Definations

Hypoglycemia : failure to maintain serum glucos >60 mg/dl

Euglycemia : serum glucos level of 70-110 mg/dl
Therapeutic euglycemia maintenance: 100-250 mg\dl

Epydemiology

Accidental insulin everdose : most common cause of hypoglycemia due to

combinations of insulin dose miscalculations, reduced caloric intake,
increased exercise level or intercurrent infections or other illnesses.
Long acting (LA) sulfonylureas: most common caouse of non-insulin, druginduced hypoglycemia, Especially chlorpropamide LA and glyburide LA `
Market withdrawals : (1) the biguanide, phenformin, was withdrawn in
1976, due to fatalactic acidosis; (2) troglitazone (Rezulin), a
thiazolidinedione, was withdrawn in the 1990s, due to fatal hepatotoxicity

Etiologies of hypoglycemia

Pathophysiological : endocrinopathy (addisons disease, sheehans

syndrome); neoplasms (insulinomas, multiple endocrine adenomatosis
[MEA] type 1) liver disease (alcoholism, cirrhosis); crhonic renal failure
(CRF) and hemodialysis; miscellaneous (AIDS, autoimmune diseases,
pregnancy)
Drug-induced; oral hypoglycemic agents, parenteral insulin preparations.
Food or drug potentiation of hypoglycemic agents; Foods (unripe
Jamaican ackee fruit hypoglycin (vomiting, hypoglycemia, CNS
depression, seizures), ethanol); drugs (ACE inhibitors, blockers,
chloramphenicol, disopyramide, MAOIs, quinine-quinidine, salicylates,
sulfonamides).

Clinical Manifestations of Hypoglycemia

Manifestations Caused by Catecholamine Release

Cardiovascular effects: Arrhythmias (SVT, PVCs, atrial fibrilation);

hypertension-headache; angina from cardiac ischemia, myocardial
infarction.
Autonomic effects: Anxiety, diaphoresis, dry mouth, pallor, piloerection.
Gastrointestinal effects: Hunger, nausea.

Manifestations Due to Cerebral Glucose Depletion

Acute delirium: Confusion, bizarre behavior, mania.

Coma: Posturing, CNS and respiratory depression, hypothermia, preserved
brainstem reflexes (dolls eyes, oculocephalic, oculovestibular, and
papillary light reflexes).
Focal neurologic deficits: Mimics cerebrovascular accident (CVA) or stroke,
ataxia, weakness, hemiparesis, hemiplegia.
Solitary or refractory seizures: No postictal periods.

Orally Administered Hypoglycemic Agents

Sulfonylureas

First-vs. Second-generation sulfonylureas are derivatives of the

sulfonamide antibiotics that stimulate insulin release from pancreatic beta
isket cells by blocking K channels and opening Na channels to cause
depolarization and release of endogenous insulin. Sulfonamides also
decrease hepatic gluconeogenesis and increase peripheral tissue
sensitivity to insulin.

Intestinal Alpha-Glucosidase inhibitor

Acarbose (Precose); reduces sugar absorption from gut, does not cause
hypoglycemia, must be used concomitantly with sulfonylureas.

definations
Hipoglikemia: Kegagalan untuk mempertahankan glucos serum> 60 mg / dl
euglikemia: tingkat glucos serum 70-110 mg / dl
pemeliharaan euglycemia Terapi: 100-250 mg \ dl
Epydemiology
Terkadang everdose insulin: penyebab paling umum dari hipoglikemia karena
kombinasi dari kesalahan perhitungan dosis insulin, mengurangi asupan kalori,
meningkatkan tingkat atau kambuhan infeksi olahraga atau penyakit lainnya.
Panjang bertindak (LA) sulfonilurea: caouse paling umum dari non-insulin,
hipoglikemia akibat obat, Terutama klorpropamid LA dan glyburide LA `
penarikan Market: (1) biguanide, phenformin, ditarik pada tahun 1976, karena
asidosis fatalactic; (2) troglitazone (Rezulin), thiazolidinedione sebuah, ditarik
pada 1990-an, karena hepatotoksisitas yang fatal..................