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Category: Volume 07 Issue 07 July 2019
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Title: Diabetic Emergencies: Blood Glucose Crisis in Type-1 DM

Authors: Dr R.Sowmya, Dr C. Nithish, Dr Ranga Bhanu Prasad, Dr Harisa Kounain

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.34

Abstract

Introduction

Type 1 diabetes is an autoimmune disorder afflicting millions of people worldwide. Once diagnosed, patients require lifelong insulin treatment and can experience numerous disease-associated complications. Type 1 diabetes is generally thought to be precipitated by an immune-associated, if not directly immune-mediated, destruction of insulin-producing pancreatic β cells [1, 2]

Type 1 diabetes develops as a consequence of a combination of genetic predisposition, largely unknown environmental factors, and stochastic events, its incidence has increased drastically over the last two decades, especially in children less than five years old [3]. Those under the age of 18 are most often afflicted [4], but an equal number of adults over 18 are thought to develop the disease, although incidence in older people, it is not considered as serious event in the clinical world, but it has to be considered as per the current scenario.

Type 1 diabetes was largely considered a disorder in children and adolescents, but this opinion has changed over the past decade, so that age at symptomatic onset is no longer a restricting factor [5].

Despite of providing insulin exogenously, hypoglycemia is the major issue in Diabetes millets.

Signs that your blood sugar is too low may include: Racing pulse, Feeling incredibly hungry, Cold sweats, Headache, Shivering, Feeling restless, Nervous or Anxious, Difficulty in concentration, Confusion. These symptoms do not occur all at once. The signs of hypoglycemia not only depend on the blood sugar level, but also vary from person to person. People who have severe hypoglycemia may feel very drowsy and confused, and might even become unconscious. If this happens, someone else can inject the hormone glucagon.

References

  1. Todd JA. Etiology of type 1 diabetes. Immunity. 2010;32:457–67. 
  2. Bluestone JA, Herold K, Eisenbarth G. Genetics, pathogenesis and clinical interventions in type 1 diabetes. Nature. 2010;464:1293–300. 
  3. Harjutsalo V, Sjoberg L, Tuomilehto J. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet. 2008;371:1777–1782. 
  4. Lorenzen T, Pociot F, Hougaard P, Nerup J. Long-term risk of IDDM in first-degree relatives of patients with IDDM. Diabetology. 1994;37:321–327. 
  5. Leslie RD. Predicting adult-onset autoimmune diabetes: clarity from complexity. 2010;59:330–31.
  6. Hyperglycemia and hypoglycemia in type 1 diabetes-Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-Created: May 29, 2007; Last Update: June 29, 2017; Next update: 2020.
  1. McCrimmon R. The mechanisms that underlie glucose sensing during hypoglycaemia in diabetes. Diabet Med 2008;25:513–522
  2. Gerich JE, Langlois M, Noacco C, Karam JH, Forsham PH. Lack of glucagon response to hypoglycemia in diabetes: evidence for an intrinsic pancreatic alpha cell defect. Science 1973;182:171–173
  3. Fukuda M, Tanaka A, Tahara Y, Ikegami H, Yamamoto Y, Kumahara Y, Shima K. Correlation between minimal secretory capacity of pancreatic beta-cells and stability of diabetic control. Diabetes 1988;37:81–88
  4. Paranjape SA, Chan O, Zhu W, Horblitt AM, McNay EC, Cresswell JA, Bogan JS, McCrimmon RJ, Sherwin RS. Influence of insulin in the ventromedial hypothalamus on pancreatic glucagon secretion in vivo. Diabetes 2010;59:1521–1527
  5. Mundinger TO, Mei Q, Figlewicz DP, Lernmark A, Taborsky GJ Jr. Impaired glucagon response to sympathetic nerve stimulation in the BB diabetic rat: effect of early sympathetic islet neuropathy. Am J Physiol Endocrinol Metab 2003;285: E1047–E1054
  6. Segel SA, Paramore DS, Cryer PE. Hypoglycemia-associated autonomic failure in advanced type 2 diabetes. Diabetes 2002;51:724–733
  7. Fanelli CG, De Feo P, Porcellati F, Perriello G, Torlone E, Santeusanio F, Brunetti P, Bolli GB. Adrenergic mechanisms contribute to the late phase of hypoglycemic glucose counterregulation in humans by stimulating lipolysis. J Clin Invest 1992;89:2005–2013
  8. Heller SR, Cryer PE. Reduced neuroendocrine and symptomatic responses to subsequent hypoglycemia after 1 episode of hypoglycemia in nondiabetic humans. Diabetes 1991;40:223–226
  9. Service FJ, McMahon MM, o’Brien PC, Ballard DJ. Functioning insulinoma—incidence, recurrence, and longterm survival of patients: a 60-year study. Mayo Clin Proc. 1991 ;66:711-719
  10. Prevention of blindness from the diabetes mellitus. Report of a WHO consultation
  11. Frier BM. The incidence and impact of hypoglycemia in type 1 and type 2 diabetes. Int Diabetes Monit 2009;21:210-8
  12. King P Kong M, Parkin H, MacDonald I, Tattersall R. well-being, cerebral function, and physical fatigue after nocturnal hypoglycemia in IDDM. Diabetes care 1998;21:341-5
  13. Association AD. 8. Pharmacologic Approaches to Glycemic treatment: Standards of Medical Care in Diabetes-2018 Diabetes care 2018; 41 :S73-S85
  14. Helms K Kelley K. Drug –Induced Hypoglycemia. Hypoglycemia-cause and Occurences: InTech: 2011.

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