Low blood sugar, diabetes, blood glucose compliance stumbling block
Posted on November 2, 2009
Filed Under Hypoglycemia | Leave a Comment
Non-diabetes blood glucose below 2.8 mmol / L referred to as low blood sugar, diabetes less than 3.9 mmol / L is considered low blood sugar. In clinical, low blood sugar can be expressed as sweat, hunger, weakness, pale and trembling limbs, palpitations and other symptoms, which are caused by low blood sugar symptoms of sympathetic stimulation, with the increase in the secretion of adrenaline. When the blood glucose below 2.8 mmol / L, the inhibition of central nervous system will emerge and brain disorders, mainly by the insufficient energy supply of brain cells, manifested as dizziness, drowsiness, slurring in speech, blurred vision, but also showed abnormal behavior, disorientation, coma, convulsions and even death.
Characteristics of insulin-induced hypoglycemia and incentives
Insulin-induced hypoglycemia has certain peculiarities. Islet function in some patients due to significantly decreased blood glucose fluctuations, blood glucose lowering treatment will suddenly fast hypoglycemia symptoms. Long-term use of insulin treatment, such as the frequent occurrence of hypoglycemia will lead to the symptoms was not obvious, or even asymptomatic hypoglycemia, particularly in elderly patients with diabetes were frequently found to be timely and result in serious consequences. Application of insulin in patients with decreased sensation at night, so night-time hypoglycemia is more common at this time will appear fasting hyperglycemia (high blood sugar reactions), so the discovery of the early morning fasting blood glucose is high, should be detected at 2 ~ 3 points if the occurrence of low blood sugar, and insulin dosage adjusted appropriately. It is reported in the literature, insulin-induced hypoglycemia occurred mainly at night and sleep at this time patients are frequently unable to make timely and accurate judgments, and therefore more dangerous. Insulin therapy in fatal case of low blood sugar tends to occur at night.
Application of insulin after blood sugar levels by age, drugs, diet, exercise and sleep and other factors. The most common causes of low blood sugar has the following two kinds: first, improper use of insulin, insulin dose or mixed disproportionate; followed by injection of insulin after eating enough or eating late in the increased activity. Low fasting blood sugar of the most common movement was triggered by insufficient or excessive eating; postprandial hypoglycemia, mainly due to the consumption of delay, postprandial vomiting, caused by drinking or into the staple food; night sleep, low blood sugar often appear in the treatment of program of the adjustment process, or taking β-blockers, disable the hormone drugs and so on.
Application of insulin to prevent hypoglycemia
Normal insulin secretion by regulating blood glucose, postprandial blood glucose increased insulin secretion can rapidly reach peak (10 minutes), followed by rapid decline, in the 60 to 90 minutes or so after the meal a second peak, then gradually restore the basis of level. Postprandial insulin secretion can rapidly reduce elevated blood glucose levels, while the basal insulin secretion, inhibits glycogen primarily xenobiotic, prompting a constant blood sugar within normal range.
Application of exogenous insulin ideal way is to meet the physiological insulin secretion and the role of the character. In the use of insulin, such as dosage and the role of the peak is inconsistent with the body’s glucose metabolism, that may lead to low blood sugar. Therefore, in order to avoid the occurrence of hypoglycemia, the patient shall be performed after injection of insulin when you eat; insulin dose to be accurate; liver and kidney dysfunction, the elderly, infants and young children in the use of small doses of insulin should be started, and gradually increase the amount of; not immediately after the injection of insulin exercise.
Adjustment of insulin treatment, it is easy hypoglycemia. Or short-acting insulin by the quick change in the efficiency or mixed insulin therapy, plus clothes hypoglycemic drugs or oral hypoglycemic drugs in combination before bedtime intermediate-acting insulin therapy, easy to induce hypoglycemia at night or early morning, clinicians should pay attention to the adjustment program appropriate reduction of insulin dosage, and to remind patients to monitor blood glucose at night, snacks and timely. Frequent hypoglycemia insulin doses may be excessive or disproportionate mixture of insulin, should be adjusted appropriately.
In addition, should be actively treated with low blood sugar may lead to diseases, such as pituitary dysfunction, adrenal insufficiency and thyroid dysfunction and so on. Easily lead to low blood sugar taking the drug must be careful and pay attention to monitoring of blood glucose.
Insulin treatment of hypoglycemia applications
Diabetes education to reduce the incidence of hypoglycemia in patients with and correct understanding and treatment of low blood sugar are of crucial importance. Hypoglycemia, the light can eat a little sugar water, fruit juice, biscuits and so on, rapid increase in blood sugar levels, a serious condition when taken to the hospital for medical treatment in time. For patients with unclear consciousness should be promptly intravenous injection of 50% glucose 40 ~ 60 ml, after waking to enable patients to eat a small amount in order to prevent re-coma. Patient’s family and his colleagues should also be low blood sugar understand the performance and handling, so as to enable patients in some special circumstances, the rapid and rational treatment, such as when found in patients with altered mental status or coma, the evacuation should be immediately fed with glucose hospital for treatment.
How to Reach the Target blood glucose while avoiding hypoglycemia
Intensive insulin therapy can be strict control of blood sugar, greatly reducing the chronic complications of diabetes, but at the same time the risk of low blood sugar is also a corresponding increase, so intensive insulin therapy at the same time pay attention to blood glucose monitoring. Diabetes starting insulin therapy were measured daily for at least 3 to 4 times blood glucose, blood sugar levels stable measurement can be reduced to 2 ~ 4 times a week. In exceptional circumstances, such as volatile and frequent blood sugar hypoglycemia may consider the application of continuous glucose monitoring to help understand the dynamics of blood glucose, adjusting insulin dosage and programs.
In addition, the choice is closer to physiological insulin secretion patterns of treatment may be safer to control blood sugar. Domestic and international studies have shown that conventional insulin + intermediate-acting insulin (NPH) compared with the intensive treatment program using quick + new long-acting insulin analogue insulin analogues in the treatment program can be better blood glucose control during the day, and obviously to reduce the incidence of hypoglycemia at night.
Insulin pumps can also be used to simulate normal insulin secretion way, and dose-adjusted flexibly in the effective control of blood glucose at the same time, can significantly reduce the incidence of low blood sugar. However, in patients with insulin pump have to note that the amount of insulin infusion should be based on diet, exercise, make reasonable adjustment to the situation. Insulin pump can be aimed at different times of the day to give a different basis the rate of infusion. For example, during the night can be the basis for a lower volume to prevent the occurrence of low blood sugar. Pre-meal insulin for additional types and quantities according to the consumption of appropriate adjustments, for example, converted according to the amount of carbohydrates each meal dose of insulin before a meal, generally every 6 ~ 12 g with 1 unit of insulin, in order to achieve good control of postprandial blood glucose. Either type 1 or type 2 diabetes, and even brittle (unstable) diabetes, insulin pump can be better control of blood glucose, and effectively prevent the occurrence of low blood sugar.
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