Differences Between Hypoglycemia and Hyperglycemia

Introduction

• Presenter: Eddie Watson, ICU Advantage
• Topic: Differences between hypoglycemia and hyperglycemia
• Focus: Glucose irregularities in the body
• Importance: Glucose is the primary energy source for the body

Glucose Overview

• Formula: C₆H₁₂O₆
• Category: Most abundant monosaccharide within carbohydrates
• Role: Primary energy source for the body
• Regulation: Crucial for proper body function

Hypoglycemia

• Definition: Blood glucose < 60 mg/dL
• Impact: Can lead to coma or death if untreated
• Causes:
  • Endogenous: Tumors, metabolic errors (overuse of glucose, overproduction of insulin)
  • Exogenous: Excessive insulin, oral anti-diabetics, drugs, alcohol
  • Functional: Excessive muscle use, prolonged seizure activity, hypermetabolic states (e.g., sepsis), dumping syndrome

Symptoms

• Mild Hypoglycemia: Adrenergic response (diaphoresis, tremors, tachycardia, paresthesia, pallor, excessive hunger, anxiety)
• Moderate to Severe Hypoglycemia: CNS response (headache, mood changes, inability to concentrate, drowsiness, confusion, impaired judgment, staggering gait, slurred speech, double vision, psychosis, seizures, coma)
• Stroke Mimic: Symptoms often mimic stroke; blood sugar checking necessary

Diagnosis and Treatment

• Diagnosis: Serum blood sugar < 60 mg/dL; seizures at 20-40 mg/dL; coma/death < 20 mg/dL
• Prevention: Monitoring, recognition, patient education
• Treatment:
  • Primary Treatment: 10-15 grams of oral glucose (snack or glucose gel)
  • If Persistent: Repeat in 10 minutes, followed by complex carbs (milk, cheese)
  • Alternate Treatments:
    • Glucagon (1-2 mg, IV/IM/subcutaneous)
    • IV dextrose (25 grams of D50 solution via IV push)

Hyperglycemia

• Significance: Increases morbidity and mortality in hospitalized patients
• Impact: Hospitalized Patients: 12% develop hyperglycemia and have 18x greater mortality if no diabetes history
• Stress Response: Release of glucocorticoids, catecholamines, growth hormone, cytokines leading to catabolism of fat and protein

Causes

• Hospital-related: MI, stroke, surgery, trauma, pain, sepsis (stress response triggers hormone release)
• Diabetes: Common comorbidity (inadequate uptake of glucose by cells)
  • Type 1: Pancreatic beta-cell insulin production/secretion issues
  • Type 2: Insulin receptor sensitivity issues

Management in ICU

• Frequent Blood Glucose Monitoring: Essential for management
• Insulin Management: Continuous IV infusion typically used
• Controversy: Optimal blood glucose level control; some advocate <110 mg/dL despite increased hypoglycemia risk, while general ICU patients may target <180 mg/dL
• Conditions: Management differs for DKA (diabetic ketoacidosis) and HHS (hyperosmolar hyperglycemic state)

Conclusion

• Key Points: Recognition, monitoring, and treatment of hypo/hyperglycemia essential in ICU care
• Next Topic: Differences between DKA and HHS
• Further Learning: Previous series on heart failure