tubuh memperlihatkan respon terhadap rendahnya kadar gula darah dengan melepasakan epinefrin (adrenalin) dari kelenjar adrenal dan beberapa ujung saraf.

Epinefrin merangsang pelepasan gula dari cadangan tubuh tetapi jugamenyebabkan gejala yang ibarat serangan kecemasan (berkeringat, kegelisahan, gemetaran, pingsan, jantung berdebar-debar dan kadang rasa lapar). Hipoglikemia yang lebih berat menyebabkan berkurangnya glukosa ke otak dan menyebabkan pusing, bingung, lelah, lemah, sakit kepala, perilaku yang tidak biasa, tidak bisa berkonsentrasi, gangguan penglihatan, kejang dan koma.

Hipoglikemia yang berlangsung lama bisa menyebabkan kerusakan otak yang permanen. Gejala yang ibarat kecemasan maupun gangguan fungsi otak bisa terjadi secara perlahan maupun secara tiba-tiba. Hal ini paling sering terjadi pada orang yang memakai insulin atau obat hipoglikemik per-oral.

Pada penderita tumor pankreas penghasil insulin, gejalanya terjadi pada pagi hari setelah puasa semalaman, terutama bila cadangan gula darah habis karena melaksanakan olah raga sebelum sarapan pagi. Pada mulanya hanya terjadi serangan hipoglikemia pathway hipoglikemia, tetapi lama-lama serangan lebih sering terjadi dan lebih berat.

Yang akut misalnya : pada pasien DMT I dengan glukosa darah terkontrol sangat ketat mendekati normal, adanya neuropati autonom pada pasien yang sudah lama menderita DM, dan menggunakan beta pathway hipoglikemia yang non selektif,kehilangan kewaspadaan yang kronik biasanya irreversible dan di anggap merupakan komplikasi DM yang serius. Factor-faktor yang dapat menimbulkan hipoglikemia berat dan berkepanjangan yakni kegagalan sekresi hormone glukagen dan adrenalin pasien telah lama menderita DM) adanya antibody terhadap insulin, blockade farmakologik (beta bloker non selektif), dan pemberian obat sulfonylurea (obat anti DM yang berkasiat lama).

(Mansjoer A, 1997). Pertama, hipoglikemia dalam diabetic pathway hipoglikemia lebih umum ketimbang ketoasidosis,meskipun sebagian besar penyebaran terdapat pada kelompok ketergantungan insulin.Kedua awitan dari hipoglikemia yakni lebih cepat dan manifestasinya yakni lebih bervariasi, sering terjadi dengan cara yang tidak terperinci sehingga dapat mengelakan perhatian seseorang hingga orang tersebut tidak menyadari apa yang bahwasanya yang sedang terjadi dan tidak bisa untuk mencarari pengobatan yang tidak sesuai, sehingga reaksi hipoglikemia jawaban insulin dapat terjadi di tengah-tengah kehidupan sehari-hari pasien.Yang setidaknya dapat memalukan dan yang lebih buruk sangat membahayakan.

Ketiga meskipun pemulihan yang berarti dan hipoglikemia dapat cepat dan tepat dalam beberapa menit setelah pengobatan yang sesuai, pathway hipoglikemia pasien secara emosional (kemungkinan secara psikologis) tetap terguncang selama beberapa jam atau bahkan selama beberapa hari setelah reaksi insulin. Akhirnya dalam kondisi hipoglikemia ekstrim, masih mempunyai kemungkinan untuk menyebabkan kerusakan otak permanen dan bahkan fatal.(Ester, 2000:). Pemeriksaan dengan menggunakan materi darah untuk memperoleh kadar gula darah yang bahwasanya karena pasien tidak dapat mengontrol hasil tes dalam waktu 2- 3 bulan.

HBA1c menunjukkan pathway hipoglikemia hemoglobin terglikosilasi yang pada orang normal antara 4- 6%. Semakin tinggi maka akan menunjukkan bahwa orang tersebut menderita DM dan beresiko terjadinya komplikasi. Sesudah diagnosis hipoglikemi ditegakkan dengan pemeriksaan glukosa darah kapiler, 10- 20 gram glukosa oral harus segera diberikan. Idealnya dalam bentuk tablet, jelly atau 150- 200 ml minuman yang mengandung glukosa mirip jus buah segar dan nondiet cola.

Sebaiknya coklat manis tidak diberikan karena lemak dalam coklat dapat mengabsorbsi glukosa. Bila belum ada agenda makan dalam 1- 2 jam perlu diberikan tambahan 10- 20 gram karbohidrat kompleks.Bila pasien mengalami kesulitan menelan dan keadaan tidak terlalu gawat, pemberian gawat, pemberian madu atau gel glukosa lewat mukosa rongga hidung dapat dicoba.

Glukagon 1 mg intramuskuler dapat diberikan dan kesannya akan tampak dalam 10 menit. Glukagon yakni hormon yang dihasilkan oleh sel pulau pankreas, yang merangsang pembentukan sejumlah besar glukosa dari cadangan karbohidrat di dalam hati. Glukagon tersedia dalam bentuk suntikan dan biasanya mengembalikan gula darah dalam waktu 5-15 menit.

Kecepatan kerja glucagon tersebut sama dengan pemberian glukosa intravena. Bila pasien sudah sadar pemberian pathway hipoglikemia harus diikuti dengan pemberian glukosa oral 20 gram (4 sendok makan) dan dilanjutkan dengan pemberian 40 gram karbohidrat dalam bentuk tepung mirip crakers dan biscuit untuk mempertahankan pemulihan, mengingat kerja 1 mg glucagon yang singkat (awitannya 8 hingga 10 menit dengan kerja yang berlangsung selama 12 hingga 27 menit).

Reaksi insulin dapt pulih dalam waktu5 hingga 15 menit. Pada keadaan puasa yang panjang atau hipoglikemi yang diinduksi alcohol, pemberian glucagon mungkin tidak efektif. Efektifitas glucagon tergantung dari stimulasi glikogenolisis yang terjadi. Gejala hipoglikemia akan menghilang dalam beberapa menit setelah penderita mengkonsumsi gula (dalam bentuk permen atau tablet glukosa) maupun minum jus buah, air gula atau segelas susu.

Seseorang yang sering mengalami hipoglikemia (terutama penderita diabetes), hendaknya selalu membawa tablet glukosa karena efeknya cepat timbul dan memperlihatkan sejumlah gula yang konsisten.

Baik penderita diabetes maupun bukan, sebaiknya sesudah makan gula diikuti dengan makanan yang mengandung karbohidrat yang bertahan lama (misalnya roti atau biskuit). Jika hipoglikemianya berat dan berlangsung lama serta tidak mungkin untuk memasukkan gula melalui verbal penderita, maka diberikan glukosa intravena untuk mencegah kerusakan otak yang serius.

Seseorang yang memiliki resiko mengalami episode hipoglikemia berat sebaiknya selalu membawa glukagon. Glukagon yakni hormon yang dihasilkan oleh sel pulau pankreas, yang merangsang pembentukan sejumlah besar glukosa dari pathway hipoglikemia karbohidrat di dalam hati. Glukagon tersedia dalam bentuk suntikan dan biasanya mengembalikan gula darah dalam waktu 5-15 menit.

Tumor penghasil insulin harus diangkat melalui pembedahan. Sebelum pembedahan, diberikan obat untuk menghambat pelepasan insulin oleh tumor (misalnya diazoksid). Bukan penderita diabetes yang sering mengalami hipoglikemia dapat menghindari serangan hipoglikemia dengan sering makan dalam porsi kecil.

Menilai kesadaran pasien dengan cepat, apakah pasien sadar, hanya respon terhadap nyeri atau sama sekali tidak sadar. Kaji pula tingkat mobilisasi pasien.

pathway hipoglikemia

Posisikan pasien posisi semi fowler, esktensikan kepala, untuk memaksimalkan ventilasi. Pathway hipoglikemia berikan Oksigen sesuai dengan ke butuhan, atau arahan dokter.

Gejala : Adanya riwayat hipertensi, IM akut, klaudikasi, kebas dankesemutan pada ekstremitas, ulkus pada kaki, penyembuhan yanglama, takikardia.Tanda : Perubahan tekanan darah postural, hipertensi, nadi yangmenurun/tidak ada, disritmia, krekels, distensi vena jugularis, kulit panas, kering, dan kemerahan, bola mata cekung Gejala : Perubahan pola berkemih (poliuria), nokturia, rasanyeri/terbakar, kesulitan berkemih (infeksi), ISK baru/berulang, nyeritekan abdomen, diare.Tanda : Urine encer, pucat, kuning, poliuri ( dapat berkembangmenjadi oliguria/anuria, bila terjadi hipovolemia berat), urin berkabut, bacin busuk (infeksi), abdomen keras, adanya asites, bising usus lemahdan menurun, hiperaktif (diare) Gejala : Hilang nafsu makan, mual/muntah, tidak mematuhi diet, peningkatan masukan glukosa/karbohidrat, penurunan berat badanlebih dari beberapa pathway hipoglikemia, haus, penggunaan diuretik (Thiazid)Tanda : Kulit kering/bersisik, turgor jelek, kekakuan/distensiabdomen, muntah, pembesaran tiroid (peningkatan kebutuhanmetabolik dengan peningkatan gula darah), bacin halisitosis/manis, bacin buah (napas aseton) Gejala : Pusing/pening, sakit kepala, kesemutan, kebas, kelemahan pada otot, parestesi, gangguan penglihatanTanda : Disorientasi, mengantuk, alergi, stupor/koma (tahap lanjut),gangguan memori (baru, masa lalu), kacau mental, refleks tendondalam menurun (koma), aktifitas kejang (tahap lanjut dari DKA).

Gejala : Faktor resiko keluarga DM, jantung, stroke, hipertensi.Penyembuhan yang lambat, penggunaan obat sepertii steroid, diuretik (thiazid), dilantin dan fenobarbital (dapat meningkatkan kadar glukosa darah). Mungkin atau tidak memerlukan obat diabetik sesuai pesanan. Rencana pemulangan : Mungkin memerlukan sumbangan dalam pengaturan diit, pengobatan, perawatan diri, pemantauan terhadapglukosa darah.

Pemeriksaan laboratorium menunjukkan adanya peningkatan gula darah, urea darah, serum creatinin (BUN), mikoro albumunurea, dan glikohemoglobin (Hb) Ph dan episode tekanan pathway hipoglikemia karbon dioksida (PCO2).

tabel 51-1 menjelaskan bahwa rasional peningkatan dari studi ini. Periksa episode urinary menunjukkan adanya pemeriksaan.tabel 51-2 menunjukkan gula darah normal, penjelasan mengenai interprestasi yang tidak normal pada keadaan koma, perawat memberi perawatan hingga pemeriksaan gula darah selanjutnya. (Donna 1991).

Gluconeogenesis Pathway Made Simple - BIOCHEMISTERY




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