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Definition of hypoglycemia:
Interferences with Point of Care Glucose Testing:
Important Toxicologic Considerations:
Glimepiride
Glyburide
Chlorpropamide
Tolbutamide
Tolazamide
Nateglide
Repaglinide
Similar action to sulfonylureas but shorter duration of action.
Ethanol:
Dulaglutide (Trulicity®)
Exenatide (Byetta,Bydureon®)
Liraglutide (Victoza®)
Amylin analogue:
Do not cause hypoglycemia
Pramlintide (Symlin®)
Antidiabetic drugs that are expected to cause hypoglycemia
- Organ dysfunction in the setting of inadequate glucose concentrations
- Whipple’s Triad:
- Symptoms consistent with hypoglycemia
- Low serum glucose
- Improvement of symptoms after glucose levels have been raised
Interferences with Point of Care Glucose Testing:
- Point of care testing can be inaccurate in both extremes of blood glucose.
- From the package insert for Accu-Chek®
- The ACCU-CHEK® test strips are for testing fresh capillary, venous, arterial, or neonatal whole blood. Cord blood samples cannot be used.
Important Toxicologic Considerations:
- Beta blockers do not cause hypoglycemia
- Sulfonylureas
- Ethanol
- Insulin
- Salicylates
- Normal functioning pancreas:
- Hypoglycemia can be profound
- Dextrose boluses can stimulate insulin secretion
- Increase basal insulin at night for growth demands
- Low threshold for admission/observation
- Prophylactic dextrose is not needed
- IV dextrose if they are symptomatic
- Oral carbohydrates if they are asymptomatic
Glimepiride
Glyburide
Chlorpropamide
Tolbutamide
Tolazamide
- One pill can kill
- Hypoglycemia can be delayed
- Long duration of action
- All patients must be observed for 24-hours
Nateglide
Repaglinide
Similar action to sulfonylureas but shorter duration of action.
Ethanol:
- Decreases glucose supply by:
- Inhibiting gluconeogenesis
- Decreased oral intake
- Decreased glycogen stores leading to ineffective glycogenolysis.
- Do not Cause hypoglycemia
Dulaglutide (Trulicity®)
Exenatide (Byetta,Bydureon®)
Liraglutide (Victoza®)
Amylin analogue:
Do not cause hypoglycemia
Pramlintide (Symlin®)
Antidiabetic drugs that are expected to cause hypoglycemia
- Sulfonylureas
- Maglitinides
- Insulin
- SGLT-2 inhibitors, in overdose
Normoglycemic Ketoacidosis:
- Associated with SGLT-2 inhibitors:
- End with “flozin”
- Canagloflozin
- Dapagloflozin
- Can be in combination with metformin
- End with “flozin”
- Blood glucose less than expected for DKA
- High anion gap acidosis
- Ketosis:
- Ketonemia with or without ketonuria
- Pathophysiology:
- Decreased glucose
- Relative insulin deficiency
- Risk factors:
- Surgery
- Infections
- Reduction or omission of insulin
- Excessive alcohol intake
- Diet restriction
- Late onset autoimmune diabetes
- Management:
- Insulin infusion
- Hydration
- Carbohydrate supplementation