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Prevalence and Presentation of Diabetes-Related Hypoglycemia Amongst Persons with Diabetes in a Tertiary Health Instition in Nigeria
Ohenhen Oluwatoyin Abisoye
,
Uwameiye Oseribhor
Issue: Volume 5, Issue 3, September 2020
Pages: 34-40
Received: Nov. 23, 2019
Accepted: Jul. 22, 2020
Published: Aug. 18, 2020
DOI:
10.11648/j.ijde.20200503.11
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Abstract: Background: Hypoglycaemia is the most common acute complication of Diabetes Mellitus and often treatment-limiting, serious adverse effect of intensive diabetes therapy. Although it is preventable, hypoglycaemic episodes, especially if severe or recurrent may result in significant psychosocial dysfunction and lower quality of life. Aim: To determine the prevalence, frequency and timing of diabetes-related hypoglycaemia amongst persons with diabetes mellitus. Methods: This was a cross-sectional observational study involving patients attending the diabetes clinic and selected using systematic random sampling. An interviewer- administered questionnaire was used to obtain socio-demographic characteristics as well as experience of hypoglycaemia in the past 12months and severity graded. Data analysis was performed using SPSS 21.0, IBM SPSS Statistics, New York, USA Result: A total of 216 patients were recruited for the study. Eighty nine patients (41.2%) reported experiencing hypoglycaemia, out of which 46 (51.7%) occurred in the morning before breakfast and 16 (18.0%) experienced severe Hypoglycaemia. Skipped meal (58.4%) and overdose of GLA (31.5%) were the most common recognized causes of hypoglycaemia. Level 1 hypoglycaemia was the commonest grade of hypoglycaemia, while males and those on insulin alone had higher odds of having hypoglycaemia (P=0.059). Conclusion: The reported prevalence of hypoglycaemia amongst persons with diabetes mellitus within the last one year prior to the study was rather high which shows that hypoglycaemia is a common experience amongst type 2 diabetic undergoing management. Continuous patient education on the risks, causes, symptoms, and treatment of hypoglycaemia as well as self-monitoring of blood glucose is recommended for every person with diabetes at every health visits.
Abstract: Background: Hypoglycaemia is the most common acute complication of Diabetes Mellitus and often treatment-limiting, serious adverse effect of intensive diabetes therapy. Although it is preventable, hypoglycaemic episodes, especially if severe or recurrent may result in significant psychosocial dysfunction and lower quality of life. Aim: To determine...
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Whipple Triad Its Limitations in Diagnosis and Management of Hypoglycemia as a Co-morbidity in Covid-19 Diabetics and Diabetes Mellitus in General- A Review
Adegbenga Bolanle Ademolu
Issue: Volume 5, Issue 2, June 2020
Pages: 23-26
Received: Feb. 25, 2020
Accepted: Apr. 10, 2020
Published: May 29, 2020
DOI:
10.11648/j.ijde.20200502.12
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Abstract: In 1938 Allen Oldfather Whipple (1881-1963) an American surgeon invented a triad of two clinical and one laboratory parameter to give the Whipple triad which had been in clinical use for decades and beneficial to perhaps millions of people worldwide with hypoglycemia as health challenges. The Whipple triad is characteristically presence of hypoglycemic symptoms, documentation of low blood sugar at the time of hypoglycemic symptoms, and reversal of these symptoms when the blood glucose level is restored to normal. Of note is the fact that over the years Whipple triad had been invaluable in diagnosing hypoglycemia in diabetics, but we should not lose sight of this singular fact that though good and useful for diagnostic purposes, Whipple triad has it's limitations as a diagnostic tool. With Corona virus disease 2019 (COVID 19) pandemic caused by severe acute respiratory distress syndrome coronavirus 2 (SARS CoV-2) affecting the immunosuppresed including diabetics, knowing the limitation of the diagnostic tool for diagnosing the hypoglycemia, a lifelong challenging issue in diabetics is a proactive way of recognizing a possible additional co-morbidity that if not recognized may further put the COVID-19 diabetic patient at risk. Though the issue of hypoglycemia in infected diabetic patient with COVID 19 has not been a major issue for now worldwide, the fact that asymptomatic carrier of COVID 19 diabetic patient could develop hypoglycemia makes it an important issue to be borne in mind by physicians. A google search was conducted in English by typing in the words Whipple, hypoglycemia, diabetes, probable hypoglycemia in pubmed. A literature review was done going through relevant articles. The limitations to Whipple triads were found in hypoglycemia with reversible neurological damage, hypoglycemia with irreversible neurological sequelae, hypoglycemia unawareness and in patients with rebound hypoglycemia. Similarly, Whipple triad limitation of application was found in unconscious patient from other causes other than hypoglycemia. Further limitations were also found in probable symptomatic hypoglycemia and in symptomatic hypoglycemia. Whipple triad has its limitation in medical practice which may be diverse and this have to be borne in mind by the clinician for a holistic approach to patient management especially during this COVID-19 pandemic and thereafter. The question to be addressed in the future remains of all hypoglycemic episodes occurring annually worldwide in diabetic and non diabetic subjects, how many can Whipple triad diagnose? In other words what is the sensitivity, specificity and predictive value of Whipple triad?
Abstract: In 1938 Allen Oldfather Whipple (1881-1963) an American surgeon invented a triad of two clinical and one laboratory parameter to give the Whipple triad which had been in clinical use for decades and beneficial to perhaps millions of people worldwide with hypoglycemia as health challenges. The Whipple triad is characteristically presence of hypoglyc...
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Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia
Adegbenga Bolanle Ademolu
Issue: Volume 5, Issue 1, March 2020
Pages: 9-17
Received: Feb. 23, 2020
Accepted: Mar. 24, 2020
Published: Apr. 14, 2020
DOI:
10.11648/j.ijde.20200501.13
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Abstract: The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.
Abstract: The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. ...
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Sulfonylureas Induced Hypoglycemia in Diabetics - A Review
Adegbenga Bolanle Ademolu
Issue: Volume 4, Issue 4, December 2019
Pages: 108-112
Received: Nov. 14, 2019
Accepted: Nov. 26, 2019
Published: Dec. 04, 2019
DOI:
10.11648/j.ijde.20190404.14
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Abstract: Diabetes is a metabolic disorder of glucose characterized by glucotoxicity, lipotoxicity and insulin resistance. In insulin resistance states, a higher level of insulin is needed to generate the usual body response to keep plasma glucose at physiologic level. The type 2 diabetics with insulin resistance cannot keep plasma glucose normal not because of absolute insulin deficiency but due to a relative deficiency as insulin is now required at a higher plasma level to achieve a near physiological or physiological plasma glucose level. Hence the need for a chemical agent to increase insulin secretion from the pancreatic beta cells at pharmacological dose (insulin secretagogues) was conceptualized and arrived at. Sulfonylureas are insulin secretagogues. Two generations of sulfonylurea’s are in use. The first and second. The class effects of sulfonylurea include weight gain, allergic reaction and hypoglycemia. But not enough emphasis is placed on the severity and grading of the hypoglycemia complicating use of sulfonylureas. Meanwhile hypoglycemia induced by sulfonylurea use is of various degree, severity and duration. The classification of hypoglycemia into grades in ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA makes it easier for scientist to understand, compare and monitor the severity of sulfonylureas. Mrs KFO is a 67 years old diabetic diagnosed over 8 years ago. She had asymptomatic hypoglycemia with a glucometer reading low (ADEMOLUS PHENOMENON) on a clinic day visit. She had been on glimepiride for three years. Mrs A. F. is a 75 years old diabetic diagnosed 4 years prior to presentation. She had a glucometer reading of low during a random blood sugar check at 8pm on day 2 of admission with associated general body weakness. She was on metformin and glibenclamide. Mrs. I E is a 72 years old diabetic who had a glucometer reading of low during her outpatient clinic visit. She was on gliclazide. Sulfonylureas use has been shown by these cases to be associated with symptomatic and asymptomatic very severe hypoglycemia. A possibility of synthesizing a new equally potent third generation of sulfonylureas with minimal or no hypoglycemic effect should be looked into.
Abstract: Diabetes is a metabolic disorder of glucose characterized by glucotoxicity, lipotoxicity and insulin resistance. In insulin resistance states, a higher level of insulin is needed to generate the usual body response to keep plasma glucose at physiologic level. The type 2 diabetics with insulin resistance cannot keep plasma glucose normal not because...
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Alpha-cells: Its Role as the Islet Harmonizer
Nabil Kamal Elnaggar
,
Mohamed Nabil Elnaggar
Issue: Volume 4, Issue 4, December 2019
Pages: 104-107
Received: Oct. 16, 2019
Accepted: Nov. 18, 2019
Published: Nov. 27, 2019
DOI:
10.11648/j.ijde.20190404.13
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Abstract: It has long been thought that the alpha cells and its secretory products play an important role solely in maintaining euglycemia and preventing hypoglycemia through a contradictory action to the B cell’s insulin. The α-cell function is tightly regulated by various physiological inputs including systemic energy status, central and autonomic nervous systems, and the endocrine system. It is also an important amino acid sensor, glucagon blockade suppresses hepatic amino acid catabolism and increases the serum amino acid level. In addition to those controllers, the intra-islet microenvironment, where α-cells are located, has been recently revealed to be important in the regulation of the various cellular secretory functions including the overlapping of glucagon and insulin secretion through a precise cell-cell crosstalk. Paracrine interactions between pancreatic islet cells have been proposed as a mechanism to regulate hormone secretion and glucose homeostasis, alpha and B cells are closely positioned on the sides of their blood supply where acetylcholine acts as the paracrine communicator of signals inside the islets. Recently, it has been demonstrated that blocking acetylcholine esterase increases insulin secretion. Moreover, it has also been suggested that glucagon is not exclusively a counter-regulatory hormone that elevates blood glucose levels, in contrast it can cause hypoglycemia conditioned by the presence of intact B cells and a functional GLP-1R (glucagon-like peptide 1 receptor). These data argue for glucagon agonism in modern management of T2DM. Alpha-cells also, have been shown to be able to trans-differentiate into β-cells only in the presence of insulin-positive cells with α-cell origin in the lineage tracing analyses, confirming the role of α-cells as a source of β-cell regeneration. The article reviews the updated knowledge about the functions of the alpha-cells and its role in the paracrine control of islet cell secretions and the future therapeutic potentials.
Abstract: It has long been thought that the alpha cells and its secretory products play an important role solely in maintaining euglycemia and preventing hypoglycemia through a contradictory action to the B cell’s insulin. The α-cell function is tightly regulated by various physiological inputs including systemic energy status, central and autonomic nervous ...
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