HYPOGLYCEMIA Hypoglycemia, also known as low blood sugar, is an abnormal condi ion in w!ic! !e sugar "glucose# le$el in !

e blood is oo low% Hypoglycemia can !appen by i sel& or can be a symp om o& or occur wi ! a $arie y o& mild o serious diseases, disorders and condi ions% CA'(E Hypoglycemia can be caused by o$er)e*ercising and no ea ing enoug! carbo!ydra es and by s ar$a ion die ing% Hypoglycemia can also occur in some people a& er drinking alco!ol, especially large amoun s o& alco!ol% (erious disease, disorders and condi ions !a can also increase !e risk o& de$eloping !ypoglycemia include ype + diabe es, insulin)secre ing umors o& !e pancreas, kidney disease, Addison,s disease and li$er disease% Hypoglycemia can also be a side e&&ec o& some medica ions% In some cases, i is no possible o diagnose !e underlying cause o& !ypoglycemia% -or more de ails on causes, re&er o causes o& !ypoglycemia% Hypoglycemia can occur in any age group or popula ion% .epending on !e cause, !ypoglycemia can be s!or ) erm and disappear /uickly, suc! as w!en !ypoglycemia occurs a& er a single episode o& o$er)e*ercising bu is /uickly rea ed by ea ing a meal% Hypoglycemia can also recur o$er a longer period o& ime, suc! as w!en !ypoglycemia is due o kidney disease or li$er disease%

(YMP0OM( (ymp oms o& low blood sugar "!ypoglycemia# 1 1 1 1 1 1 1 1 1 2er$ousness 3eakness Hunger Lig! !eadedness or di44iness 0rembling (wea ing 5apid !ear bea -eeling cold and clammy Irri abili y

1 1 1 1 1

Con&usion .rowsiness (lurred speec! .ouble $ision In se$ere cases, loss o& consciousness, sei4ures, and e$en coma

(e$ere !ypoglycemia !a is no rea ed /uickly can lead o unconsciousness and e$en dea ! in e* reme un rea ed cases% .IAG2O(I( Hypoglycemia is easy o diagnose during a rou ine o&&ice $isi wi ! a simple blood es , called a &as ing blood glucose es % Hypoglycemia is generally de&ined as !a$ing a &as ing blood sugar le$el o& less !an 66mg7dL% In an emergency, !ypoglycemia can be /uickly diagnosed on a random blood glucose es % Making a diagnosis generally also includes per&orming a $arie y o& es s o !elp o diagnose po en ial underlying diseases, condi ions or disorders and e$alua e o$erall !eal !% 8lood es s can include a comple e blood coun "C8C#, c!emis ry panel, urinanalysis, and li$er &unc ion es s% .epending on !e suspec ed cause, es s may also include special imaging es s, suc! as 9)ray, nuclear imaging, C0 scan and7or M5I%

05EA0ME20 0rea men o& !ypoglycemia in$ol$es inges ing &oods and7or &luids !a con ain glucose% In se$ere and emergency cases, glucose may be gi$en $ia in ramuscular in:ec ion or in ra$enously% 0!e underlying diseases, disorders and condi ions also re/uire rea men o pre$en or minimi4e &u ure episodes o& !ypoglycemia% Oral in ake o& glucose;edi < 0!e blood glucose can usually be raised o normal wi !in minu es wi ! +6)=> grams o& carbo!ydra e, al !oug! o$er rea men s!ould be a$oided i& a all possible% I can be aken as &ood or drink i& !e person is conscious and able o swallow% 0!is amoun o& carbo!ydra e is con ained in abou ?)@ ounces "+>>)+=> mL# o& orange, apple, or grape :uice, abou @)6 ounces "+=>)+6> mL# o& regular "non)die # soda, abou one slice o& bread, abou @ crackers, or abou + ser$ing o& mos s arc!y &oods% ( arc! is /uickly diges ed o glucose, bu adding &a or pro ein re ards diges ion% Composi ion o& !e rea men s!ould be considered, as &rui :uice is ypically !ig!er in &ruc ose w!ic! akes !e body longer o me aboli4e !an simple de* rose alone% -ollowing rea men , symp oms s!ould begin o impro$e wi !in 6 o +> minu es, al !oug! &ull reco$ery may ake +>A=> minu es% I s!ould be no ed !a o$er rea men does no speed reco$ery,

and will simply produce !yperglycemia a& erwards, w!ic! ul ima ely will need o be correc ed%

In ra$enous glucose;edi < I& a person canno recei$e oral glucose gel or able s, suc! as !e case wi ! unconsciousness, sei4ures, or al ered men al s a us, !en emergency personnel "EM0s7Paramedics and in)!ospi al personnel# can es ablis! a perip!eral or cen ral IB line and adminis er a solu ion con aining de* rose and saline% 0!ese are normally re&erred o as .e* rose "Concen ra ion# 3a er, and come in 6C, +>C, =6C and 6>C% .e* rose 6C and +>C come in IB bag and syringe &orm, and are mainly used in in&an s and o pro$ide a &luid medium &or medica ions% .e* rose =6C and 6>C are !ea$ily necro ic due o !eir !yperosmolari y, and s!ould only be gi$en !roug! a pa en IB line ) Any in&il ra ion can cause massi$e issue necrosis% CA'0IO2D .e* rose =6C and 6>C can easily cause necrosis in small $eins% I is M'CH sa&er o use a .e* rose +>C solu ion w!en rea ing !ypoglycemia $ia IB in c!ildren under !e age o& +@% 3!en using .e* rose =6C in a c!ild i is sa&er o adminis er i !roug! a cen ral line or an in ra) oseous line%;ci a ion needed<

Glucagon;edi < Glucagon is a !ormone !a rapidly coun ers !e me abolic e&&ec s o& insulin in !e li$er, causing glycogenolysis and release o& glucose in o !e blood% I can raise !e glucose by ?>A+>> mg7dL wi !in minu es in any &orm o& !ypoglycemia caused by insulin e*cess "including all ypes o& diabe ic !ypoglycemia#% I comes in a glucagon emergency rescue ki w!ic! includes iny $ials con aining + mg, w!ic! is a s andard adul dose% 0!e glucagon in !e $ial is a lyop!ili4ed pelle , w!ic! mus be recons i u ed wi ! + mL o& s erile wa er, included in !e Eki E% In !e widely used Lilly Emergency Fi , !e wa er is con ained in a syringe wi ! a large needle &or in ramuscular in:ec ion and mus be in:ec ed in o !e $ial wi ! !e pelle o& glucagon be&ore being in:ec ed% Glucagon works i& gi$en subcu aneously, bu absorp ion and reco$ery are &as er i& i is in:ec ed deep in o a muscle "usually !e middle o& !e ou side o& !e !ig!#% I !as an e$en more rapid e&&ec w!en gi$en in ra$enously bu !is is rarely prac icable% (ide e&&ec s o& glucagon can include nausea and !eadac!e, bu !ese can also occur a& er se$ere !ypoglycemia e$en w!en glucagon is no used% 5isks o& glucagon use are &ar lower !an risks o& se$ere !ypoglycemia, and i can usually produce a &as er reco$ery !an calling &or paramedics and wai ing &or !em o s ar an in ra$enous line o gi$e de* rose% I& someone uses !is ki , !ey s!ould be seen in an emergency room, as glucagon deple es glycogen s ores, and can lead o a deadly rebound !ypoglycemia%

In !e 'ni ed ( a es, caregi$ers &or pa ien s wi ! 0ype + diabe es are ins ruc ed o !a$e

an une*pired glucagon emergency ki on !and a all imes%;G<

A number o& companies are de$eloping glucagon in:ec ion de$ices wi ! !e goal o& simpli&ying adminis ra ion &or caregi$ers and pa ien s during se$ere !ypoglycemic e$en s% -or many, !e curren s andard o& care " !e glucagon emergency ki # is burdensome and no caregi$er or pa ien )&riendly due o !e mul iple s eps re/uired o adminis er !e drug, especially during an emergency si ua ion%;H< 0o impro$e !ypoglycemia rea men , many companies are de$eloping more e&&icien glucagon deli$ery solu ions% 9eris P!armaceu icals, Inc% is de$eloping !e Glucagon 5escue Pen or G)Pen using a pa en ed non)a/ueous &ormula ion o& glucagon !a is room) empera ure s able, low)$olume, and pre)mi*ed in an au o)in:ec able de$ice "similar o an EpiPen# !a akes !e in:ec ion process down o wo s eps "as opposed o nine s eps wi ! glucagon emergency ki s curren ly on !e marke #%;I< (imilarly, GlucaPen, an au oin:ec or in de$elopmen by En:ec , Inc% promises o simpli&y !e deli$ery o& glucagon% ;J<