Talk:Diabetic hypoglycemia
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[edit] Temperature Extremes
I would like this article to open up debate on whether temperature extremes (either extreme cold conditions or extreme hot conditions) can make risk of hypoglycaemia in diabetics more likely. Any information on this subject will be gratefully received. ACEO 08:12, 24 July 2006 (UTC)
- A better place is the talk:Diabetic hypoglycemia page, before putting anything in an article. If you move the question there I will tell you what I know about the topic. alteripse 11:31, 24 July 2006 (UTC)
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- Thank you Alteripse. I have now raised this question on the Wikipedia site talk: Diabetes, so I do hope that you will be able to respond. By the way, are you a qualified medical doctor? I have seen a number of comments from you on medical articles in Wikipedia, and also believe that your name is in the category
Category:Wikipedian physicians. I am not a medical doctor myself (my doctorate is a Ph.D. in Psychology, not an M.D.) but do find medical articles in Wikipedia very interesting and, from what I know about medicine, pretty good compared with some other health information on the web! ACEO 12:44, 26 July 2006 (UTC)
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- This article is the best place to talk about diabetic hypoglycemia. In general, be wary of medical articles on wikipedia. They can be excellent or poor and can change overnight when a crank drops by. Witness our difficulties with the chromium-obsessed at diabetes mellitus or the Armour-thyroid-evangelists at desiccated thyroid extract or those who think that fraud is just another equally respectable point of view at HGH quackery.
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- Temperature extremes can affect hypoglycemia risk in several possible ways, but the effects are not always direct and are rarely large. The principal direct effect of both extremes is similar to exercise but smaller. One increases glucose consumption rates at both very hot or very cold to defend body temperature; this effect tends to lower glucose. However, like exercise, there is a concurrent stress effect involving adrenalin, which is hard to predict and may drive glucose up. Extremes can also affect recognition of lows. Extreme heat and cold can interfere with performance of several meters. Extreme heat and cold might accelerate insulin degradation, especially in a pump, which could lead to hyperglycemia. Does that cover the issues? alteripse 19:24, 26 July 2006 (UTC)
- Thank you Alteripse, that covers issues nicely. It makes me wonder whether a similar principle might be at work in hibernation insofar as I can see how that could result in changes in glucose metabolism at extreme temperatures. I found the bit about how temperature extremes might affect ability to recognise blood glucose levels especially interesting. By the way, I take your points about medical information on Wikipedia - especially the way that articles might change overnight, I suppose that that is both the strength and the weakness of Wikipedia. Wikipedia can be very up-to-date, but the last time I looked at the article on whooping cough, it still seemed a little dated. ACEO 19:37, 26 July 2006 (UTC)
- I think hibernation is pretty straightforward. The metabolic rate slows, glucose consumption slows, food intake and storage drops to zero, and less energy is expended maintaining a temperature gradient. The net effect: your average type 1 bear needs a drastic reduction in his insulin dose. alteripse 02:16, 27 July 2006 (UTC)
- Thank you Alteripse, that covers issues nicely. It makes me wonder whether a similar principle might be at work in hibernation insofar as I can see how that could result in changes in glucose metabolism at extreme temperatures. I found the bit about how temperature extremes might affect ability to recognise blood glucose levels especially interesting. By the way, I take your points about medical information on Wikipedia - especially the way that articles might change overnight, I suppose that that is both the strength and the weakness of Wikipedia. Wikipedia can be very up-to-date, but the last time I looked at the article on whooping cough, it still seemed a little dated. ACEO 19:37, 26 July 2006 (UTC)
- Temperature extremes can affect hypoglycemia risk in several possible ways, but the effects are not always direct and are rarely large. The principal direct effect of both extremes is similar to exercise but smaller. One increases glucose consumption rates at both very hot or very cold to defend body temperature; this effect tends to lower glucose. However, like exercise, there is a concurrent stress effect involving adrenalin, which is hard to predict and may drive glucose up. Extremes can also affect recognition of lows. Extreme heat and cold can interfere with performance of several meters. Extreme heat and cold might accelerate insulin degradation, especially in a pump, which could lead to hyperglycemia. Does that cover the issues? alteripse 19:24, 26 July 2006 (UTC)
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[edit] Hypoglycemia Unawareness
A former article on the above topic was deleted because of copyright violations. To me, the piece was not long or involved enough to merit its own article, so perhaps some of this article could be devoted to hypoglycemia unawareness in diabetics, dealing with issues such as loss of adrenergic symptoms. ACEO 20:19, 17 November 2006 (UTC). As a diabetic myself who has not suffered symtpms of hypglycemia for years except for a slightly depressed nature and inability tmo fall asleep, I think it should be noted that a loss of symptoms can occure if hypo's are suffered for a while.
[edit] Treatment
I think that the treatment for diabetes related glycemia is to low. (4-5 ounces of regular soda) As much as 300 ml or a full can and a snakck sized piece of confectionary can be required to raise a persons blood sugar level to an acceptable level.
- Yes that much can occasionally be required, but that is the exception rather than common, and that much usually results in a blood sugar far above normal. Research on adults has repeatedly shown that (1) 15 g usually brings the glucose to the normal range of 60-130, and (2) higher amounts usually bring the glucose far higer than normal and (3) the practice is a common contributor to poor glycemic control. I would be happy to explain or discuss further, but please take a minute to make an account so you can sign your posts. alteripse 11:34, 18 January 2007 (UTC)
Fifteen to twenty grams is only a rule of thumb -- what's actually required depends on just how low the blood sugar is, how much excess active insulin is in the system, and how big the patient is. Children with diabetes are usually recommended a smaller initial carbohydrate dose, and patient instructions for treating diabetic hypoglycemia usually recommend re-testing, and re-treating if necessary, after 10-15 minutes.Rachelkg 21:47, 21 May 2007 (UTC)
- Of course. Trying to specify a one-size-fits-all dose is almost as pointless as trying to specify a single insulin dose for a high sugar. But an encyclopedia is not a treatment manual and can still give an average or "ballpark" figure for those who may be completely ignorant of the whole thing. alteripse 02:06, 22 May 2007 (UTC)
- Actually, most EMS textbooks recommend the administration of 10 grams of oral glutose or glucose tablets to be administered and the blood sugar to be rechecked. If IV Dextrose is given, in infants it's usually 2cc/kg of D10W, and for children and adults it's one half of the ampule of the selected dextrose solution, followed by the administration of a d-stick test, and then if the vein is still patient and the blood sugar is <80, the administration of the rest of the dextrose. Also, alteripse, where did you get the range of 60 to 130. Most textbooks, nursing and EMS, and even most facility lab values recommend a value of 80 to 120 of a normal value. Chancegemt 24.176.124.137 (talk) 21:12, 8 May 2008 (UTC)
[edit] risks
I removed the mention of risks of hypotension because that has, I think, only been reported with larger dose use for GI procedures, not treatment of diabetic hypoglycemia. I checked both Uptodate and the prescribing information. The PI warning only mentions allergic reactions and potential hypertension in patients with pheo or rebound hypoglycemia in patients with insulinoma. Like hypotension from GI procedures, these are so rare that including them in a brief discussion of use for diabetic hypoglycemia is somewhat misleading to laymen and likely to do harm if it discourages use. alteripse 05:28, 12 February 2007 (UTC)
[edit] Changed information on Treatment
I changed the format of the treatment information to provide more of clinical information, as well as to clarify some things for American readers. The Lilly kit is in use mostly outside of the United States. Also, the drug dosages are from Brady Paramedic Textbook, Second Edition, and the Infant/Neonate dose is from the S.T.A.B.L.E. Stabilization and Pre-Transport Care of Sick Infants and Neonates Textbook. Chancegemt (talk) 11:08, 8 May 2008 (UTC)
