Talk:Diabetic hypoglycemia

Temperature Extremes
I would like this article to open up debate on whether temperature extremes (either extreme cold conditions or extreme hot conditions) can make risk of hypoglycaemia in diabetics more likely. Any information on this subject will be gratefully received. ACEO 08:12, 24 July 2006 (UTC)


 * A better place is the talk:Diabetic hypoglycemia page, before putting anything in an article. If you move the question there I will tell you what I know about the topic. alteripse 11:31, 24 July 2006 (UTC)


 * Thank you Alteripse. I have now raised this question on the Wikipedia site talk: Diabetes, so I do hope that you will be able to respond. By the way, are you a qualified medical doctor? I have seen a number of comments from you on medical articles in Wikipedia, and also believe that your name is in the category

Category:Wikipedian physicians. I am not a medical doctor myself (my doctorate is a Ph.D. in Psychology, not an M.D.) but do find medical articles in Wikipedia very interesting and, from what I know about medicine, pretty good compared with some other health  information on the web! ACEO 12:44, 26 July 2006 (UTC)


 * This article is the best place to talk about diabetic hypoglycemia. In general, be wary of medical articles on wikipedia. They can be excellent or poor and can change overnight when a crank drops by. Witness our difficulties with the chromium-obsessed at diabetes mellitus or the Armour-thyroid-evangelists at desiccated thyroid extract or those who think that fraud is just another equally respectable point of view at HGH quackery.


 * Temperature extremes can affect hypoglycemia risk in several possible ways, but the effects are not always direct and are rarely large. The principal direct effect of both extremes is similar to exercise but smaller. One increases glucose consumption rates at both very hot or very cold to defend body temperature; this effect tends to lower glucose. However, like exercise, there is a concurrent stress effect involving adrenalin, which is hard to predict and may drive glucose up. Extremes can also affect recognition of lows. Extreme heat and cold can interfere with performance of several meters. Extreme heat and cold might accelerate insulin degradation, especially in a pump, which could lead to hyperglycemia. Does that cover the issues? alteripse 19:24, 26 July 2006 (UTC)
 * Thank you Alteripse, that covers issues nicely. It makes me wonder whether a similar principle might be at work in hibernation insofar as I can see how that could result in changes in glucose metabolism at extreme temperatures. I found the bit about how temperature extremes might affect ability to recognise blood glucose levels especially interesting. By the way, I take your points about medical information on Wikipedia - especially the way that articles might change overnight, I suppose that that is both the strength and the weakness of Wikipedia. Wikipedia can be very up-to-date, but the last time I looked at the article on whooping cough, it still seemed a little dated. ACEO 19:37, 26 July 2006 (UTC)
 * I think hibernation is pretty straightforward. The metabolic rate slows, glucose consumption slows, food intake and storage drops to zero, and less energy is expended maintaining a temperature gradient. The net effect: your average type 1 bear needs a drastic reduction in his insulin dose. alteripse 02:16, 27 July 2006 (UTC)


 * Heh. I thought most bears were type 2. We should award Alteripse a barnstar for surreal comments on talkpages :-). JFW | T@lk  19:49, 27 July 2006 (UTC)

Hypoglycemia Unawareness
A former article on the above topic was deleted because of copyright violations. To me, the piece was not long or involved enough to merit its own article, so perhaps some of this article could be devoted to  hypoglycemia unawareness in diabetics, dealing with issues such as loss of adrenergic symptoms. ACEO 20:19, 17 November 2006 (UTC). As a diabetic myself who has not suffered symtpms of hypglycemia for years except for a slightly depressed nature and inability tmo fall asleep, I think it should be noted that a loss of symptoms can occure if hypo's are suffered for a while.

Treatment
I think that the treatment for diabetes related glycemia is to low. (4-5 ounces of regular soda) As much as 300 ml or a full can and a snakck sized piece of confectionary can be required to raise a persons blood sugar level to an acceptable level. Fifteen to twenty grams is only a rule of thumb -- what's actually required depends on just how low the blood sugar is, how much excess active insulin is in the system, and how big the patient is. Children with diabetes are usually recommended a smaller initial carbohydrate dose, and patient instructions for treating diabetic hypoglycemia usually recommend re-testing, and re-treating if necessary, after 10-15 minutes.Rachelkg 21:47, 21 May 2007 (UTC)
 * Yes that much can occasionally be required, but that is the exception rather than common, and that much usually results in a blood sugar far above normal. Research on adults has repeatedly shown that (1) 15 g usually brings the glucose to the normal range of 60-130, and (2) higher amounts usually bring the glucose far higer than normal and (3) the practice is a common contributor to poor glycemic control. I would be happy to explain or discuss further, but please take a minute to make an account so you can sign your posts. alteripse 11:34, 18 January 2007 (UTC)
 * Of course. Trying to specify a one-size-fits-all dose is almost as pointless as trying to specify a single insulin dose for a high sugar. But an encyclopedia is not a treatment manual and can still give an average or "ballpark" figure for those who may be completely ignorant of the whole thing. alteripse 02:06, 22 May 2007 (UTC)
 * Actually, most EMS textbooks recommend the administration of 10 grams of oral glutose or glucose tablets to be administered and the blood sugar to be rechecked. If IV Dextrose is given, in infants it's usually 2cc/kg of D10W, and for children and adults it's one half of the ampule of the selected dextrose solution, followed by the administration of a d-stick test, and then if the vein is still patient and the blood sugar is <80, the administration of the rest of the dextrose. Also, alteripse, where did you get the range of 60 to 130. Most textbooks, nursing and EMS, and even most facility lab values recommend a value of 80 to 120 of a normal value. Chancegemt 24.176.124.137 (talk) 21:12, 8 May 2008 (UTC)
 * What all of this analysis neglects to mention is that the treatment required necessarily depends on the cause of the hypoglycemia, which varies enormously. If the insulin requirements have suddenly, spontaneously, and dramatically declined, as they often do, then the amount of treatment required will depend on the magnitude of this decline.  If the hypoglycemia is the result of an overdose of insulin in relation to calories consumed or exercise performed, then the amount of treatment required will depend on the magnitude of these factors.  To pretend, as this article inaccurately does, that some predetermined dose will work just fine for all the endlessly varied cases and causes of hypoglycemia amounts to lethally stupid misinformation.  Since hypoglycemia can worsen more quickly than the patient can treat it, to specify some amount of carbohydrates which will suit all cases will falsely encourage patients to limit their treatment as their consciousness and capacity to respond to the hypoglycemic emergency is rapidly worsening.  I can't count the number of times I have seen diabetics in the emergency ward, totally unconscious from hypoglycemia, but clutching a half-eaten piece of candy.  — Preceding unsigned comment added by 74.14.32.183 (talk) 20:24, 16 October 2015 (UTC)

risks
I removed the mention of risks of hypotension because that has, I think, only been reported with larger dose use for GI procedures, not treatment of diabetic hypoglycemia. I checked both Uptodate and the prescribing information. The PI warning only mentions allergic reactions and potential hypertension in patients with pheo or rebound hypoglycemia in patients with insulinoma. Like hypotension from GI procedures, these are so rare that including them in a brief discussion of use for diabetic hypoglycemia is somewhat misleading to laymen and likely to do harm if it discourages use. alteripse 05:28, 12 February 2007 (UTC)

Changed information on Treatment
I changed the format of the treatment information to provide more of clinical information, as well as to clarify some things for American readers. The Lilly kit is in use mostly outside of the United States. Also, the drug dosages are from Brady Paramedic Textbook, Second Edition, and the Infant/Neonate dose is from the S.T.A.B.L.E. Stabilization and Pre-Transport Care of Sick Infants and Neonates Textbook. Chancegemt (talk) 11:08, 8 May 2008 (UTC)

Inserting link.
I'd like to insert a link to the new journal publication 'Diabetic Hypoglycaemia' (www.hypodiab.com), which is obviously directly related to the subject of this page and expands upon the suject matter with background info and updates on research in this field. Just raising the idea first before making any amendments to the Wikipedia page, for any comments/suggestions.

Rdrake7000 (talk) 13:14, 8 July 2008 (UTC)

Dogs that can detect hypoglycemia
There is evidence, if admittedly anecdotal,that dogs (and indeed, other pets) can detect low blood sugar in their diabetic owners. This is mentioned in "Balance" (the magazine of the charity Diabetes U.K.) for Jan-Feb 2008; I believe that Rupert Sheldrake has also discussed this in "Dogs that Know when their owners are on the way home".Could this be mentioned here? ACEOREVIVED (talk) 21:21, 25 October 2008 (UTC)

There was also an article on this in the magazine "Balance" dated 2004. I may insert a little more information from this article some time. ACEOREVIVED (talk) 21:18, 3 November 2008 (UTC)

List of Meds that may affect bg levels
Diabetes In Control-Drugs that may affect blood glucose levels

We hope (talk) 14:07, 7 March 2010 (UTC)

adrenergic
This article links to one on adrenergic, which is a stub. Please go to that article and discuss how it relates to this one, or discuss the issues on this article. 4.249.72.179 (talk) 21:32, 23 April 2012 (UTC)

Misleading Phrase
To say simply that diabetic hypoglycemia can be "easily recognized by the patient" is profoundly misleading, since that is only true some of the time. The problem is that as blood glucose levels sink, the cognitive capacity of the patient to identify and respond to the worsening hypoglycemia also declines, so a vicious cycle can develop in which the declining blood sugar gets away from the ability of the patient to handle it. Also, you should add the information that about half of all hypoglycemia episodes in type 1 diabetics occur when they are asleep, so recognition of symptoms and intervention are obviously made much more difficult by this fact.

Important Data Missing
The central datum on the etiology of diabetic hypoglycemia is the often-cited statistic that strict blood sugar control regimens triple the rate of hypoglycemia, and the article should contain that information.

Signs and symptoms
It might be of practical service to readers if the Signs and symptoms section gave some examples of common signs and symptoms in plain English. --Frans Fowler (talk) 20:54, 30 November 2017 (UTC)