Endocrine System: Hypoglycemia and Hyperglycemia

Jun 30, 2024

Endocrine System: Hypoglycemia and Hyperglycemia

Lecturer: Eddie Watson, ICU Advantage

Introduction

  • Differences between hypoglycemia and hyperglycemia
  • Importance of glucose in the body

Glucose Overview

  • Chemical formula: C6H12O6
  • Primary energy source for the body

Hypoglycemia

  • Definition: Blood glucose < 60 mg/dL
  • Significance: Can lead to coma or death if untreated
  • Primary issue: Imbalance between glucose production and utilization

Causes

  1. Endogenous (Tumors or metabolic errors)
    • Overuse of glucose
    • Overproduction of insulin
  2. Exogenous
    • Excessive insulin intake
    • Use of oral anti-diabetics
    • Drugs and alcohol
  3. Functional
    • Excessive muscle use, continuous activities, prolonged seizures
    • Hypermetabolic states (e.g., sepsis)
    • Dumping syndrome

Signs and Symptoms

  1. Mild Hypoglycemia (Adrenergic response)
    • Diaphoresis, tremors, tachycardia
    • Paresthesia, pallor, excessive hunger, anxiety
  2. Moderate to Severe Hypoglycemia (CNS response)
    • Headache, mood changes, confusion
    • Drowsiness, impaired judgment, staggering gait
    • Double vision, psychosis, seizures, coma
    • Symptoms may mimic stroke

Diagnosis

  • Serum blood sugar < 60 mg/dL
  • Blood sugar ranges:
    • 20-40 mg/dL: Potential seizures
    • < 20 mg/dL: Coma, risk of death

Treatment

  • Prevention: Monitoring, recognition, and patient education
  • Oral glucose: 10-15 grams, repeat in 10 minutes if necessary, followed by complex carbs
  • Non-oral options:
    • 1-2 mg glucagon (IV, IM, or subcutaneous)
    • 25 grams of D50 IV push

Hyperglycemia

  • Significance: Increased morbidity and mortality in hospitalized patients
  • Prevalence: 12% of hospitalized patients without diabetes may develop hyperglycemia
  • Complications: Increased mortality in non-diabetic patients with hyperglycemia

Causes

  • Acute illness/injury: MIs, strokes, surgery, trauma, pain, sepsis
  • Stress response: Release of glucocorticoids, catecholamines, growth hormone, cytokines
  • Diabetes: Inadequate glucose uptake (Type 1 and 2)
    • Type 1: Issues with insulin production
    • Type 2: Issues with insulin receptor sensitivity

Management in ICU

  • Blood glucose monitoring: Frequent checks
  • Insulin management: Continuous IV infusion
  • Controversy: Tight control levels due to differing mortality rates
    • General goal: Blood glucose < 180 mg/dL
    • DKA and HHS management specifics

Conclusion

  • Importance of recognizing and treating hypoglycemia and hyperglycemia in ICU patients
  • Brief preview of upcoming lesson covering DKA and HHS

Call to Action

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  • Check out the previous series on heart failure

End of Lesson