Hypoglycemia presents a unique challenge for a practice nurse, since it is one of the most serious complications associated with glucose-lowering medication. Hypoglycemia therefore acts as a limitation regarding initiation and optimization of glucose-lowering therapy…
Many patients opt to increase their food intake to an extent where hyperglycemia becomes inevitable. Others respond by being psychologically upset which in turn compromises their quality of lif e. Long-term consequences may include a less productive lifestyle coupled with feelings of anxiety and fear.
Glucose acts as the primary fuel for the large variety of functions that nervous system performs. Despite the fact that glucose is vital for neuronal survival, the local storage of glucose within the substance of brain is limited; astrocytes contain glycogen which may produce glucose for a very limited period of time. For this reason, neuronal survival is mainly dependent upon a sustained supply of glucose through the blood brain barrier. Consequently, brain becomes one of the primary targets of hypoglycemia and suffers the first insult when blood glucose level starts to fall below a certain level (65 mg/dl). Irregular electrical activity at neuronal level may precipitate seizures when the level falls below 40mg/dl. Neuronal electrical activity ceases to exist when blood glucose level is below the 10mg/dl range (Ahrens et al, 2010). Since the control mechanism related to glycemia is affected in diabetes, it is common for diabetics to encounter hypoglycemic events due to reduced food intake, altered level of activity or overuse of glucose-lowering drugs. In severe cases, hypoglycemia may bring forth worst prognostic outcomes like coma or death.
Due to the fact that different symptoms like hunger, irritability or anxiety are often attributed to hypoglycemia by health care workers without documenting actual hypoglycemia, the exact incidence of hypoglycemia cannot be determined with certainty. Among people presenting with symptoms suggestive of hypoglycemia, only 5-10% are actually hypoglycemic i.e. blood sugar levels below 50 mg/dL. Moreover, the incidence ...
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