By Philip E. Cryer M.D.
Intended for diabetes researchers and doctors who paintings heavily with sufferers with diabetes, Hypoglycemia in Diabetes presents direct perception into the reasons and outcomes of this critical scientific situation from one of many most effective specialists within the box. in line with the newest advancements and developments within the clinical and scientific literature, readers are given the main points they wish so one can be told approximately the best way to establish, hinder, and deal with this unlucky situation of the diabetes care regimen.
The moment version includes up to date and accelerated references from the most recent learn. The dialogue of iatrogenic hypoglycemia has been increased all through to hide those new findings and to maintain the dialogue of the subject correct.
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Extra info for Hypoglycemia in Diabetes: Pathophysiology, Prevalence, and Prevention
Example text
2002), activate hepatic glycogen synthesis (Ramnanan et al. 2011b), and modulate regional glucose metabolism (Bingham et al. 2002), among other effects (Benedict et al. 2006)—it does not stimulate blood-to-brain glucose transport (Knudsen et al. 1999; Seaquist et al. 2001). Insulin is a potent and critical hormone. Its deficiency causes hyperglycemia (diabetes), and its excess can cause hypoglycemia (Cryer 2001, 2008, 2010, 2011a; Cherrington 2001; Cryer et al. 2009). Nonetheless, it is not the only factor involved in maintenance of systemic glucose balance.
2004; Fagius 2003). However, the method is operator dependent, time-consuming, and demanding for the subject; does not allow movement by the subject; is not practical in the presence of autonomic neuropathy; and measures only one aspect of sympathetic nerve activity in only one region of the body (typically the lower extremity). Another approach is measurement of the extracellular norepinephrine concentration by microdialysis (Bruce et al. 2002; Maggs et al. 1997). That method has been used to document norepinephrine release in skeletal muscle and fat during hypoglycemia (Maggs et al.
1987; Mitrakou et al. 1991; Fanelli et al. 1994a). 1. The earliest physiological response is a decrease in insulin secretion. That occurs as plasma glucose levels decline within the physiological range. The secretion of glucose counterregulatory (plasma glucose–raising) hormones, including glucagon and epinephrine, increases as plasma glucose concentrations fall just below the postabsorptive physiological range. Lower glucose levels cause symptoms. Even lower levels cause functional brain failure (Cryer 2007).