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Hypoglycemia - Wikipedia

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Not to be present confused with the facing disorder, hyperglycemia.

Hypoglycemia
Other namesHypoglycaemia, hypoglycæmia, low blood glucose
Glucose test.JPG
Glucose meter
SpecialtyEndocrinology
SymptomsClumsiness, trouble talking, confusion, loss on consciousness, seizures[1]
Usual onsetRapid[1]
CausesMedications (insulin including sulfonylureas), sepsis, kidney failure, convinced tumors, liver disease[1][2][3]
Diagnostic methodBlood sugar level < 3.9 mmol/L (70 mg/dL) inside a diabetic[1]
TreatmentEating foods towering inside clear sugars, dextrose, glucagon[1]

Hypoglycemia, and famous when low blood sugar, is when blood sugar decreases to beneath normal levels.[1] This may consequence inside a diversity on symptoms containing clumsiness, trouble talking, confusion, loss on consciousness, seizures or death.[1] A sentiment on hunger, sweating, shakiness including frailty may and be present present.[1] Symptoms typically come supported by quickly.[1]

The the majority common cause on hypoglycemia is medications second-hand to behave towards diabetes mellitus such when insulin including sulfonylureas.[2][3] Risk is greater inside diabetics who keep eaten smaller than usual, exercised additional than customary or keep drunk alcohol.[1] Other causes on hypoglycemia involve kidney failure, convinced tumors, such when insulinoma, liver disease, hypothyroidism, starvation, inborn error on metabolism, severe infections, reactive hypoglycemia including a figure on drugs containing alcohol.[1][3] Low blood sugar may take place inside otherwise healthy babies who keep not eaten appropriate to a one or two hours.[4]

The glucose level that defines hypoglycemia is variable.[1] In people with diabetes, levels beneath 3.9 mmol/L (70 mg/dL) is diagnostic.[1] In adults lacking diabetes, symptoms related to low blood sugar, low blood sugar at the while on symptoms including increase when blood sugar is restored to normal support the diagnosis.[5] Otherwise, a level beneath 2.8 mmol/L (50 mg/dL) at the end of not eating or next use may be present used.[1] In newborns, a level beneath 2.2 mmol/L (40 mg/dL), or smaller than 3.3 mmol/L (60 mg/dL) assuming symptoms are present, indicates hypoglycemia.[4] Other tests that may be present useful inside determining the cause involve insulin including C peptide levels inside the blood.[3]

Among people with diabetes, prevention is by matching the foods eaten with the lot on use including the medications used.[1] When people feel their blood sugar is low, difficult with a glucose monitor is recommended.[1] Some people keep one or two initial symptoms on low blood sugar, including repeated routine difficult inside this group is recommended.[1] Treatment on hypoglycemia is by eating foods towering inside clear sugars or winning dextrose.[1] If a being is not capable to grip food by mouth, an injection on glucagon may help.[1] The treatment on hypoglycemia unconnected to diabetes includes treating the basic difficulty when well including a healthy diet.[1] The term "hypoglycemia" is at times incorrectly second-hand to pass on to idiopathic postprandial syndrome, a controversial condition with alike symptoms that take place next eating however with normal blood sugar levels.[6][7]

Signs including symptoms[edit]

Hypoglycemic symptoms including manifestations can be present divided into those produced by the counterregulatory hormones (epinephrine/adrenaline including glucagon) triggered by the falling glucose, including the neuroglycopenic effects produced by the reduced mind sugar.

Central anxious system[edit]

Not all on the upon manifestations take place inside each and every event on hypoglycemia. There is not at all consistent order to the appearance on the symptoms, assuming symptoms regular occur. Specific manifestations may and differ by age, by severity on the hypoglycemia including the rate on the decline. In juvenile children, vomiting can at times accompany forenoon hypoglycemia with ketosis. In older children including adults, moderately serious hypoglycemia can resemble mania, rational illness, drug intoxication, or drunkenness. In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise. The symptoms on a one being may be present alike from event to episode, however are not necessarily thus including may be present influenced by the rate at which glucose levels are dropping, when well when former incidents.

In newborns, hypoglycemia can produce irritability, jitters, myoclonic jerks, cyanosis, respiratory distress, apneic episodes, sweating, hypothermia, somnolence, hypotonia, refusal to feed, including seizures or "spells." Hypoglycemia can resemble asphyxia, hypocalcemia, sepsis, or heart failure.

In both juvenile including old people with hypoglycemia, the mind may habituate to low glucose levels, with a reduction on obvious symptoms in the face of neuroglycopenic impairment. In insulin-dependent diabetic people this happening is termed hypoglycemia unawareness including is a marked unemotional difficulty when improved glycemic control is attempted. Another feature on this happening occurs inside type I glycogenosis, when chronic hypoglycemia ahead of diagnosis may be present better tolerated than acute hypoglycemia at the end of treatment is underway.

Hypoglycemic symptoms can and take place when only is sleeping. Examples on symptoms during slumber(s) can involve damp bed sheets or wear from perspiration. Having nightmares or the perform on crying not in can be present a sign on hypoglycemia. Once the separate is awake they may feel tired, irritable, or confused including these may be present signs on hypoglycemia when well.[8]

In nearly all cases, hypoglycemia that is serious sufficient to cause seizures or insensibility can be present reversed lacking clear harm to the brain. Cases on death or permanent neurological damage occurring with a one event keep generally involved prolonged, untreated unconsciousness, interference with breathing, serious simultaneous disease, or some more sort on vulnerability. Nevertheless, mind damage or death has at times resulted from serious hypoglycemia.

Research inside healthy adults shows that rational efficiency declines a bit however measurably when blood glucose falls beneath 3.6 mM (65 mg/dL). Hormonal defense mechanisms (adrenaline including glucagon) are normally activated when it drops beneath a threshold level (about 55 mg/dL (3.0 mM) appropriate to the majority people), producing the typical hypoglycemic symptoms on shakiness including dysphoria.[9]:1589 Obvious disability may not take place until the glucose falls beneath 40 mg/dL (2.2 mM), including various healthy people may at times keep glucose levels beneath 65 inside the forenoon lacking apparent effects. Since the mind effects on hypoglycemia, termed neuroglycopenia, determine whether a specified low glucose is a "problem" appropriate to that person, the majority doctors utilize the term hypoglycemia sole when a moderately low glucose level is accompanied by symptoms or mind effects.

Determining the existence on both parts on this description is not always straightforward, when hypoglycemic symptoms including effects are vague including can be present produced by more conditions; people with recurrently low glucose levels can lose their threshold symptoms thus that serious neuroglycopenic disability can take place lacking a lot warning, including various length methods (especially glucose meters) are imprecise at low levels.

It may grip longer to recover from serious hypoglycemia with insensibility or fit regular at the end of restoration on normal blood glucose. When a being has not been unconscious, lack of success on carbohydrate to reverse the symptoms inside 10–15 record increases the chance that hypoglycemia was not the cause on the symptoms. When serious hypoglycemia has persisted inside a hospitalized person, the lot on glucose required to continue acceptable blood glucose levels becomes an significant clue to the basic cause. Glucose requirements upon 10 mg/kg/minute inside infants, or 6 mg/kg/minute inside children including adults are strong proof appropriate to hyperinsulinism. In this context this is referred to when the glucose injection rate (GIR). Finally, the blood glucose response to glucagon specified when the glucose is low can and help distinguish in the midst of various types on hypoglycemia. A rise on blood glucose by additional than 30 mg/dL (1.70 mmol/l) suggests insulin surfeit when the probable cause on the hypoglycemia.

Long-term effects[edit]

Significant hypoglycemia appears to increase the danger on cardiovascular disease.[10]

Causes[edit]

The the majority common cause on hypoglycemia is medications second-hand to behave towards diabetes mellitus such when insulin, sulfonylureas, including biguanides.[2][3] Risk is greater inside diabetics who keep eaten smaller than usual, exercised additional than usual, or drank alcohol.[1] Other causes on hypoglycemia involve kidney failure, convinced tumors, liver disease, hypothyroidism, starvation, inborn errors on metabolism, severe infections, reactive hypoglycemia, including a figure on drugs containing alcohol.[1][3] Low blood sugar may take place inside babies who are otherwise healthy who keep not eaten appropriate to a one or two hours.[4] Inborn errors on metabolism may involve the lack on an enzyme to make glycogen (glycogen storage sort 0).

Serious illness[edit]

Serious illness may consequence inside low blood sugar.[1] Severe condition on nearly all major part of the body systems can cause hypoglycemia when a minor problem. Hospitalized persons, especially inside intensive mind units or those prevented from eating, can develop hypoglycemia from a diversity on circumstances related to the mind on their primary disease. Hypoglycemia inside these circumstances is much multifactorial or caused by the healthcare. Once identified, these types on hypoglycemia are willingly reversed including prevented, including the basic condition becomes the primary problem.

Hormone deficiency[edit]

Not sufficient cortisol, such when inside Addison's disease, not sufficient glucagon, or not sufficient epinephrine can consequence inside low blood sugar.[1] This is a additional common cause inside children.[1]

Pathophysiology[edit]

Like the majority animal tissues, mind metabolism depends chiefly supported by glucose appropriate to fuel inside the majority circumstances. A restricted lot on glucose can be present derived from glycogen stored inside astrocytes, however it is consumed in minutes. For the majority efficient purposes, the mind is reliant supported by a continual provide on glucose diffusing from the blood into the interstitial tissue in the central anxious system including into the neurons themselves.

Therefore, assuming the lot on glucose supplied by the blood falls, the mind is only on the initial organs affected. In the majority people, subtle reduction on rational efficiency can be present observed when the glucose falls beneath 65 mg/dL (3.6 mM). Impairment on action including judgment generally becomes clear beneath 40 mg/dL (2.2 mM). Seizures may take place when the glucose falls further. As blood glucose levels fall beneath 10 mg/dL (0.55 mM), the majority neurons become electrically silent including nonfunctional, resulting inside coma. These mind effects are collectively referred to when neuroglycopenia.

The importance on an adequate provide on glucose to the mind is apparent from the figure on nervous, hormonal including metabolic responses to a falling glucose level. Most on these are defensive or adaptive, tending to move up the blood sugar by glycogenolysis including gluconeogenesis or provide alternative fuels. If the blood sugar level falls as well low, the liver converts a storage on glycogen into glucose including releases it into the bloodstream, to avoid the being going into a diabetic coma, appropriate to a brief time.

Brief or mild hypoglycemia produces not at all lasting effects supported by the brain, although it can briefly alter mind responses to additional hypoglycemia. Prolonged, serious hypoglycemia can produce lasting damage on a wide range. This can involve disability on cognitive function, motor control, or regular consciousness. The chance on permanent mind damage from any specified instance on serious hypoglycemia is hard to estimate including depends supported by a lot on factors such when age, recent blood including mind glucose experience, simultaneous problems such when hypoxia, including accessibility on alternative fuels. Prior hypoglycemia and blunts the counterregulatory response to future hypoglycemia [11]. While the mechanism top to blunted counterregulation is new some keep been proposed.[12]

It has been frequently start that those sort 1 diabetics start "dead inside bed" inside the forenoon at the end of suspected serious hypoglycemia had some basic coronary pathology that led to an induced devastating feelings attack.[13] In 2010, a event inform of was published demonstrating the initial famous event on an separate start "dead inside bed" whilst wearing a continuous glucose monitor (CGM), which provided a history on glucose levels ahead of the devastating event; the being had suffered a serious hypoglycemic incident, including while the authors described sole a "minimal counter-regulatory response" they stated not at all "anatomic abnormalities" were observed during autopsy.[14]

The vast majority on symptomatic hypoglycemic episodes consequence inside not at all detectable permanent harm.[15]

Diagnosis[edit]

The glucose level that defines hypoglycemia is variable. In diabetics a level beneath 3.9 mmol/L (70 mg/dL) is diagnostic.[1] In adults lacking diabetes, symptoms related to low blood sugar, low blood sugar at the while on symptoms, including increase when blood sugar is restored to normal support the diagnosis.[5] This is famous when the Whipple's triad.[5] Otherwise a level beneath 2.8 mmol/L (50 mg/dL) at the end of not eating or next use may be present used.[1] In newborns a level beneath 2.2 mmol/L (40 mg/dL) or smaller than 3.3 mmol/L (60 mg/dL) assuming symptoms are current indicates hypoglycemia.[4] Other tests that may be present useful inside determining the cause involve insulin including C peptide levels inside the blood.[3]Hyperglycemia, a towering blood sugar, is the facing condition.

Throughout a 24‑hour term blood plasma glucose levels are generally maintained between 4–8 mmol/L (72 including 144 mg/dL).[16]:11 Although 3.3 or 3.9 mmol/L (60 or 70 mg/dL) is commonly cited when the under limit on normal glucose, symptoms on hypoglycemia generally perform not take place until 2.8 to 3.0 mmol/L (50 to 54 mg/dL).[17]

In cases on recurrent hypoglycemia with serious symptoms, the finest process on excluding dangerous conditions is much a diagnostic fast. This is generally conducted inside the hospital, including the length depends supported by the days on the being including response to the fast. A healthy adult can generally continue a glucose level upon 50 mg/dL (2.8 mM) appropriate to 72 hours, a baby appropriate to 36 hours, including an infant appropriate to 24 hours. The point on the fast is to determine whether the being can continue his or her blood glucose when long when normal, including can respond to fasting with the right metabolic changes. At the end on the fast the insulin should be present nearly undetectable including ketosis should be present fully established. The person's blood glucose levels are monitored including a crucial specimen is obtained assuming the glucose falls. Despite its unpleasantness including expense, a symptomatic fast may be present the sole efficient way to support or refute a figure on grave forms on hypoglycemia, especially those involving immoderate insulin.

The specific level on glucose considered low sufficient to define hypoglycemia is reliant supported by (1) the length method, (2) the days on the person, (3) existence or absence on effects, including (4) the point on the definition. While there is not at all disagreement when to the normal series on blood sugar, debate continues when to what degree on hypoglycemia warrants medical evaluation or treatment, or can cause harm.[18][19][20]

Deciding whether a blood glucose inside the borderline series on 45–75 mg/dL (2.5–4.2 mM) represents clinically tricky hypoglycemia is not always simple. This leads people to utilize different "cutoff levels" on glucose inside different contexts including appropriate to different purposes. Because on all the variations, the Endocrine Society recommends that a diagnosis on hypoglycemia when a difficulty appropriate to an separate be present based supported by the mix on a low glucose level including proof on adverse effects.[5]

Glucose concentrations are expressed when milligrams per deciliter (mg/dL or mg/100 mL) inside Lebanon, the United States, Japan, Portugal, Spain, France, Belgium, Egypt, Turkey, Saudi Arabia, Colombia, India including Israel, while millimoles per liter (mmol/L or mM) are the units second-hand inside the majority on the rest on the world. Glucose concentrations expressed when mg/dL can be present converted to mmol/L by dividing by 18.0 g/dmol (the molar mass on glucose). For example, a glucose concentration on 90 mg/dL is 5.0 mmol/L or 5.0 mM.

The circumstances on hypoglycemia provide the majority on the clues to diagnosis. Circumstances involve the days on the person, while on day, while since preceding meal, former episodes, nutritional status, physical including rational development, drugs or toxins (especially insulin or more diabetes drugs), diseases on more part of the body systems, family history, including response to treatment. When hypoglycemia occurs repeatedly, a file or "diary" on the spells over some months, noting the circumstances on every single spell (time on day, relation to preceding meal, world on preceding meal, response to carbohydrate, including thus forth) may be present useful inside recognizing the world including cause on the hypoglycemia.

Method on measurement[edit]

Blood glucose levels discussed inside this feature are venous plasma or serum levels steady by standard, automated glucose oxidase methods second-hand inside medical laboratories. For unemotional purposes, plasma including antihistamine levels are alike sufficient to be present interchangeable. Arterial plasma or antihistamine levels are a bit higher than venous levels, including capillary levels are typically inside between.[21] This dissimilarity between arterial including venous levels is small inside the fasting country however is amplified including can be present greater than 10% inside the postprandial state. On the more hand, whole blood glucose levels (e.g., by fingerprick meters) are regarding 10–15% under than venous plasma levels.[21] Furthermore, accessible fingerstick glucose meters are sole warranted to be present right to in 15% on a simultaneous laboratory use under optimal conditions,[citation needed] including dwelling utilize inside the investigation on hypoglycemia is trying with misleading low numbers.[23][24] In more words, a meter glucose perusal on 39 mg/dL could be present properly obtained from a being whose laboratory antihistamine glucose was 53 mg/dL; regular wider variations can take place with "real world" dwelling use.

Two more factors significantly involve glucose measurement: hematocrit including put off at the end of blood drawing. The disparity between venous including whole blood concentrations is greater when the hematocrit is high, when inside newborn infants, or adults with polycythemia. High neonatal hematocrits are particularly inclined to confound glucose length by meter. Second, unless the specimen is tense into a fluoride tube or processed at once to separate the antihistamine or plasma from the cells, the measurable glucose drive be present slowly lowered by in vitro metabolism on the glucose at a pace on almost 7 mg/dL/h, or regular additional inside the existence on leukocytosis.[25][26] The put off that occurs when blood is tense at a communications satellite site including transported to a inner laboratory hours later appropriate to routine processing is a common cause on mildly low glucose levels inside accepted chemistry panels.

Age[edit]

Children's blood sugar levels are much a bit under than adults'. Overnight fasting glucose levels are beneath 70 mg/dL (3.9 mM) inside 5% on healthy adults, however up to 5% on children can be present beneath 60 mg/dL (3.3 mM) inside the forenoon fasting state.[27] As the length on fasting is extended, a higher percentage on infants including children drive keep mildly low plasma glucose levels, typically lacking symptoms. The normal series on newborn blood sugars continues to be present debated.[18][19][20] It has been proposed that newborn brains are capable to utilize alternate fuels when glucose levels are low additional willingly than adults. Experts continue to debate the significance including danger on such levels, although the trend has been to recommend maintenance on glucose levels upon 60–70 mg/dL the initial twenty-four hours at the end of birth.

Diabetic hypoglycemia represents a important event with respect to the relationship on steady glucose including hypoglycemic symptoms appropriate to some reasons. First, while dwelling glucose meter readings are much misleading, the likelihood that a low reading, whether accompanied by symptoms or not, represents actual hypoglycemia is a lot higher inside a being who takes insulin than inside somebody who does not.[28][29]

Other tests[edit]

The next is a short inventory on hormones including metabolites which may be present steady inside a crucial sample. Not all tests are checked supported by each and every person. A "basic version" would involve insulin, cortisol, including electrolytes, with C-peptide including drug cover appropriate to adults including development hormone inside children. The use on additional particular tests depends supported by the the majority inclined diagnoses appropriate to an separate person, based supported by the circumstances described above. Many on these levels change in minutes, especially assuming glucose is given, including there is not at all use inside measuring them at the end of the hypoglycemia is reversed. Others, especially those under inside the list, continue abnormal regular at the end of hypoglycemia is reversed, including can be present usefully steady regular assuming a crucial specimen is missed.

Part on the use on the crucial example may simply be present the demonstration that the symptoms are indeed due to hypoglycemia. More often, length on convinced hormones including metabolites at the while on hypoglycemia indicates which organs including body systems are responding appropriately including which are functioning abnormally. For example, when the blood glucose is low, hormones which move up the glucose should be present rising including insulin secretion should be present completely suppressed.

Differential diagnosis[edit]

It can and be present mistaken appropriate to alcohol intoxication.[30]

Prevention[edit]

The the majority efficient means on preventing more distant episodes on hypoglycemia depends supported by the cause.

The danger on more distant episodes on diabetic hypoglycemia can much (but not always) be present reduced by lowering the amount on insulin or more medications, or by additional meticulous attention to blood sugar balance during unusual hours, higher levels on exercise, or decreasing alcohol intake.

Many on the natural errors on metabolism require avoidance or shortening on fasting intervals, or more carbohydrates. For the additional serious disorders, such when sort 1 glycogen storage disease, this may be present supplied inside the sort on cornstarch each and every one or two hours or by continuous stomach infusion.

Several treatments are second-hand appropriate to hyperinsulinemic hypoglycemia, depending supported by the exact sort including severity. Some forms on innate hyperinsulinism respond to diazoxide or octreotide. Surgical extraction on the overactive part on the pancreas is curative with smallest danger when hyperinsulinism is focal or due to a benevolent insulin-producing tumor on the pancreas. When innate hyperinsulinism is distribute including unmanageable to medications, near-total pancreatectomy may be present the treatment on preceding resort, however inside this condition is smaller consistently efficient including trying with additional complications.

Hypoglycemia due to hormone deficiencies such when hypopituitarism or adrenal insufficiency generally ceases when the right hormone is replaced.

Hypoglycemia due to dumping condition including more post-surgical conditions is finest dealt with by altering diet. Including fat including protein with carbohydrates may sluggish ingestion including reduce early insulin secretion. Some forms on this respond to treatment with an alpha-glucosidase inhibitor, which slows starch digestion.

Reactive hypoglycemia with demonstrably low blood glucose levels is the majority much a predictable nuisance which can be present avoided by gripping fat including protein with carbohydrates, by adding forenoon or afternoon snacks, including reducing alcohol intake.

Idiopathic postprandial condition lacking demonstrably low glucose levels at the while on symptoms can be present additional on a administration challenge. Many people find increase by changing eating patterns (smaller meals, avoiding immoderate sugar, mixed meals instead of than carbohydrates by themselves), reducing intake on stimulants such when caffeine, or by making lifestyle changes to reduce stress. See the next section on this article.

Treatment[edit]

Treatment on some forms on hypoglycemia, such when inside diabetes, involves at once raising the blood sugar to normal through the eating on carbohydrates such when sugars, determining the cause, including winning measures to hopefully avoid future episodes. However, this treatment is not optimal inside more forms such when reactive hypoglycemia, where rapid carbohydrate ingestion may lead to a more distant hypoglycemic episode.

Blood glucose can be present raised to normal in record by winning (or receiving) 10–20 grams on carbohydrate.[31] It can be present taken when food or drain assuming the being is aware of including capable to swallow. This lot on carbohydrate is contained inside regarding 3–4 ounces (100–120 ml) on orange, apple, or grape liquid while fruit juices contain a higher share on fructose which is additional slowly metabolized than pure dextrose. Alternatively, regarding 4–5 ounces (120–150 ml) on frequent (non-diet) soda may and work, when drive regarding only segment on bread, regarding 4 crackers, or regarding 1 serving on the majority starchy foods. Starch is swiftly digested to glucose (unless the being is winning acarbose), however adding fat or protein retards digestion. Symptoms should start to improve in 5 minutes, although filled recovery may grip 10–20 minutes. Overfeeding does not rate recovery including assuming the being has diabetes drive simply produce hyperglycemia afterwards. A mnemonic second-hand by the American Diabetes Association including others is the "rule on 15" – gripping 15 grams on carbohydrate followed by a 15-minute wait, repeated assuming glucose remains low (variable by individual, at times 70 mg/dL).[32]

If a being has such serious effects on hypoglycemia that they cannot (due to combativeness) or should not (due to seizures or unconsciousness) be present specified anything by mouth, medical personnel such when paramedics, or in-hospital personnel can found IV admission including give intravenous dextrose, concentrations varying depending supported by days (infants are specified 2 ml/kg dextrose 10%, children are specified dextrose 25%, including adults are specified dextrose 50%). Care must be present taken inside giving these solutions since they can cause skin necrosis assuming the IV is infiltrated, sclerosis on veins, including various more solution including electrolyte disturbances assuming administered incorrectly. If IV admission cannot be present established, the being can be present specified 1 to 2 milligrams on glucagon inside an intramuscular injection. More treatment facts can be present start inside the feature diabetic hypoglycemia. If a being has smaller serious effects, including is aware of with the ability to swallow, medical special may administer glutinous oral glucose. The soft drain Lucozade has been second-hand appropriate to hypoglycemia inside the United Kingdom, however it has newly replaced a lot on its glucose with the artificial sugars, which perform not behave towards hypoglycemia.[33]

One situation where starch may be present smaller efficient than glucose or sucrose is when a being is winning acarbose. Since acarbose including more alpha-glucosidase inhibitors prevents starch including more sugars from thing broken to the other end of into monosaccharides that can be present absorbed by the body, people winning these medications should consume monosaccharide-containing foods such when glucose tablets, honey, or liquid to reverse hypoglycemia.

History[edit]

Hypoglycemia was initial discovered by James Collip when he was working with Frederick Banting supported by purifying insulin inside 1922. Collip was tasked with developing an analyse to measure the activity on insulin. He initial injected insulin into a rabbit, including then steady the reduction inside blood glucose levels. Measuring blood glucose was a while gripping step. Collip observed that assuming he injected rabbits with a as well great a amount on insulin, the rabbits began convulsing, went into a coma, including then died. This observation simplified his assay. He defined only whole on insulin when the lot necessary to produce this convulsing hypoglycemic reaction inside a rabbit. Collip later start he could rescue money, including rabbits, by injecting them with glucose on only occasion they were convulsing.[34]

Etymology[edit]

The name hypoglycemia is also spelled hypoglycaemia or hypoglycæmia. The term means low blood sugar inside Greek. ὑπογλυκαιμία, from hypo-, glykys, haima.

See also[edit]

References[edit]

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  2. ^ a b c Yanai H, Adachi H, Katsuyama H, Moriyama S, Hamasaki H, Sako A (February 2015). "Causative anti-diabetic drugs including the basic unemotional factors appropriate to hypoglycemia inside patients with diabetes". World Journal on Diabetes. 6 (1): 30–6. doi:10.4239/wjd.v6.i1.30. PMC 4317315. PMID 25685276.
  3. ^ a b c d e f g Schrier RW (2007). The internal medicine casebook actual patients, actual answers (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. p. 119. ISBN 978-0-7817-6529-9.
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