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Hypoglycemia

 

Diagnosis and Conventional Treatment

Diagnosis

A set of diagnostic criteria called Whipple’s Triad are used to establish a diagnosis of hypoglycemia. Whipple’s Triad includes 1) clinical symptoms/signs consistent with hypoglycemia; 2) low blood glucose levels at the time of the symptoms; and 3) relief of symptoms after the administration of glucose (Ng 2010; Bjelakovic 2011; Cryer 2009; Mayo Clinic 2012b).

If onset is associated with a drug known to lower blood glucose, such as insulin, then the cause is deemed to be iatrogenic (treatment related) (Cryer 1992; Martorella 2011). If the underlying cause of hypoglycemia is not immediately obvious, several tests can be conducted to help determine the cause. Laboratory tests that may be helpful include: fasting glucose and insulin, an oral glucose tolerance test (which measures the body’s ability to react to ingestion of sugar), C-peptide levels (which may be elevated with use of sulfonylureas), cortisol (which can measure adrenal insufficiency), magnetic resonance imaging (MRI) (which can help identify an insulin-secreting tumor), and other blood tests (Cryer 2009; MedlinePlus 2013; Toth 2013; Hamdy 2013).

Conventional Treatment

Management of hypoglycemia includes two priorities: 1) immediately restoring glucose levels in a patient who presents with severe hypoglycemia, and 2) taking steps to help stabilize long-term glucose control and prevent additional episodes of hypoglycemia.

Immediate treatment of hypoglycemia involves the administration of glucose (Merck 2007). Another option, in some cases, is to administer glucagon. However, this is ineffective in people who have been fasting or have experienced prolonged hypoglycemia. This is because glucagon stimulates glycogenolysis to restore blood glucose levels, but in fasting or prolonged hypoglycemic patients, liver glycogen stores have already been used up (Merck 2007; Roach 2012; Dohm 1986; Butler 1989; Koubi 1991; Kimmig 1983; Castle 2010).

From a long-term management perspective, prevention of hypoglycemia encompasses treatment of the underlying cause. Since hypoglycemia most often occurs in diabetics being treated with glucose-lowering therapy, modification of dose or switching to a different drug is typically considered. For example, use of sulfonylureas for glucose management in type 2 diabetics is associated with increased frequency of hypoglycemia compared to metformin (Bodmer 2008).