Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.L...Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.展开更多
The interplay between glucose metabolism and that of the two other primary nutrient classes, amino acids and fatty acids is critical for regulated insulin secretion. Mitochondrial metabolism of glucose, amino acid and...The interplay between glucose metabolism and that of the two other primary nutrient classes, amino acids and fatty acids is critical for regulated insulin secretion. Mitochondrial metabolism of glucose, amino acid and fatty acids generates metabolic coupling factors(such as ATP, NADPH, glutamate, long chain acyl-CoA and diacylglycerol) which trigger insulin secretion. The observation of protein induced hypoglycaemia in patients with mutations in GLUD1 gene, encoding the enzyme glutamate dehydrogenase(GDH) and HADH gene, encoding for the enzyme short-chain 3-hydroxyacyl-CoA dehydrogenase has provided new mechanistic insights into the regulation of insulin secretion by amino acid and fatty acid metabolism. Metabolic signals arising from amino acid and fatty acid metabolism converge on the enzyme GDH which integrates both signals from both pathways and controls insulin secretion. Hence GDH seems to play a pivotal role in regulating both amino acid and fatty acid metabolism.展开更多
Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication ...Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication with limited study of its burden, knowledge, determinants and preventive measures adopted by type 2 diabetics. Methods: Patients with type 2 diabetes who presented at Diabetes Clinic of a University teaching hospital and fulfilled selection criteria were recruited. The information obtained included sociodemographic, clinical details with hypoglycaemic symptoms and laboratory measurements. Results: There were 113 participants with a mean age of 60.94 ± 11.95 years. The majority of the patients had fair knowledge of hypoglycaemic symptoms and also knew what actions to take to ameliorate the symptoms when it occurs. The incidence of hypoglycaemia was 45.1% and most commonly occurred in the afternoon before lunch. The commonest symptoms reported by patients were shivering (76.1%), hunger (71.7%) sweatiness (71.5%) and weakness (69.9%). Almost one-fifth (19.6%) of those who reported hypoglycaemia had severe symptoms, of which 16.1% had hospital admission for its management. Use of insulin, duration of diabetes, age and possession of glucometers were some of the determinants of hypoglycaemic symptoms. Conclusions:?The burden of reported hypoglycaemia among type 2 diabetics is significant. Hence, diabetics at risk should always be asked about symptoms at each clinic visit. Early recognition of hypoglycaemia risks, self-monitoring of blood glucose (SMBG), appropriate education programs for both health care providers and patients with diabetes are the major ways to minimize risks of hypoglycaemia.展开更多
The relationship between Nigerian Bonny Light crude oil (NBLCO) induced hypoglycaemia and endogenous serum insulin concentration;the role of antioxidant vitamin C or E supplementation was the focus of this study. Fort...The relationship between Nigerian Bonny Light crude oil (NBLCO) induced hypoglycaemia and endogenous serum insulin concentration;the role of antioxidant vitamin C or E supplementation was the focus of this study. Forty adult male Wistar rats were randomly divided into group I, which served as the control, group II, which was oral gavaged 6 ml/kg of NBLCO, groups III and IV, which were in addition to 6 ml/kg of NBLCO supplemented with 9 ml/kg and 1 mg/kg of vitamin E or C, respectively for 28 days. Results showed that NBLCO significantly (p < 0.05) lower body weight and food intake compared with control. These effects exerted by NBLCO were however significantly (p < 0.05) reversed by vitamin E or C supplementation. The NBLCO significantly (p < 0.05) reduced fasting blood glucose (FBG) when compared with control, the antioxidant vitamins supplementation significantly (p < 0.05) reversed the crude oil effect. The mean serum insulin level in NBLCO, vitamin E or C supplemented groups is not significantly different from the control. There was no significant correlation between FBG and fasting serum insulin concentrations in all the groups on day 28. It has been demonstrated in this study that direct oral ingestion of crude oil (NBLCO) could reduce food intake, body weight and cause hypoglycemia;the hypoglycemia may not be a function of serum insulin concentration. Interestingly, the hazardous effects of NBLCO could be ameliorated with antioxidant vitamin C or E supplementation.展开更多
Background: Neonatal hypoglycaemia is the most common metabolic abnormality in neonates and is associated with neurological damage and death when it occurs during the first few days of life. The main objective of this...Background: Neonatal hypoglycaemia is the most common metabolic abnormality in neonates and is associated with neurological damage and death when it occurs during the first few days of life. The main objective of this study was to determine the prevalence of hypoglycaemia in the newborn and the associated maternal/neonatal risk factors. Setting and Methods: This prospective descriptive study was conducted at the labour room and the Special Care Baby Unit of Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria, between July 2017-March 2018. Results: Of the 168 neonates, 140 (83.3%) were delivered in the hospital and 28 (16.7%) were delivered outside the hospital. Hypoglycaemia was found in 19 (11.0%) of the neonates. The mean (standard deviation) of gestational age was 37.8 (3.0) weeks. 91 (54.2%) were males and 77 (45.8%) were females. Male to female ratio is 1.2:1. A significantly higher proportion of 9 (32.1%) out born compared with 10 (7.1%) of inborn, 4 (44.4%) of birth 1500 g compared with 5 (22.7%) birth weight 1500 g - 2499 g and 10 (7.3%) of birth weight ≥ 2500 g and 7 (22.6%) of babies with temperature ≤ 36.5°C compared with 7 (6.3%) of temperature 36.5°C - 37.5°C and 5 (19.2%) of temperature > 37.5°C, demonstrated hypoglycaemia respectively. Neonatal risk factors, such as, prematurity, low birth weight and respiratory distress syndrome, were significantly associated with hypoglycaemia p-value of 0.02, 0.01 and 0.00 respectively. There were no statistically significant associations between maternal risk factors and hypoglycaemia. The common presenting symptoms were jitteriness,展开更多
In January 2006, the Canisius-Wilhelmina Hospital introduced the concept of Single Room Maternity Care (SMRC) by realizing 13 labour rooms for mother, infant and partner. Benefits of this new care concept not only inc...In January 2006, the Canisius-Wilhelmina Hospital introduced the concept of Single Room Maternity Care (SMRC) by realizing 13 labour rooms for mother, infant and partner. Benefits of this new care concept not only include maternal satisfaction and increased staff satisfaction, but also significant health benefits for the neonate. Since the introduction of the concept, we registered a sharp decrease in the number of hypoglycaemias (from 15.6% in 2005 to 2.5% in 2009). Varying causes, such as successful breastfeeding and/or improved attachment between mother and infant may contribute to the decrease of hypoglycaemias.展开更多
We report a case of a patient presenting with profound insulin-independent hypoglycaemia. A large hepatic leasion was identified and surgically resected. Histology confirmed a 17.5 cm hepatic solitary fibrous tumour. ...We report a case of a patient presenting with profound insulin-independent hypoglycaemia. A large hepatic leasion was identified and surgically resected. Histology confirmed a 17.5 cm hepatic solitary fibrous tumour. The clinical and biochemical presentation is consistent with IGF-II mediated hypoglycaemia.展开更多
The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 year...The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.展开更多
Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly em...Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly employed capillary BG monitoring is convenient and rapid,it is inaccurate and prone to high bias,overestimating BG levels in critically ill patients.The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach.Each of these has its own fallacies,while tight control increases risk of hypoglycemia,liberal BG targets make the patients prone to hyperglycemia.Moreover,the recent evidence suggests that BG indices,such as glycemic variability and time in target range,may also affect patient outcomes.In this review,we highlight the nuances associated with BG monitoring,including the various indices required to be monitored,BG targets and recent advances in BG monitoring in critically ill patients.展开更多
In neonates, persistent hyperinsulinemic hypoglycemia (PHH) is associated with nesidioblastosis. In adults, PHH is usually caused by solitary benign insulinomas. We report on an adult patient who suffered from insulin...In neonates, persistent hyperinsulinemic hypoglycemia (PHH) is associated with nesidioblastosis. In adults, PHH is usually caused by solitary benign insulinomas. We report on an adult patient who suffered from insulin-de- pendent diabetes mellitus, and subsequently developed PHH caused by diffuse nesidioblastosis. Mutations of the MEN1 and Mody 2/3 genes were ruled out. Preoperative diagnostic procedures, the histopathological criteria and the surgical treatment options of adult nesidioblastosis are discussed. So far only one similar case of adult nesidioblastosis subsequent to diabetes mellitus Ⅱ has been reported in the literature. In case of conversion of diabetes into hyperinsulinemic hypoglycemia syndrome, nesidioblastosis in addition to insulinoma should be con- sidered.展开更多
文摘Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.
文摘The interplay between glucose metabolism and that of the two other primary nutrient classes, amino acids and fatty acids is critical for regulated insulin secretion. Mitochondrial metabolism of glucose, amino acid and fatty acids generates metabolic coupling factors(such as ATP, NADPH, glutamate, long chain acyl-CoA and diacylglycerol) which trigger insulin secretion. The observation of protein induced hypoglycaemia in patients with mutations in GLUD1 gene, encoding the enzyme glutamate dehydrogenase(GDH) and HADH gene, encoding for the enzyme short-chain 3-hydroxyacyl-CoA dehydrogenase has provided new mechanistic insights into the regulation of insulin secretion by amino acid and fatty acid metabolism. Metabolic signals arising from amino acid and fatty acid metabolism converge on the enzyme GDH which integrates both signals from both pathways and controls insulin secretion. Hence GDH seems to play a pivotal role in regulating both amino acid and fatty acid metabolism.
文摘Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication with limited study of its burden, knowledge, determinants and preventive measures adopted by type 2 diabetics. Methods: Patients with type 2 diabetes who presented at Diabetes Clinic of a University teaching hospital and fulfilled selection criteria were recruited. The information obtained included sociodemographic, clinical details with hypoglycaemic symptoms and laboratory measurements. Results: There were 113 participants with a mean age of 60.94 ± 11.95 years. The majority of the patients had fair knowledge of hypoglycaemic symptoms and also knew what actions to take to ameliorate the symptoms when it occurs. The incidence of hypoglycaemia was 45.1% and most commonly occurred in the afternoon before lunch. The commonest symptoms reported by patients were shivering (76.1%), hunger (71.7%) sweatiness (71.5%) and weakness (69.9%). Almost one-fifth (19.6%) of those who reported hypoglycaemia had severe symptoms, of which 16.1% had hospital admission for its management. Use of insulin, duration of diabetes, age and possession of glucometers were some of the determinants of hypoglycaemic symptoms. Conclusions:?The burden of reported hypoglycaemia among type 2 diabetics is significant. Hence, diabetics at risk should always be asked about symptoms at each clinic visit. Early recognition of hypoglycaemia risks, self-monitoring of blood glucose (SMBG), appropriate education programs for both health care providers and patients with diabetes are the major ways to minimize risks of hypoglycaemia.
文摘The relationship between Nigerian Bonny Light crude oil (NBLCO) induced hypoglycaemia and endogenous serum insulin concentration;the role of antioxidant vitamin C or E supplementation was the focus of this study. Forty adult male Wistar rats were randomly divided into group I, which served as the control, group II, which was oral gavaged 6 ml/kg of NBLCO, groups III and IV, which were in addition to 6 ml/kg of NBLCO supplemented with 9 ml/kg and 1 mg/kg of vitamin E or C, respectively for 28 days. Results showed that NBLCO significantly (p < 0.05) lower body weight and food intake compared with control. These effects exerted by NBLCO were however significantly (p < 0.05) reversed by vitamin E or C supplementation. The NBLCO significantly (p < 0.05) reduced fasting blood glucose (FBG) when compared with control, the antioxidant vitamins supplementation significantly (p < 0.05) reversed the crude oil effect. The mean serum insulin level in NBLCO, vitamin E or C supplemented groups is not significantly different from the control. There was no significant correlation between FBG and fasting serum insulin concentrations in all the groups on day 28. It has been demonstrated in this study that direct oral ingestion of crude oil (NBLCO) could reduce food intake, body weight and cause hypoglycemia;the hypoglycemia may not be a function of serum insulin concentration. Interestingly, the hazardous effects of NBLCO could be ameliorated with antioxidant vitamin C or E supplementation.
文摘Background: Neonatal hypoglycaemia is the most common metabolic abnormality in neonates and is associated with neurological damage and death when it occurs during the first few days of life. The main objective of this study was to determine the prevalence of hypoglycaemia in the newborn and the associated maternal/neonatal risk factors. Setting and Methods: This prospective descriptive study was conducted at the labour room and the Special Care Baby Unit of Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria, between July 2017-March 2018. Results: Of the 168 neonates, 140 (83.3%) were delivered in the hospital and 28 (16.7%) were delivered outside the hospital. Hypoglycaemia was found in 19 (11.0%) of the neonates. The mean (standard deviation) of gestational age was 37.8 (3.0) weeks. 91 (54.2%) were males and 77 (45.8%) were females. Male to female ratio is 1.2:1. A significantly higher proportion of 9 (32.1%) out born compared with 10 (7.1%) of inborn, 4 (44.4%) of birth 1500 g compared with 5 (22.7%) birth weight 1500 g - 2499 g and 10 (7.3%) of birth weight ≥ 2500 g and 7 (22.6%) of babies with temperature ≤ 36.5°C compared with 7 (6.3%) of temperature 36.5°C - 37.5°C and 5 (19.2%) of temperature > 37.5°C, demonstrated hypoglycaemia respectively. Neonatal risk factors, such as, prematurity, low birth weight and respiratory distress syndrome, were significantly associated with hypoglycaemia p-value of 0.02, 0.01 and 0.00 respectively. There were no statistically significant associations between maternal risk factors and hypoglycaemia. The common presenting symptoms were jitteriness,
文摘In January 2006, the Canisius-Wilhelmina Hospital introduced the concept of Single Room Maternity Care (SMRC) by realizing 13 labour rooms for mother, infant and partner. Benefits of this new care concept not only include maternal satisfaction and increased staff satisfaction, but also significant health benefits for the neonate. Since the introduction of the concept, we registered a sharp decrease in the number of hypoglycaemias (from 15.6% in 2005 to 2.5% in 2009). Varying causes, such as successful breastfeeding and/or improved attachment between mother and infant may contribute to the decrease of hypoglycaemias.
文摘We report a case of a patient presenting with profound insulin-independent hypoglycaemia. A large hepatic leasion was identified and surgically resected. Histology confirmed a 17.5 cm hepatic solitary fibrous tumour. The clinical and biochemical presentation is consistent with IGF-II mediated hypoglycaemia.
文摘The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.
文摘Critically ill patients are prone to high glycemic variations irrespective of their diabetes status.This mandates frequent blood glucose(BG)monitoring and regulation of insulin therapy.Even though the most commonly employed capillary BG monitoring is convenient and rapid,it is inaccurate and prone to high bias,overestimating BG levels in critically ill patients.The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach.Each of these has its own fallacies,while tight control increases risk of hypoglycemia,liberal BG targets make the patients prone to hyperglycemia.Moreover,the recent evidence suggests that BG indices,such as glycemic variability and time in target range,may also affect patient outcomes.In this review,we highlight the nuances associated with BG monitoring,including the various indices required to be monitored,BG targets and recent advances in BG monitoring in critically ill patients.
文摘In neonates, persistent hyperinsulinemic hypoglycemia (PHH) is associated with nesidioblastosis. In adults, PHH is usually caused by solitary benign insulinomas. We report on an adult patient who suffered from insulin-de- pendent diabetes mellitus, and subsequently developed PHH caused by diffuse nesidioblastosis. Mutations of the MEN1 and Mody 2/3 genes were ruled out. Preoperative diagnostic procedures, the histopathological criteria and the surgical treatment options of adult nesidioblastosis are discussed. So far only one similar case of adult nesidioblastosis subsequent to diabetes mellitus Ⅱ has been reported in the literature. In case of conversion of diabetes into hyperinsulinemic hypoglycemia syndrome, nesidioblastosis in addition to insulinoma should be con- sidered.
