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Your search term(s) "hypoglycemia" returned 234 results.

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Hypoglycaemia in Type 2 Diabetes and in Elderly People. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 238-264.

This chapter on hypoglycemia in type 2 diabetes and in elderly people is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The authors note that as both the prevalence of type 2 diabetes and life expectancy increases, it is inevitable that the number of older people with insulin-treated diabetes will increase. Topics include the pathophysiology of hypoglycemia, the effects of aging on the body’s responses to hypoglycemia, counterregulation, moderators of hypoglycemia in type 2 diabetes, hypoglycemia and oral diabetes agents, insulin secretagogues, studies comparing hypoglycemia secondary to insulin or oral antidiabetes agents, inhaled insulin and hypoglycemia, incretin mimetics and hypoglycemia, and the morbidity of hypoglycemia and indications for emergency treatment. 4 figures. 5 tables. 138 references.

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Hypoglycemia and Employment/Licensure. Diabetes Care. 30 (Suppl 1): S85. January 2007.

Despite the significant medical and technological advances made in managing diabetes, discrimination in employment and licensure against people with diabetes still occurs. Much of this discrimination may be founded on concerns that hypoglycemia will cause sudden unexpected incapacitation. This article is from a supplement to the Diabetes Care journal that contains the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes, the major position statement of the organization. This section of the supplement presents a position statement on hypoglycemia and employment and licensure. The section first reviews the problem of hypoglycemia and then explains how and when hypoglycemia can become a concern. The authors stress that most people with diabetes can manage their disease in such a way that there is only minimal risk of incapacitation from hypoglycemia. In addition, people with diabetes vary widely in their responses to the disease. Thus, people with diabetes should be individually considered for employment based on the requirements of the specific job. It is inappropriate to consider all people with diabetes the same.

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Hypoglycemia and the Autonomic Nervous System. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 379-388.

This chapter on hypoglycemia and the autonomic nervous system is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of diabetic neuropathy. The author notes that intensive diabetes management regimens have increased the incidence of severe hypoglycemic events, with resulting morbidity and even mortality. Hypoglycemia provokes a sequence of counterregulatory metabolic, neural, and clinical responses. For example, insulin secretion decreases whereas glucagon, epinephrine, norepinephrine, pancreatic polypeptide, cortisol, and growth hormone increase. Decreased symptom perception can be due to decreased autonomic nervous system activation, resulting in a cycle of hypoglycemic unawareness and decreased counterregulatory hormone responses to the hypoglycemia. The author concludes that the mechanisms of hypoglycemia-induced autonomic failure are not fully understood. 2 figures. 69 references.

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Hypoglycemic Disorders. IN: Gardner, D.; Shoback, D., eds. Greenspan's Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007 . pp 748-769.

This chapter on hypoglycemic disorders is from a textbook on endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors note that, under the usual metabolic conditions, the central nervous system is completely dependent on plasma glucose and counteracts declining blood glucose concentrations with a carefully programmed response. Topics discussed include the pathophysiology of the counterregulatory response to neuroglycopenia; the maintenance of euglycemia in the postabsorptive state, that is, longer than 4 to 6 hours after a meal; the role of the kidney; the classification of hypoglycemic disorders into symptomatic and asymptomatic hypoglycemia; the clinical presentation of hypoglycemia; the documentation of low plasma glucose values; the reversibility of symptoms with treatment; specific hypoglycemia conditions, including insulin reaction, sulfonylurea overdose, surreptitious insulin or sulfonylurea administration, autoimmune hypoglycemia, pentamidine-induced hypoglycemia, and pancreatic beta cell tumors; symptomatic fasting hypoglycemia that presents without hyperinsulinism, including that due to ethanol and to nonpancreatic tumors; nonfasting hypoglycemia, also called reactive hypoglycemia, including postgastrectomy alimentary hypoglycemia, postgastric bypass hypoglycemia, functional alimentary hypoglycemia, pancreatic islet hyperplasia in adults, and late hypoglycemia, also called occult diabetes; and congenital hyperinsulinism. 3 figures. 5 tables. 43 references.

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Impaired Awareness of Hypoglycaemia. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 141-170.

This chapter on impaired awareness of hypoglycemia is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The author defines hypoglycemia unawareness as an acquired abnormality that is effectively a complication of insulin therapy and one that should be considered along with the other complications of diabetes in terms of morbidity. Topics covered in the chapter include normal physiological responses to hypoglycemia, perceiving hypoglycemia, the prevalence of hypoglycemia unawareness, the pathogenesis of hypoglycemia unawareness, the role of peripheral autonomic neuropathy, hypoglycemia-associated autonomic failure, central nervous system adaptation to hypoglycemia, episodic hypoglycemia, the long-term effect of hypoglycemia on cognitive function, and treatment strategies. The author concludes that when hypoglycemia unawareness results from strict glycemic control, the total insulin dose should be reduced, the insulin regimen should be reviewed for suitability, and overall glycemic control should be relaxed. 9 figures. 7 tables. 86 references.

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Insulin Analogs and Pregnancy. Diabetes Spectrum. 20(2): 94-101. Spring 2007.

Diabetes during pregnancy is a major risk factor for poor fetal, neonatal, and maternal outcomes; however, this risk can be greatly reduced by the early use of medical nutrition therapy (MNT) and insulin treatment. This article explores the use of insulin analogs and pregnancy, focusing on the newer, rapid-acting insulin analogs lispro and aspart. The author stresses that maintaining maternal glycemic as near to normal as possible reduces the risk of congenital anomalies, macrosomia, neonatal hypoglycemia, and large-for-gestational-age infants. Topics include pregestational diabetes; gestational diabetes mellitus (GDM); the use of NPH insulin during pregnancy; current categories for drug use in pregnancy; long-acting insulin analogs, such as glargine and detemir, problems with retinopathy and insulin analogs; concerns about congenital anomalies and insulin analogs; and macrosomia and insulin analogs. The author concludes that, when compared with human regular insulin, the rapid-acting insulin analogs are effective at reducing hyperglycemia during pregnancy, with a safety profile that resulted in a lower incidence of neonatal complications. The long-acting insulin analogs do not yet have sufficient safety evaluation in clinical studies to warrant their use during pregnancy. The article includes a patient treatment algorithm as a guideline for all insulin-requiring pregnant women with type 2 diabetes, GDM, or type 1 diabetes. 1 figure. 7 tables. 67 references.

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Insulin Pump Therapy. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 265-320.

Insulin pump therapy allows patients to manage their diabetes intensively by using a method that is pharmacologically superior to multiple daily injections (MDI). This chapter about insulin pump therapy is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author discusses the evolution of modern insulin pump technology, patient selection for pump therapy, improved overall glycemic control and reduced glycemic variability in patients using insulin pumps, talking about pump therapy with prospective patients, initiating pump therapy in the primary care setting, fine-tuning pump therapy, long-term follow-up of insulin pump patients, exercising with an insulin pump, and the use of insulin pump therapy in patients with type 2 diabetes. The author concludes that, compared with MDIs, insulin pump therapy has better insulin pharmacokinetics, less variability in insulin absorption, and decreased risk of hypoglycemia. Patients using insulin pumps enjoy greater lifestyle flexibility and often become more proactive in their approach to diabetes self-management. Although more expensive than MDIs, pump therapy offers patients a much more physiologic approach to controlling their diabetes. Careful evaluation of pump candidates, ongoing patient education, and timely follow-up visits are vital to the success of pump therapy. The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 3 appendices. 9 figures. 9 tables. 32 references.

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Living With Hypoglycaemia. IN: Frier, B. and Fisher, M.; Frier, B., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 309-332.

This chapter on living with hypoglycemia is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The author notes that because hypoglycemia can occur at any time of the day or night, is often unpredictable, affects intellectual and physical performance, and disrupts the life of the affected individual and others, its effects have an impact on every aspect of everyday living. Adverse experiences of severe hypoglycemia can influence the subsequent behavior of an individual as he or she attempts to avoid further events, and the effect on a patient’s self-care of diabetes may result in poor glycemic control. Topics include psychosocial effects, including fear of hypoglycemia; exercise; the prevention of hypoglycemia following exercise, sports, and recreational activities; the effect of hypoglycemia on automobile driving; the risk of accidents and restriction of driving licenses and vocational driving licenses; advice for drivers who have diabetes; medico-legal aspects; travel; employment; specialist medical reports for employment; school and academic examinations; police custody and hypoglycemia; and the management of diabetes in prison. 2 figures. 10 tables. 63 references.

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Long-Term Effects of Hypoglycaemia on Cognitive Function And the Brain in Diabetes. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 284-308.

This chapter on the long-term effects of hypoglycemia on cognitive function and the brain in diabetes is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The authors review the effects of diabetes on the brain, with an emphasis on the chronic complications of hypoglycemia. Topics include hypoglycemia and mental functions in children and adolescents, evidence for the neuropsychological deterioration following repeated hypoglycemia in adults, hypoglycemia-induced neurological syndromes, reversible effects of hypoglycemia on the brain, convulsions and associated morbidity, permanent neurological effects of hypoglycemia on the brain, structural changes of the brain in diabetes, the effect of hypoglycemia on cerebral blood flow and structure, structural changes associated with hypoglycemia, the mechanisms of hypoglycemia-induced brain injury, and evidence for diabetic encephalopathy. The authors conclude that hypoglycemia should be considered as a possible diagnosis in all patients with diabetes presenting with any neurological syndrome. The pathogenesis of diabetic encephalopathy is not known, but hypoglycemia probably plays a significant contributory role. 10 figures. 4 tables. 88 references.

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Moderators, Monitoring And Management of Hypoglycaemia. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 100-120.

This chapter on moderators, monitoring, and management of hypoglycemia is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The authors note that despite advances in insulin pharmacology and delivery and in patient education, the lifetime frequency of symptomatic hypoglycemia remains substantial, with the average patient likely to experience thousands of episodes over the course of his or her life with insulin-treated diabetes. They review risk factors for the development of hypoglycemia and address lifestyle moderators, including alcohol and hypoglycemia, and caffeine. The authors also address monitoring, including self-awareness self-monitoring of blood glucose (SMBG), and continuous glucose monitoring systems (CGMS). Treatment of hypoglycemia can be thought of as a spectrum of increasing therapeutic complexity, depending on the severity of the hypoglycemia and the clinical status of the patient. 11 figures. 3 tables. 65 references.

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