Page 290 - fbkCardioDiabetes_2017

266 Hypoglycemia How Critical it is?

PATHOGENESIS OF HYPOGLYCEMIA IN jection were subjected to gel chromatography, and
ICU the fractions obtained were measured by RIA for be-
ta-endorphin. In four healthy subjects, basal plasma
Spontaneous episodes of severe hypoglycemia are beta-endorphin levels were less than 3 to 3.1 pg/ml,
rare during the management of critically ill patients and the levels rose substantially to 47.5 +/- 12.4 pg/
(usually observed in less than 1.5% of patients) and ml (mean +/- SE) 45 min after insulin injection . Basal
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are observed mainly during fulminant hepatic failure plasma beta-endorphin levels in three hyperthyroid
and/or overt adrenal failure during septic shock, es- patients (less than 3 to 3.8 pg/ml) did not seem to
pecially in patients with severe comorbidities (malnu- be different from those in healthy subjects; however,
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trition, liver cirrhosis, chronic renal failure) . Since the the rise after insulin injection tended to be higher in
introduction of the strict glycemic control strategy in cases of hyperthyroidism, with a peak value of 68.5
intensive care units (ICUs),hypoglycemia has become
+/- 9.7 pg/ml. Plasma beta-lipotropin and ACTH lev-
els also rose in parallel
with beta-endorphin in
response to insulin-in-
duced hypoglycemia
in both healthy sub-
jects and hyperthyroid
patients . It would thus
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appear that beta-en-
dorphin, like ACTH or
beta-lipotropin, is re-
leased in human sub-
jects by hypoglycemic
stress .
1
Prevalence of
Hypoglycemia
Overall prevalence of
hypoglycemia among
a daily concern during the management of critically medical surgical patients with type2 diabetes (T2DM)
ill patients . treated with insulin ranges from 3%-29%
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Absolute or relative insulin excess, with inadequate Upto 1 in 4 patients with diabetes may experience
or interrupted nutritional support and/or insufficient hypoglycemia during hospital admission.
provision of exogenous glucose, together with fea- Upto 20% of patients with diabetes treated with insu-
tures of critical illness that limit endogenous glucose lin or anti- diabetic agents(ADAs) have hypoglycemia
production and accelerate glucose utilization are the related symptoms that required Emergency Depart-
fundamental causes of hypoglycemia in the ICU .
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ment evaluation and treatment.
The occurrence of occasional human errors or inabil-
ity to follow the algorithm because of workload can Recognition of Hypoglycemia
also represent additional risks for hypoglycemia. Sec- Symptoms of hypoglycemia can be divided into ad-
ond, other circumstances contributing to the occur- renergic (rapidly falling and changing glucose levels)
rence of hypoglycemia (such as renal and/or hepat- andneuroglycopenic.
ic failure, adrenal insufficiency, antibiotic treatment
with a quinolone) can be present . 1 The adrenergic symptoms are inversely correlated
to the developing rate of hypoglycemia, being most
βEndorphin is involved in the regulation of insulin pronounced with acute onsets. Adrenergic features,
secretion and carbohydrate metabolism in hyper- when present, precede neurobehavioral features,
androgenic, hyperinsulinemic women . To elucidate thus functioning as an early warning system. Inpa-
2
whether insulin-induced hypoglycemia enhances the tient team members must be alert to early adrenergic
release of beta-endorphin in man, plasma extracts hypoglycemia signs and symptoms, including anx-
obtained from healthy subjects and patients with iety, irritability, dizziness, diaphoresis, pallor, tachy-
Graves’ disease before and 45 min after insulin in-
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cardia, headache, shakiness, and hunger .

GCDC 2017