Hypoglycemia
is the condition in which a patient’s glucose levels are significantly lower
than normal. In fact, neonatal hypoglycemia is a common condition. These common
condition in neonatal patients is associated with brain injury and on the rise
due to preterm birth and maternal diabetes. The widely accepted definition of hypoglycemia
is a blood glucose concentration of <2.6 mmol/L. This value is suspected to
associated with the altered brain function and possible delayed development neurologically.
The prior
and common management of hypoglycemia is increased feeding, and supplemental infant
formal, or IV dextrose, a simple carbohydrate. However, a downside to
supplemental formal is that this may disrupt breast feeding which is recommended
for all infants at minimum up to six months. The IV treatment is quite
expensive and requires separation of mother and infant. Furthermore, these IV treatments
are not available in resource-poor setting and in settings providing lower
levels of perinatal care. Carbohydrates are low within breastmilk on the first
few days thus formal milk also provides a more effective treatment for neonatal
hypoglycemia.
Dextrose
gel is a simple carbohydrate, dextrose, within an aqueous solution. This gel
can be directly applied to mucosal surface allowing for rapid access to circulation.
Dextrose gel is widely available and has shown to be effective in the treatment
of neonatal hypoglycemia. Offering a more affordable treatment for hypoglycemia. Dextrose may be administered directly to mucosal
surfaces within the mouth such as the buccal and lingual surfaces. Not only
does dextrose gel provided rapid access to circulation but a small proportion
of the dose may be swallowed. The swallowed dextrose may be absorbed within the
gastrointestinal tract. Dextrose works by bypassing the portal circulation providing
a more rapid access to circulation. This rapid absorption allows the glucose in
dextrose to be take up by liver through the portal circulation thus directly
influencing the blood glucose concentration bringing them back up to normal.
Weston, P. J., Harris, D. L., Battin, M., Brown, J., Hegarty,
J. E., & Harding, J. E. (2016). Oral dextrose gel for the treatment of hypoglycaemia in newborn
infants. The Cochrane database of systematic reviews, (5), CD011027.
https://doi.org/10.1002/14651858.CD011027.pub2
Hi Brooke, great post! As we have mostly covered hyperglycemia in class, it was interesting to hear potential treatments for hypoglycemia in newborn infants. In doing so, I was curious about the treatment of hypoglycemia in adults. Upon further research, the traditional method for combating hypoglycemia in adults is to follow the “15-15 rule”. If your blood sugar is below 70 mg/dL, you should consume 15 grams of carbohydrates such as 4 ounces of juice or a tablespoon of honey. After 15 minutes, the patient should then check their blood sugar again to see if it is above or below 70 mg/dL, to which if it’s still below they will repeat the process until it’s above. Following this rule is extremely important, as many people tend to want to eat as much as possible until they feel better. However, if patients continue to eat until they feel better, their blood sugar levels could easily shoot up into hyperglycemic ranges
ReplyDeleteAs you mentioned, IV treatment is also available to combat severe hypoglycemia. If continued tries of the 15-15 rule is unsuccessful in raising your blood glucose levels to over 70 mg/dL, the patient would need to get IV or injectable glucagon into their system. As discussed in both biochemistry and physiology, administering glucagon directly into the bloodstream stimulates the body to create glucose via gluconeogenesis and glycogenolysis. As a result, the creation of glucose from other metabolic intermediates is able to raise the blood sugar to over 70 mg/dL, and the patient will no longer have the symptoms of hypoglycemia such as feeling anxious, nervous and weak.
https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia