1. Hypoglycemia DR. Hamed Habib Consultant pediatrician

2. ACUTE EMRGENCIES OF DIABETES MELLITUS Hypoglycemia Hyperglycemia

3. Hypoglycemia  Hypoglycemia is biochemical symptom  In diabetic Hypoglycemia is meanly due to: A mismatch among food, exercise, and insulin or oral hypoglycemic agents Attempting to achieve near normal blood sugar levels Attempting to achieve near normal blood sugar levels

4. Hypoglycemia  Hypoglycemia is more frequent in type I than in type II probably because the pancreas continues to make and be able to shut off insulin secretion in the type II except late in the disease course.  Type I patient has a defect in primary counter- regulation to hypoglycemia. They cannot shut off insulin secretion and they are paralyzed in their ability to respond by glucagon.

5. Insulin Counter Regulatory Response  If we induce hypoglycemia by infusing a high dose of insulin to a normal individual  The first thing that happens in a decrease in insulin secretion  Then an increase in glucagon and epinephrine as kind of regulatory hormone responses  Then growth hormone and cortisol will follows.  And finally hopefully hypoglycemia get corrected

6. Hypoglycemia Primary Causes Insulin excess (accidental or deliberate) Inadequate or poorly timed food intake Exercise Alcohol ingestion Onset of menses Immediate postpartum period Autonomic neuropathy Emotional stress

7. Hypoglycemia Clinical Levels Blood glucose level < 70 mg/dl should alert patient of impending hypoglycemia patient of impending hypoglycemia Biochemical Hypoglycemia defined as blood glucose level < 50 mg/dl with or without glucose level < 50 mg/dl with or without classic symptoms classic symptoms Clinical severity of hypoglycemia poorly Clinical severity of hypoglycemia poorly correlated with biochemical levels correlated with biochemical levels

8. Hypoglycemia

9. Hypoglycemia Clinical Levels (continued) SYMPTOMS SYMPTOMSEARLY Grouchiness Grouchiness Sweatiness Sweatiness Shakiness Shakiness Tachycardia Tachycardia Pale Skin Pale Skin Dizziness Dizziness Headache Headache Hunger Hunger TREATMENT TREATMENT QUICK-ACTING SUGAR 15 Grams of carbohydrate (simple sugar)15 Grams of carbohydrate (simple sugar) If not better in 15 minutes, repeat treatmentIf not better in 15 minutes, repeat treatment If next meal or snack is more than 30 minutes away, give an extra snack of carbohydrate and proteinIf next meal or snack is more than 30 minutes away, give an extra snack of carbohydrate and protein

10. Hypoglycemia Clinical Levels (continued) SYMPTOMS SYMPTOMSMODERATE Confusion Confusion Poor coordination Poor coordination Inability to cooperate Inability to cooperate TREATMENT TREATMENT INSTANT GLUCOSE Insert tube between gum and cheekInsert tube between gum and cheek Administer appropriate amountAdminister appropriate amount If no response in 15 minutes, give glucagonIf no response in 15 minutes, give glucagon If next meal is more than 30 minutes away, give an extra snack of carbohydrate and proteinIf next meal is more than 30 minutes away, give an extra snack of carbohydrate and protein

11. Hypoglycemia Clinical Levels (continued) SYMPTOMS SYMPTOMSSEVEREUnconsciousnessConvulsions TREATMENT TREATMENT Administer IV dextrose or administer glucagon as directedAdminister IV dextrose or administer glucagon as directed Notify diabetologistNotify diabetologist Feed as soon as possible after awakeningFeed as soon as possible after awakening

13. Hypoglycemia Prevention Education (patient/significant others) symptoms symptoms signs signs causes causes treatment treatment Have patients check B/S or begin treatment at first indication of hypoglycemia

14. Hypoglycemia Prevention (continued) Adjust treatment plan if hypoglycemia is occurring on a routine basis Institute B/S monitoring regimen Institute B/S monitoring regimen acceptable to patient acceptable to patientExercise monitoring regimen treatment plan monitoring regimen treatment plan

15. Hypoglycemia Prevention (continued) Institute regimen of periodic nighttime B/S monitoring B/S monitoring Have patient wear identification indicating diabetes indicating diabetes Give patients positive feedback when they demonstrate good judgment they demonstrate good judgment in preventing or treating hypoglycemia in preventing or treating hypoglycemia

16. PROGNOSIS  The prognosis for hypoglycemia is very good for mild episodes that respond to treatment. Severe episodes have a good prognosis as well if hypoglycemia is rapidly corrected.  Failure to treat severe episodes quickly can result in neurological damage or death.

17. CONCLUSION The Acute Complication of Diabetes require knowledge of their presentation and of the appropriate therapy to allow the patient with diabetes to recover rapidly and without risking additional problems.