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Fasting for Laboratory Tests Poses a High Risk of hypoglycemia in Patients with Diabetes: A Pilot Prevalence Study in Clinical Practice

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International Journal of Clinical Medicine 2016年第10期7卷 653-667页

作者： Saleh Aldasouqi William Corser George S. Abela Samia Mora Keren Shahar Preethi Krishnan Farhan Bhatti Andrew Hsu Dane Gruenebaum Division of Endocrinology Department of Medicine Michigan State University (MSU) College of Human Medicine (CHM) East Lansing MI and Sparrow Health System Lansing MI USA Michigan State University Statewide Campus System College of Osteopathic Medicine East Lansing MI USA Division of Cardiology Department of Medicine MSU-CHM East Lansing MI USA Division of Preventive Medicine Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston MA USA Internal Medicine Residency Program Department of Medicine MSU-CHM East Lansing MI and Sparrow Health System Lansing MI USA Family Medicine Residency Program Department of Family Medicine MSU-CHM East Lansing MI and Sparrow Health System Lansing MI USA Care Free Clinic Lansing MI USA MSU College of Science East Lansing MI USA Corpus Christi Medical Center Corpus Christi TX USA

Objective: Fasting for lipid profiles is a deeply-rooted tradition that is being revisited. In patients with diabetes, such fasting poses a risk of hypoglycemia, as observed in recent studies and case reports. This iatrogenic, overlooked, form of hypoglycemia has been referred to as Fasting-Evoked En-route hypoglycemia in Diabetes (FEEHD). The objective of the study is to determine the prevalence of FEEHD in clinical practice. Methods: A two-page survey was administered to adults with diabetes on anti-diabetic medication(s). Patients were asked if they recalled having experienced hypoglycemia while fasting for laboratory tests (FEEHD) during the preceding 12 months. Results: Of 168 patients enrolled, 166 completed the survey, with a mean age of 55.3 (SD: 15.4) years. Seventy-nine (47.6%) were females. Of these 166 patients, 119 (71 %) had type 2 diabetes. Forty-five patients (27.1%) reported having experienced one or more FEEHD events. Notably, only 31.1% of the patients who experienced a FEEHD event informed their provider of the event, and only 40% of FEEHD events reportedly resulted in any subsequent provider-made medication change(s) to prevent future events. Conclusions: This is the first study of FEEHD prevalence in clinical practice, the results of which serve to increase awareness amongst clinicians about the occurrence of FEEHD. We believe that FEEHD appears to be overlooked by clinicians. The prevalence of FEEHD in clinical practice is strikingly high (27.1%). More concerning is the significant underreporting of FEEHD events by patients to their clinicians (31%). We hope this study will trigger further investigation to confirm these preliminary findings and modify practice guidelines.

关键词： Fasting Lipids Glucose hypoglycemia Lipid Profiles Nonfasting FEEHD

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Assessing Knowledge of hypoglycemia Symptoms among Type 2 Diabetic Patients Using Insulin, Khartoum, Sudan

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Pharmacology & Pharmacy 2019年第1期10卷 21-30页

作者： Abdelhaleem Mustafa Madani Asma Noureldaim Mahmoud Hisham Mohammed Abdelrahim Tarig Mohammed El-Hadiyah Abubakr Khidir Yousif Pharmacology Department Faculty of Pharmacy International University of Africa Khartoum Sudan Department of Pharmacy Practice Faculty of Pharmacy International University of Africa Khartoum Sudan University of National Ribat Khartoum Sudan Department of Pharmacology Faculty of Pharmacy International University of Africa Khartoum Sudan Ministry of Health Wadmadani City Sudan

Background: hypoglycemia is a traumatic dilemma that has a critical impact on not only the patient’s quality of life but also their families and communities. Improving Patient’s awareness and knowledge regarding hypoglycemia symptoms is crucial to avoid serious implications like loss of consciousness and even death. Objective: This study aimed to assess patients’ knowledge of hypoglycemia symptoms and source of diabetes information among insulin users type 2 diabetes. Methods: A single centre, hospital-based, analytical, and cross-sectional study was carried out among diabetic patients using insulin attended to Ribat University Hospital Diabetes Clinic (RUHDC), Khartoum State, Sudan during a period of study. A validated questionnaire was used to obtain socio-demographic characteristics of respondents and the patients’ knowledge regarding hypoglycemia symptoms was assessed whether good, medium or poor. Data were analyzed, using (SPSS). Descriptive (frequencies) and inferential statistics (association used chi-square) were used at a level of confidence p ≤ 0.05. Results: A majority of patients (52%) had poor knowledge of hypoglycemia symptoms and the common symptoms known to patients were hands tremor (67.2%), blurred vision (52.8%) and sweating (65.6%). No associations were found among hypoglycemia symptoms knowledge, socio-demographic and diabetes duration. Only (25.6%) had regular visiting to educating center and physicians were the major source of diabetes knowledge (74.4%). Conclusion: This study proved low patients hypoglycemia symptoms knowledge and physician were the main sources of information about diabetes at RUHDC. Further ideas are required in collaboration and integrated approach to filling the gap of patients’ awareness and multidisciplinary team in diabetes management.

关键词： hypoglycemia Symptoms Knowledge Type 2 Diabetes Insulin-Users Sudan

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Causes of Fasting-Evoked en Route hypoglycemia in Diabetes (FEEHD): A Case Series Study

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International Journal of Clinical Medicine 2012年第7期3卷 751-757页

作者： Saleh Aldasouqi Ved Gossain Matthew Hebdon Archana Reddy Jose Goldman Sameer Ansar Bhavini Bhavsar Department of Medicine Michigan State University College of Human Medicine East Lansing Michigan USA

Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. Objective: To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. Methods and Patients: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospective case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012. Results: The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and contributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided. Conclusion: Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevented by proper education and preparation.

关键词： Fasting hypoglycemia Hypoglycemic Agents Laboratory tests FEEHD

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Beliefs and Experiences of Fear of hypoglycemia and Use of Uncooked Cornstarch before Bedtime in Persons with Type 1-Diabetes

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Open Journal of Nursing 2018年第11期8卷 795-810页

作者： Therese Anderbro Erik Moberg Ulf Adamson Per-Eric Lins Unn-Britt Johansson Stockholm University Department of Psychology Stockholm Sweden Karolinska Institutet Department of Clinical Sciences Danderyd Hospital Stockholm Sweden Karolinska Institutet Department of Medicine Karolinska University Hospital Huddinge Stockholm Sweden Sophiahemmet University Stockholm Sweden Karolinska Institutet Department of Clinical Sciences and Education S&#246 dersjukhuset Stockholm Sweden

Introduction: Among persons living with type 1-diabetes hypoglycemia and fear of hypoglycemia remain limiting barriers for achieving optimal glucose control and a good quality of life. Fear of hypoglycemia has been found stable over time if not treated. Uncooked cornstarch has been found to reduce the risk of hypoglycemia but has not been studied in relation to fear of hypoglycemia. The aims of this study were to through clinical data, self-reported measures and clinical interviews explore subjects’ experience of using uncooked cornstarch before bedtime and their beliefs and experiences of fear of hypoglycemia. Methods: Mixed methods with both quantitative and qualitative data were used. Self-reported measures of hypoglycemia and fear of hypoglycemia were compared to subjects’ responses during a clinical interview. The interviews were analyzed with a functional behavior analytical approach. Results: A total of five subjects took part in the study. One subject perceived the uncooked cornstarch helpful in reducing hypoglycemia. Several subjects could recall frightening hypoglycemic episodes triggering their fear. Three out of the five subjects reported avoidance behaviors such as excessive self-monitoring of blood glucose or overeating related to fear of hypoglycemia. Conclusions: The uncooked cornstarch was found appetizing but was not perceived as having an effect on BG or hypoglycemia frequency. The clinical interviews confirmed previous research regarding experience of hypoglycemia and fear of hypoglycemia.

关键词： Adults Fear of hypoglycemia Experiences Type 1 Diabetes Uncooked Cornstarch

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Phytochemical screening and evaluation of cytotoxic and hypoglycemic properties of Mangifera indica peels

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Asian Pacific Journal of Tropical Biomedicine 2017年第1期7卷 49-52页

作者： Sabiha Chowdhury Saikat Kumar Poddar Sarah Zaheen Farah Ashrafi Noor Najneen Ahmed Sanjana Haque Abhijit Sukul Sauda Binte Sunjida MdMahabob Ullah Mazumder Nusrat Akbar Department of Clinical Pharmacy and Pharmacology Faculty of PharmacyUniversity of DhakaDhakaBangladesh Department of Pharmacy BRAC UniversityDhakaBangladesh

Objective: To investigate the presence of different phytoconstituents in Mangifera indica(M. indica) peel and evaluate its cytotoxicity to Artemia salina and hypoglycemic potential in Swiss albino mice.Methods: The methanolic extract of M. indica peel was used to determine the presence of phytoconstituents. Brine shrimp lethality bioassay method was followed to determine the cytotoxic potential of plant extract. In the case of hypoglycemic activity, oral administration of extract at 200 and 400 mg/kg and standard glibenclamide at 10 mg/kg was done, followed by determining the percentage of reduction of plasma glucose from the initial level.Results: The methanolic extract of M. indica peel showed the presence of flavonoid,saponin, steroid, tannins, terpenoids, glycosides and alkaloids. In brine shrimp lethality bioassay, the LC_(50) of the extract and standard vincristine sulfate was found to be 2.04 and0.41 mg/mL, respectively. After 90 and 150 min, the methanolic extract at 200 and 400 mg/kg showed prominent plasma glucose reduction of 13.95%, 22.48% and 14.16%,26.18% respectively compared to standard glibenclamide showing 14.90% and 20.67% plasma glucose reduction.Conclusions: This current research affirms prominent cytotoxic and moderate hypoglycemic potential of M. indica peel. Further bioactivity guided isolation of phytoconstituents and investigation on higher animals can lead to development of new drug molecules.

关键词： Mangifera indica Cytotoxicity hypoglycemia Phytoconstituents

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Hypoglycemic Activity of Jatrorrhizine

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2005年第5期25卷 491-493页

作者：付燕胡本容汤强付琴向继洲 Department of Pharmacology School of Basic Medical Sciences Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China

Summary： The hypoglycemic activity and its mechanism of Jatrorrhizine （Jat） were studied. The normal mice and alloxan-induced hyperglycemic mice were given with different doses of Jat. Blood glucose and liver glycogen levels were determined by spectrophotometry with glucose-oxidase and iodine reagents respectively. The levels of blood lactic acid （LC） and liver lactate dehydrogenase （LDH） activity were measured to explore the effect of Jat on anaerobic glycolysis. Succinate dehydrogenase （SDH） activity in liver was measured to evaluate the effect of Jat on aerobic glycolysis in liver. It was found that Jat （50 mg/kg, 100 mg/kg） could significantly decrease blood glucose level in a dose- and time-dependent manner in both normal and alloxan-diabetic mice, increase the activity of SDH, but had no significant effects on the LC level and LDH activity. Jat could significantly reduce the content of liver glycogen in normal mice. Moreover, Jat could inhibit the platelet aggregation in rabbits in vitro in a dose-effect relationship. It was concluded that Jat induced the pronounced decrease in blood glucose in normal and hyperglycemic mice. The hypoglycemic activity of Jat may be attributed to the enhancement of aerobic glycolysis.

关键词： jatrorrhizine hypoglycemia blood glucose succinate dehydrogenase liver glycogen platelet aggregation

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PEG-rhG-CSF Use Reduces Glucose Level Significantly in Cancer Patients Receiving Chemotherapy Short title:hypoglycemia secondary to PEG-rhG-CSF use

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Proceedings of Anticancer Research 2020年第6期4卷 32-35页

作者： Shasha Cui Xinqiang Liu Dayan Zhang Lu Zhang Ying Wang Department of Lab Medicine Binzhou People’s HospitalBinzhouShandongChina Department of Oncology Binzhou People’s HospitalBinzhouShandongChina Department of General surgery Binzhou People’s HospitalBinzhouShandongChina

Background:In patients receiving anticancer chemotherapy,polyethylene glycolated recombinant human granulocyte-colony stimulating factor(PEG-rhG-CSF)was used for prophylaxis of chemotherapy-induced neutropenia.However,the side effect of PEG-rhG-CSF use on fasting blood glucose(FBG)level remains unclear.Materials and Methods:Cancer patients receiving chemotherapy and PEG-rhG-CSF were enrolled in our study.Baseline glucose(Glucose 1)was measured before PEG-rhG-CSF use,a second FBG test(Glucose 2)was performed after PEG-rhG-CSF use.Mean glucose levels were compared using t test.Results:The time interval between PEG-rhG-CSF use and the second glucose test was 2.4±1.5 days.The mean Glucose 1 was 5.18±0.53 mmol/L,and Glucose 2 was 3.80±1.13 mmol/L.Statistical analysis showed a significant difference between Glucose 1 and 2 existed(P<0.001).Conclusion:Our study identifies a hypoglycemic side effect of PEG-rhG-CSF occurs in cancer patients undergoing anti-cancer chemotherapy.Our results highlight the caution required when using PEG-rhG-CSF for prophylaxis of chemotherapyinduced neutropenia.

关键词： hypoglycemia PEG-rhG-CSF Complication Chemotherapy Cancer

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Pancreatic neuroendocrine tumor with hypoglycemia and elevated insulin-like growth factor II:a case report

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Journal of Cancer Metastasis and Treatment 2016年第1期2卷 345-347页

作者： Roberta Modica Antonella Di Sarno Annamaria Colao Antongiulio Faggiano Department of Clinical Medicine and Surgery Federico II University80131 NaplesItaly UOC of Oncology A.O.Dei ColliMonaldi Unit80131 NaplesItaly Thyroid and Parathyroid Surgery Unit Istituto Nazionale per lo studio e la cura dei tumori“Fondazione G.Pascale”-IRCCS80131 NaplesItaly

Pancreatic neuroendocrine tumors(pNETs)can be associated with different clinical syndromes.Insulinoma is the most common functioning pNET characterized by hypoglycemia and hyperinsulinemia.The authors report a case of a man presenting with hypoglycemia and biochemical features of insulinoma.A pancreatic lesion was found and growth hormone(GH)deficiency was also diagnosed associated with an empty sella present on the pituitary magnetic resonance imaging.The disappearance of hypoglycemia and normalization of GH secretion after surgical resection of the pancreatic lesion,revealed a rare pNET secreting insulin-like growth factor II.

关键词： Pancreatic neuroendocrine tumor insulinoma hypoglycemia insulin-like growth factor II

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Sulfonylurea Induced Severe hypoglycemia in a Diabetic with Renal Failure— A Case Report

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Journal of Biosciences and Medicines 2015年第11期3卷 68-70页

作者： Abdul H. Zaid Sunil Sapru Jennifer Costello Chirag Boradia Saint Barnabas Medical Center Livingston USA

Introduction: Persistent hypoglycemia in the setting of acute renal insufficiency while on sulfonylureas is potentially a life-threatening complication. A case of severe hypoglycemia in a diabetic with acute on chronic renal insufficiency while on glimepiride is described here. Case Report: A seventy-six years old man presented to our emergency department with gradually progressive generalized weakness, dyspnea on exertion and lightheadedness. His medical history included congestive heart failure, hypertension and chronic kidney disease from non-insulin dependent diabetes. He reported good compliance with his medications which included glimepiride, 2 mg daily. Patient’s spouse reported a blood sugar reading of 22 mg/dL at home which prompted the emergency department visit. On presentation, the patient was tachycardic, tachypneic and diaphoretic. Initial glucose meter reading was found to be 36 mg/dL and a blood glucose level on the metabolic panel was 49 mg/dL. Patient serum creatinine was 2.5 mg/dL, increased from a baseline of 1.8 mg/dL. While in the emergency room, the patient received 50% dextrose intravenously eventually requiring an intravenous infusion of 10% dextrose. Despite this treatment, the patient remained persistently hypoglycemic with blood sugars less than 80 mg/dL. A decision was made at this point to administer 50 micrograms of octreotide subcutaneously. Two hours later, the patient’s blood sugar started to improve and the intravenous 10% dextrose was discontinued. Eight hours later, the patient received another dose of 50 micrograms of octreotide and remained consistently euglycemic. Upon discharge, he was asked to discontinue glimepiride. Conclusion: Severe refractory hypoglycemia is a serious complication of sulfonylurea therapy in diabetics with renal insufficiency. Prompt recognition and initiation of octreotide are effective in reversing hypoglycemia in these instances rapidly and safely.

关键词： Persistent hypoglycemia Chronic Renal Insufficiency

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Syncope and hypoglycemia

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International Journal of Clinical Medicine 2011年第2期2卷 129-132页

作者： Alfonso Lagi 不详

Objective: This review focuses on syncope in diabetic patients who suffer from hypoglycemia. Clinically, transient loss of consciousness during hypoglycemia appears similar to vasovagal syncope. Research Design and Methods: Current understanding of this problem is based on physicians’ personal experiences as well as on published case reports. It is difficult to explain a temporary loss of consciousness as a result of hypoglycemia. Demonstration that hypoglycemia can be transient, with the patient suffering from neuroglycopenia without autonomic symptoms due to delayed counterregulation, might be a first step in confirming that a diabetic patient suffered from a transient loss of consciousness with spontaneous recovery. Results: Hypoglycemic syncope is uncommon, affecting 1.9% of diabetic patients using insulin therapy. It is characterized clinically by brief periods of unconsciousness with slow recovery and without loss of postural muscle tone. The difficulty in correlating loss of consciousness to hypoglycemia arises from mismatching symptoms, that is, there may be mental symptoms such as confusion, loss of memory or consciousness, in the absence of autonomic manifestations such as sweating or blurred vision. There are currently no established glucose values that define the level of hypoglycemia that causes loss of consciousness. Conclusion: Hypoglycemic syncope should be suspected in older diabetic patients with preserved postural tone, usually but not always using insulin therapy, who show a slow recovery from transient loss of consciousness with persisting neurological impairment and low blood glucose levels.

关键词： Syncope Diabetes hypoglycemia Transient Loss of Consciousness

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