Management of Hypoglycemia and Hyperglycemia

This presentation provides an overview of hypoglycemia and hyperglycemia, including their definitions, symptoms, and management strategies. It discusses the differences between the two conditions and highlights the risk factors and complications associated with each. The presentation also covers the action plans for managing hypoglycemia and hyperglycemia, including dietary modifications, medication options, and patient education. References are provided for further reading.

Definition of hyperglycemia compared to hypoglycemia:
hypoglycemia refers to the dangerously low blood glucose
level, approximately below 70 mg/dL (Macauley et al. 2015).
According to International Hypoglycemia Study Group (2015),
significant hypoglycemia referred to the condition where the
blood glucose levels of individuals become below 54mg/dl. It is
a complication observed in individuals who are using insulin or
specific kind of diabetic medication which degrade the blood
glucose. As discussed by Cryer (2016), in individuals without
diabetes, it can result in the production of excessive insulin in
the body and induce the sudden drop of glucose. It can be
considered as early signs of diabetes. As discussed by Hering
et al. (2016) erratic eating pattern, skipping meals, increases
age, certain diabetic medication such as beta blocker are
identified as the potential risk factors of hypoglycemia.
figure : mechanism of hypoglycemia
source : (Hering et al., 2016)
Definition of hyperglycemia compared to hypoglycemia
On the other hand,
Hyperglycemia is referred to as the chronically high blood
glucose level in the blood. As discussed by Inzucchi, et al.
(2015), most medical professionals define hyperglycemia by
using glucose level. Hyperglycemia does not occur in the body
until blood glucose level significantly elevated in the body. It is
usually above 180 to 200 milligrams per deciliter (mg/dl) or 10
to 11 millimeter per liter (Mäe et al., 2018). Another study
highlighted that the symptoms of hyperglycemia in individuals
developed over several weeks and considerate number
individuals failed to recognize the early symptoms. A study by
An and He (2016), suggested that hyperglycemia resulted
from the overproduction of glucose because of the excessive
rate of gluconeogenesis and gluconeogenesis. As discussed
by Kalyani et al. (2015), living sedentary lifestyle, eating
excessive carbohydrate foods, experiencing emotional
distress, being injured or using steroids are identified as the
risk factors of the hyperglycemia.
Signs of the hypoglycemia:
As discussed by Kovatchev and Cobelli, (2016), early signs of the
hypoglycemia are following.
• Shakiness,
• sweating,
• Hunger dizziness,
• Moodiness or irritability
• Anxiety or nervousness along with the severe headache.
According to Kovatchev and Cobelli, (2016), hypoglycemia can be observed in
patients where they may experience unusual symptoms such as
• Frequent nightmares,
• Damp sheets because of the perspiration frequently.
• Few patients with hypoglycemia also experiences confusing from the
walking up.
In case of the patient who is unaware of the early symptoms of hypoglycemia
because of the lack of about hypoglycemia (Egi et al. 2016). These patients
may experience the following symptoms:
• Clumsiness or jerky movements
• Rapid pulses
• Muscle weakness (Macauley et al. 2015)
• Drowsiness
• Confusion
• Frequent seizures (Macauley et al. 2015)
• Unconscious
• In the last stage, death
However, the symptoms of hypoglycemia vary from person to person
depending on the health conditions (Stanley et al. 2016).
figure : hypoglycemia
source : (Hering et al., 2016)
Action plan for management of the hypoglycemia:
In a majority of the cases, for initial treatment of the hypoglycemia following stages can be followed:
• Consumption of 15 to 20 grams of a fast-acting carbohydrate is used for treating early treatment
of the hypoglycemia since fast acting carbohydrates easily convert to sugar I the body.
• After consumption of the fast-acting carbohydrate, recheck of the blood sugar levels after 15
minutes would be done. If the blood sugar level diet elevates, another fast-acting carbohydrate would
be given to the patient (Stanley et al. 2016).
• Once the blood sugar levels are back to normal, it is crucial to provide the patient with snakes or
meals to stabilize blood sugar level.
• According to Inzucchi, et al. (2015),if a patient is impaired to consume glucose by mouth then
intravenous injection of glucose is required to give to stabilize the blood glucose level.
• Apart from the modification of the meals, medications such as Sulfonylureas, metformin, and
alpha-glycosidase inhibitors (Mäe et al., 2018).
• According to Kovatchev and Cobelli, (2016),Education is required to give to the patients who are
unaware of the early signs and symptoms of the hypoglycemia.
Student Names and ID
Action plan for the hyperglycemia:
• To manage patient with hyperglycemia, short-acting insulin can help control hyperglycemia is an effective way of controlling the
glucose level of the body.
• After providing the insulin supplements, regular exercise for 10 minutes is required for a patient for controlling blood glucose level
( An & He 2016).
• For management of hyperglycemia, medication such as Meglitinides, DDP 4 inhibitors, SGLT 2, metformin and insulin would be
effective to reduce the blood glucose level of the patient.
• Elimination of the sugar-containing food along with high lipid food would be required. The diet should be devoid of the sodium chloride
and high level of leafy vegetables to control the glucose level of the patient.
Patient education would be required for the patient who are unaware of symptoms.
Patient with hyperglycemia often experiences signs and symptoms of the diabetic ketoacidosis as well as the hyperglycemic
hyperosmolar state. For management of these conditions following action plans are required:
• Fluid replacement therapy intravenously is required to replace the fluid eliminated from the body because of the excessive urination
(Mäe et al., 2018).
• Electrolyte replacement therapy is required for a patient which would provide the minerals that were reduced because of the insulin.
Therefore, electrolytes in the tissues would help to gain the functions of the nerve, cardiac and muscle cells.
• Insulin therapy is required for the patient where insulin reverses the process which causes the ketones to build up in the blood.
References :
An, H., & He, L. (2016). Current understanding of metformin effect on the control of hyperglycemia in diabetes. Journal of Endocrinology, 228(3), R97-R106.
Cryer, P. (2016). Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention. American Diabetes Association.
Egi, M., Krinsley, J. S., Maurer, P., Amin, D. N., Kanazawa, T., Ghandi, S., ... & Bellomo, R. (2016). Pre-morbid glycemic control modifies the interaction between acute hypoglycemia
and mortality. Intensive care medicine, 42(4), 562-571.
Hering, B. J., Clarke, W. R., Bridges, N. D., Eggerman, T. L., Alejandro, R., Bellin, M. D., ... & Kaufman, D. B. (2016). Phase 3 trial of transplantation of human islets in type 1 diabetes
complicated by severe hypoglycemia. Diabetes care, 39(7), 1230-1240.
International Hypoglycaemia Study Group. (2015). Minimizing hypoglycemia in diabetes. Diabetes Care, 38(8), 1583-1591.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-
centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), 140-
149.
Kalyani, R. R., Metter, E. J., Egan, J., Golden, S. H., & Ferrucci, L. (2015). Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes care, 38(1), 82-90.
Kovatchev, B., & Cobelli, C. (2016). Glucose variability: timing, risk analysis, and relationship to hypoglycemia in diabetes. Diabetes Care, 39(4), 502-510.
Macauley, S. L., Stanley, M., Caesar, E. E., Yamada, S. A., Raichle, M. E., Perez, R., ... & Holtzman, D. M. (2015). Hyperglycemia modulates extracellular amyloid-β concentrations
and neuronal activity in vivo. The Journal of clinical investigation, 125(6), 2463-2467.
Mäe, M. A., Li, T., Bertuzzi, G., Raschperger, E., Vanlandewijck, M., He, L., ... & Keller, A. (2018). Prolonged systemic hyperglycemia does not cause pericyte loss and permeability at
the mouse blood-brain barrier. Scientific reports, 8(1), 17462.
Silambarasan, M., Tan, J., Karolina, D., Armugam, A., Kaur, C., & Jeyaseelan, K. (2016). MicroRNAs in hyperglycemia induced endothelial cell dysfunction. International journal of
molecular sciences, 17(4), 518.
Stanley, C. A., Rozance, P. J., Thornton, P. S., De Leon, D. D., Harris, D., Haymond, M. W., ... & Sperling, M. A. (2015). Re-evaluating “transitional neonatal hypoglycemia”:
mechanism and implications for management. The Journal of pediatrics, 166(6), 1520-1525.
Symptoms of the hyperglycemia:
As discussed by Kalyani et al. (2015), Early signs of the hyperglycemia are
the following :
• Increased thirst
• Headache
• Blurred vision
• Frequent urination
• Fatigue
• Weight loss (Egi et al. 2016)
• Blood sugar level more than 180mg/dl
High blood glucose may lead to the following acute and life threating
conditions which requires immediate clinical attention.
• Dry and parched mouth (Egi et al. 2016).
• Fruity breath
• Nausea or vomiting
• Abdominal pain
• Deep or rapid breathing
• Frequent irritability
• Abdominal pain
As discussed by Silambarasan et al. (2016), individuals who are unaware
of early signs of the hyperglycemia may experience the following life
threating chronic complications:
• Cerebral vascular disease
• Heart attack
• Circulation disorders
• Peripheral vascular disease
• Kidney disease
• Diabetic neuropathy
• Diabetic retinopathy (Egi et al. 2016)
• In severe stages rapid death.
Figure : hyperglycemia
source : (Mäe et al., 2018).
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