Professional Documents
Culture Documents
Hipoglicemia
Hipoglicemia
Physiologic Re sponse s to Decrea sing Plasma Glucose Concentrations Glycemic Threshold, mmol/L (mg/dL) 4.4-4.7 (80-85) 3.6-3.9 (65-70) 3.6-3.9 (65-70) 3.6-3.9 (65-70) 2.8-3.1 (50-55) Role in the Prevention or Correction of Hypoglycemia (Glucose Counterregulation) Primary glucose regulatory factor/ first defense against hypoglycemia Primary glucose counterregulatory factor Involved, critical when glucagon is deficient Involved, not critical
Prompt behavioral defense (food ingestion) (Compromises behavioral defense) Cognition 2.8 ( 50) NOTE: R a, rate of glucose appearance, glucose production by the liver and kidneys; Rd, Rate of glucose disappearanc glucose utilization by insulin-sensitive tissues such as skeletal muscle, and by the central nervous system (where glucoregulatory hormones have no direct effect on glucose utilization).
HIPOGLICEMIA
COMPLICATIE METABOLICA ACUTA IN
DZ
( tratat )
ALTE SITUATII
Causes of Hypoglycemia
Drugs Especially insulin, sulfonylureas, ethanol Sometimes pentamidine, quinine Rarely salicylates, sulfonamides, and others Endogenous hyperinsulinism Insulinoma Other cell disorders Secretagogue (sulfonylurea) Autoimmune (autoantibodies to insulin, insulin receptor, cell?) Ectopic insulin secretion Critical illnesses Hepatic, renal, or cardiac failure Sepsis Starvation and inanition Endocrine deficiencies Cortisol, growth hormone Glucagon and epinephrine (type 1 diabetes) Non--cell tumors Fibrosarcoma, mesothelioma, rhabdomyosarcoma, liposarcoma, other sarcomas Hepatoma, adrenocortical tumors, carcinoid Leukemia, lymphoma, melanoma, teratoma Disorders of infancy or childhood Transient intolerance of fasting Infants of diabetic mothers (hyperinsulinism) Persistent hyperinsulinemic hypoglycemia of infancy Inherited enzyme defects Postprandial Reactive (after gastric surgery) Ethanol-induced Autonomic symptoms without true hypoglycemia Factitious Insulin, sulfonylureas
SIMPTOMATOLOGIA SINDROAMELOR
HIPOGLICEMICE
SIMPTOME DE NEUROGLICOPENIE
- convulsii
- pierderi de cunostinta
SIMPTOMATOLOGIA SINDROAMELOR
HIPOGLICEMICE
- Pts. cu DZ invata sa recunoasca simptomele
- Recunoasterea simptomatologiei rara in alte cauze de hG
- Simptomele mai pronuntate la crize iterative
DIAGNOSTIC CONCLUDENT
- o valoare a glicemiei ( < 2,5 - 2,8 mmol/L / < 45 - 50 mg/dL), - inregistrata in cursul unui episod cu simptomatologie caracteristica hG, - mai ales daca, odata cu corectarea glicemiei, - o valoare N a G in lipsa simptomatologia se amelioreaza sau dispare - FPG
SEMIOLOGIA HIPOGLICEMIEI
- paloare - diaforeza
- tahicardie
- TA
- modificari de comportament / constienta (neuroglicopenice) - deficite neurologice tranzitorii de focar
hG din DZ
hG POSTPRANDIALA (REACTIVA)
hG DE STARVARE (FOAME)
DZ 1
hG din DZ
- pts. la care se incearca un control glicemic near-normal cateva episoade/sapt. (simptomatice / asimptomatice)
hG din DZ
DZ 2
- rar, episoade tranzitorii insulinonecesitanti
sulfonilureice (T1/2 )
repaglinide
- gliburid
(DCCT)
generarii de G
Lipsa de avertizare a hG - hypoglycemia unawareness
eveniment FP critic
- pts. cu deficit Glucagon + E episoade severe de hG de 25 x > f.d. pts. cu deficit Glucagon, dar raspuns E intact
HYPOGLYCEMIA ANAWARENESS
RASPUNSULUI CONTRAREGLATOR AL E
hG REACTIVA (POSTPRANDIALA)
- autolimitata
copii cu defecte enzimatice (intoleranta la F, galactozemie)
- nu OGTT !!! (5% din pts. N, asimptomatici au G < 2,4 mmol/L = = 43 mg/dL / 100 g. glucoza p.o.) - Testul pranzului standard documentarea triadei Whipple - hG iterative cauze ??? sensibilitate la raspunsul autonom postprandial N