Fast Hypoglycemia Cure

Guide To Beating Hypoglycemia

Here's Just A Tiny Glimpse Of The Topics Covered: The 3 main types of hypoglycemia and which type you're most likely suffering from. How snacking on chocolate bars can actually make you Fat and worsen your condition! (If you thought those delicious dark brown bars were great energy- boosters.think again!) The No. 1 question most folks have when it comes to hypoglycemia and hyperglycemia. Why you should insist on a 6-hour Gtt and not a 5-hour one. ( Why it might not be a good idea to consult a doctor to confirm your hypoglycemia. Aside from taking a Gtt, what other methods can you use to determine whether or not you're suffering from this condition? Well, refer Chapter 4, Pgs. 23-26 to take a revealing 67-question test especially designed to find out if you've got the symptoms. An inspiring motivational exercise that will help you effectively banish all of your negative thoughts that prevent you from having peace of mind. 2 good reasons why you should keep a food journal. 3 powerful nutrients that limit the effect of glucose on your blood sugar level. This is vital to a hypoglycemic as it helps slow down the absorption of sugar in the food. The secret impulse that literally forces you to say 'yes' to a candy bar or chocolate whenever you feel the hunger pangs gnawing at you. 2 ingredients that are lethal to a hypoglycemic. 'Hidden sugars' you must know to avoid buying products that can easily worsen your condition. 8 essential rules of food planning that are crucial to your speedy recovery from hypoglycemia. Leave out one of them and it could hurt your chances of recovering. How to create a healthy food plan that's suitable for both vegetarian and non- vegetarian hypoglycemics. Most food plans only focus on non-vegetarians, but this one works great for everybody! Read more here...

Guide To Beating Hypoglycemia Summary

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Hypoglycaemic Activity

A methanolic extract and its butanol-soluble fraction have been found to have hypoglycemic and gastroprotective effects and to slow gastric emptying. From the butanol-soluble fraction, four new triterpene oligoglycosides, calendasaponins A, B, C and D, were isolated, together with eight known saponins, seven known flavonol glycosides, and a known sesquiterpene glucoside. Their structures were elucidated on the basis of chemical and physicochemical evidence. The principal saponin constituents, glycosides A, B, C, D and F, exhibited potent inhibitory effects on an increase in serum glucose levels in glucose-loaded rats, gastric emptying in mice, and ethanol and indomethacin-induced gastric lesions in rats (Yoshikawa et al 2001 ).

Management of anesthesia

Intraoperative ketamine is the induction agent of choice because of the exquisite sensitivity of hypothyroid patients to drug-induced myocardial depression. MAC requirements for inhaled agents are not changed with hypothyroidism. Maintenance usually with nitrous oxide plus supplementation (opioids, ketamine, etc). Monitoring directed toward early recognition of CHF and hypothermia. Other potential problems include hypoglycemia,

Differential Diagnosis of Atrial Fibrillation

Lone Atrial Fibrillation No underlying disease state. Cardiac Causes Hypertensive heart disease with left ventricular hypertrophy, heart failure, mitral valve stenosis or regurgitation, pericarditis, hypertrophic cardiomyopathy, coronary artery disease, myocardial infarction, aortic stenosis, amyloidosis. Noncardiac Causes Hypoglycemia, theophylline intoxication, pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolism, heavy alcohol intake or alcohol withdrawal, hyperthyroidism, systemic illness, electrolyte abnormalities. Stimulant abuse, excessive caffeine, over-the-counter cold remedies, illicit drugs.

Glutamate and Neurotoxicity

The toxic effects of glutamate exposure on neurons were first recognized nearly half a century ago, when Lucas and Newhouse observed that subcutaneous administration of glutamate caused loss of neurons in the inner nuclear layer of the retina in both adult and neonatal mice (1). Olney extended these findings to other regions of brain, including neurons in the roof of the third ventricle, the hypothalamus, and the dentate gyrus (2). Changes evolved rapidly, over minutes in adult mice to several hours in neonates, and were characterized by intracellular edema and pyknotic nuclei, consistent with necrosis. In the next few years the role of glutamate as the major excitatory neurotransmitter in the mammalian central nervous system (CNS) became clear (3-6) and the existence of specific glutamate receptors was demonstrated. Excitotoxicity, the effect of glutamate receptor activation to trigger neuronal cell death, was proposed to play a role in many pathological conditions, in large part...

Drugdisease Interactions

Oral beta blockers can mask symptoms of thyrotoxicosis. Similarly, abrupt withdrawal of OBBs can exacerbate symptoms of hyperthyroidism. In a labile diabetic patient with known history of hypoglycemic unawareness, OBBs could theoretically mask the symptoms of hypoglycemia, which are mediated by catechol-amines. Patients with non-insulin-dependent diabetes mellitus receiving systemic beta blockers do not appear to be at increased risk of hypoglycemic unawareness, nor have beta blockers been shown to be associated with prolonged hypoglyce-mia due to blockade of catecholamine-mediated recovery. However, patients with insulin-dependent diabetes or labile diabetes may be potentially at greater risk for prolonged hypoglycemia when receiving systemic doses of beta blockers.97-99

Further Clinical Aspects

Hypoglycemia May Occur During Pregnancy & in the Neonate During pregnancy, fetal glucose consumption increases and there is a risk of maternal and possibly fetal hypoglycemia, particularly if there are long intervals between meals or at night. Furthermore, premature and low-birth-weight babies are more susceptible to hypoglycemia, since they have little adipose tissue to generate alternative fuels such as free fatty acids or ketone bodies during the transition from fetal dependency to the free-living state. The enzymes of gluconeogenesis may not be completely functional at this time, and the process is dependent on a supply of free fatty acids for energy. Glycerol, which would normally be released from adipose tissue, is less available for gluconeogenesis. Administration of insulin (as in the treatment of diabetes mellitus type 1) lowers the blood glucose and increases its utilization and storage in the liver and muscle as glycogen. An excess of insulin may cause hypoglycemia,...

Biomedical Importance

Increased fatty acid oxidation is a characteristic of starvation and of diabetes mellitus, leading to ketone body production by the liver (ketosis). Ketone bodies are acidic and when produced in excess over long periods, as in diabetes, cause ketoacidosis, which is ultimately fatal. Because gluconeogenesis is dependent upon fatty acid oxidation, any impairment in fatty acid oxidation leads to hypoglycemia. This occurs in various states of carnitine deficiency or deficiency of essential enzymes in fatty acid oxidation, eg, carnitine palmitoyltransferase, or inhibition of fatty acid oxidation by poisons, eg, hypoglycin.

Of Postmortem Chemical Data

The most important changes of body-fluid components after death are compiled in Table 11-1. A synopsis of postmortem chemical findings in diseases such as diabetes mellitus is shown in Table 11-2. The tables show that glucose is best determined in vitreous because blood glucose values may increase dramatically in the agonal period, particularly after resuscitation attempts (1). Hyperglycemia and diabetic ketoacidosis can be diagnosed readily but hypoglycemia cannot be confirmed by postmortem testing. The dehydration pattern (Table 11-2) has provided a compelling basis for the diagnosis of dehydration in cases of homicidal deprivation of food and water.

Gluconeogenesis Control of the Blood Glucose

Glycogen Entering Glycolysis

Gluconeogenesis is the term used to include all pathways responsible for converting noncarbohydrate precursors to glucose or glycogen. The major substrates are the glucogenic amino acids and lactate, glycerol, and propionate. Liver and kidney are the major gluco-neogenic tissues. Gluconeogenesis meets the needs of the body for glucose when carbohydrate is not available in sufficient amounts from the diet or from glycogen reserves. A supply of glucose is necessary especially for the nervous system and erythrocytes. Failure of gluconeogenesis is usually fatal. Hypoglycemia causes brain dysfunction, which can lead to coma and death. Glucose is also important in maintaining the level of intermediates of the citric acid cycle even when fatty acids are the main source of acetyl-CoA in the tissues. In addition, gluconeogenesis clears lactate produced by muscle and erythrocytes and glycerol produced by adipose tissue. Propionate, the principal glucogenic fatty acid produced in the digestion...

Clinical Presentation Of Ghad

Sometimes, GHAD will first be suspected when there is severe neonatal hypoglycemia or other signs of hypopituitarism (hypothyroidism, small phallus in male babies, or neonatal hepatitis). During early childhood, children with GHAD are detected when they demonstrate short stature and subnormal rates of growth. Often these children will have proportionally small limbs, increased body fat, and a cherubic appearance.

End Organ Targets and Receptors

Patients with GHI from GHR defects often do not respond well to exogenous GH therapy. Some patients have been treated with IGF-1 (133-135). In 1992, a 7-day trial of IGF-1 therapy in six adults with GHR defects revealed no adverse effects (136). A subsequent recent collaborative study examined IGF-1 therapy over 2 years in five patients with GHI and high basal GH levels and in three patients with complete GHD and growth hormone antibodies (133). The investigators found that with twice-daily subcutaneous IGF-1 treatment, these children initially had a greatly increased growth velocity (from 4.0 cm yr pre-treatment to 9.3 cm yr). After the first year, growth rate slowed (to 6.2 cm yr), but was still significantly greater than pre-IGF-1 treatment. Some patients on high dose (120 g IGF-1 kg twice daily) treatment developed hypoglycemia others had selective acceleration of lymphoid and renal tissue growth. It remains to be seen if IGF-1 will cause sustained gain of height velocity without...

Diagnosis Of Gh Deficiency Classical Evaluation

In most pediatric endocrine centers, provocative testing procedures for GH adequacy incorporate two of the following GH stimuli l-dopa, clonidine, arginine, propranolol, glucagon, insulin induced hypoglycemia, and or exercise. An inadequate response (currently defined in most centers as peak GH levels of < 10 ng mL) suggests GHD. Unfortunately, even provocative GH testing is not a reliable gold standard age and sex-specific norms are inadequately determined, GH assays in use are not well-standardized, and the specificity and result reproducibility of GH tests are poor (145). A consensus statement published by 16 endocrinologists at 14 centers in 1994 concluded that careful auxological evaluation, supplemented by assessment of appropriate elements of the GH-IGF axis, provides the best foundation for a rational diagnosis of GHD (146).

Clinical Aspects

Addison's disease or hypoproduction of Cortisol is usually the result of atrophy of the adrenal cortex by unexplained causes (idiopathic). This can be the result of failure at other levels of the cascade from the limbic system downward. The results of Addison's disease are sodium loss (since aldosterone usually is also deficient), excess potassium in the blood, low blood pressure, hypoglycemia, high levels of ACTH and MSH (loss of negative feedback), and pigmentation of the skin due to the high levels of MSH and or ACTH (Figure 10-32). The acute onset of Addison's disease, referred to as Addisonian shock, is shock associated with adrenal insufficiency and most commonly occurs when an individual with long-standing adrenal insufficiency is exposed to a stressful stimulus. It is treated with large intravenous doses of Cortisol, fluid replacement, and antibiotics.

GHD in the Newborn Period

In general, newborns with congenital hypopituitarism have normal birth weights and body proportions. Micropenis, with or without hypoglycemia, may be owing to hypopi-tuitarism. GH deficiency must be considered when there are midline lesions including septo-optic dysplasia (optic nerve hypoplasia and absence of the septum pellucidum).

GHD Presenting During Childhood

GHD insufficiency and hypopituitarism can present in infancy and childhood in the following clinical settings hypoglycemia growth failure (< 7 cm yr prior to age 3 yr, < 4.5-5.0 cm yr from age 3 yr to puberty, < 5.5-6.0 cm yr during pubertal yr) diabetes insipidus disorders of pubertal development including micropenis and pubertal delay children with visual, neurological abnormalities and developmental defects characteristic truncal obesity. GHD insufficiency should be considered in children with abnormal linear growth for age, subnormal height (> 2 SD below mean for age), delayed bone age, absence of organic disease that could cause growth failure, and normal body proportions. The diagnostic protocols used to detect (GHD) can be classified as either pharmacologic (use of provocative agents) or physiologic (measurement of spontaneous endogenous GH secretion). Standard provocative stimuli include insulin-induced hypoglycemia, arginine, clonidine, levodopa, propranolol, levodopa...

Beckwith Wiedemann Syndrome

Transient neonatal hypoglycemia, which may cause mental retardation if untreated, is a common feature of BWS (Engstrom et al., 1988). In approximately 6 of BWS patients, there is an increased risk of developing tumors and hemihyperplasia (Hoyme et al., 1998). Other variable defects, including visceromegaly, earlobe creases, nevus flammeus, and mid-face hypoplasia, are often observed (Pettenati et al., 1986). one study (Slatter et al., 1994), nine cases of BWS with UPD11 were compared to 23 without UPD. The UPD11 cases appeared more likely to have hemihypertrophy (6 9 versus 1 23) and less likely to have exomphalos (0 9 versus 13 23). No differences were seen with respect to other features such as neoplasia, developmental delay, hypoglycemia, and nephromegaly. In another comparison between UPD11 and non-UPD cases of BWS, the incidence of tumors was higher in UPD11 cases (50 versus 8 ), although the sample size was small (Henry et al., 1993). It would be tempting to speculate that...

Pharmacological Toxicological Effects 51 Endocrine Effects

P. ginseng may exert hypoglycemic effects possibly by accelerating hepatic lipogenesis and increasing glycogen storage (16-18). In a study of 36 newly diagnosed patients with type II diabetes, ginseng at a dose of 200 mg daily exerted a statistically significant benefit on glycosylated hemoglobin (HbA1c) compared to 100 mg of ginseng daily or placebo after 8 weeks of therapy, and patients receiving 100 mg of ginseng had smaller mean fasting blood glucose levels than patients taking 200 mg of ginseng or placebo (18). The actual difference among the mean HbA1c in the three groups was small the 200-mg ginseng group had a mean glycosylated hemoglobin of 6 vs 6.5 for the 100-mg ginseng and placebo groups. Likewise, the actual difference among mean fasting blood glucose in the three groups was small the mean fasting blood glucose was 7.7 mmol L for the 100-mg ginseng group, 7.4 mmol L for the 200-mg ginseng group, and 8.3 mmol L for the placebo group at the end of the study. The observed...

InVivo Studies in Animal Models

A thiazolidinedione hypoglycemic agent, CP-68,722, was shown to undergo biotransformation to seven metabolites in the rat (190). Five of the metabolites arose by hydroxylation and one by oxidation of the chromone. Chlorphenir-amine, a potent antihistamine, underwent extensive metabolism in the rat and was shown to form primarily hydroxylated metabolites (21). The new antiathero-sclerotic agent CI 976 was shown to undergo both P- and m-oxidation in the rat in a manner analogous to long-chain fatty acids (191). A new meta-hydroxylated metabolite of the antiarrhythmic drug mexiletine was identified in the hydrolyzed urine of rats dosed with the drug (192). Three metabolites of the new anticonvul-sant drug felbamate that arose through oxidation and hydrolysis were identified in the rat, rabbit, and dog (193). Unchanged drug and metabolites were excreted mainly in the urine. In an extension of earlier in-vitro studies, stable-isotope methodology was used to investigate the mechanism by...

Medical Implications of the AMPK System

Type 2 diabetes, which affects over 100 million people worldwide, is a hyperglycemic condition caused by reduced glucose uptake by muscle and increased glucose production by liver. Physical exercise is known to provide protection against its development, and because AMPK is activated by exercise it regulates the activity and expression of the insulin-sensitive glucose transporter GLUT4 and inhibits expression of enzymes of gluconeogenesis 30 , this suggesting that AMPK could be a promising target for therapy of Type 2 diabetes 26 . This idea has been supported by recent findings that metformin, an important oral hypoglycemic agent used to treat Type 2 diabetes, activates AMPK in vivo 29 .

Diabetes and Pregnancy

Pregnancies complicated with gestational diabetes have an increased risk of maternal and perinatal complications, long-term maternal morbidity, and morbidity to the offspring. The causes of perinatal morbidity are neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, macrosomia birth weight more than 9 lbs (or 4 kg), and with that the problem shoulder dystocia, an abnormal apgar score, and Erb's palsy.

Blood Glucose Is Derived From The Diet Gluconeogenesis Glycogenolysis

Liver Glut Transporter Bidirectional

Glucagon is the hormone produced by the A cells of the pancreatic islets. Its secretion is stimulated by hypoglycemia. In the liver, it stimulates glycogenolysis by activating phosphorylase. Unlike epinephrine, glucagon does not have an effect on muscle phosphorylase. Glucagon also enhances gluconeogenesis from amino acids and lactate. In all these actions, glucagon acts via generation of cAMP (Table 19-1). Both hepatic glycogenolysis and gluconeogenesis contribute to the The anterior pituitary gland secretes hormones that tend to elevate the blood glucose and therefore antagonize the action of insulin. These are growth hormone, ACTH (corticotropin), and possibly other diabetogenic hormones. Growth hormone secretion is stimulated by hypoglycemia it decreases glucose uptake in muscle. Some of this effect may not be direct, since it stimulates mobilization of free fatty acids from adipose tissue, which themselves inhibit glucose utilization. The glucocorticoids (11-oxysteroids) are...

Insulinlike Growth Factor1 Igf1

Preliminary studies have also been performed to identify the optimal subcutaneous dosing regimen for rhIGF-1 (53). First, an HIV-negative subject was treated with increasing doses of rhIGF-1 for a total of 23 d. Because a tendency to hypoglycemia occurred at doses greater than 90 g kg d, that dose was chosen for subsequent studies. In one HIV-negative and one HIV-positive subject who received a constant dose of 90 g kg d, given as a single subcutaneous injection for 14 d, decreases in urine urea nitrogen excretion averaging +1.6 and +3.4 g d in the HIV-negative and HIV-positive patient, respectively, were observed during the entire treatment period. Thus, there was no evidence of the tachyphylaxis reported to occur during IV infusion of rhIGF-1 in a study in HIV-positive subjects (39). Interestingly, increases in REE also occurred in a dose-dependent manner, and increases in lipid oxidation rates were observed in all three patients given rhIGF-1 (53). Overall, the nitrogen-retaining...

Phenotypic Presentation of BWS with Mosaic Paternal Isodisomy UPD11p15

In this latter study (Slatter et al., 1994), comparison of the nine cases with paternal UPD11p to those 23 BWS without paternal UPD11p indicated that the UPD cases were more likely to have hemihypertrophy (6 9 versus 1 23) and less likely to have exomphalos (0 0 versus 13 23), whereas no differences were seen with respect to other features such as neoplasia, developmental delay, hypoglycemia, and nephro-

Diabetic Ketoacidosis

History of the Present Illness Initial glucose level, ketones, anion gap. Polyuria, polyphagia, polydipsia, fatigue, lethargy, nausea, vomiting, weight loss non-compliance with insulin, hypoglycemic agents blurred vision, infection, dehydration, abdominal pain (appendicitis), dyspnea.

Imprinted Genes In The Bws 11p155 Critical Segment Igf2 and H19 in BWS

The methylation status on INS and IGF2, distal to the breakpoint of a BWS patient with a t(4 11)(p15.2 15.4)mat, was found to be diminished at the insulin locus relative to various controls (Mannens et al., 1994). At birth, both alleles were hypomethylated, but remarkably after the first three years only, the maternal allele remained as such. BWS patients have elevated levels of insulin and IGF2 so that hypomethylation of these genes could link their involvement in some features of the syndrome such as hypoglycemia, growth abnormalities, and neoplasia.

Use of GHRH in Diagnosis

In contrast to its use in adult-onset GHD, the variability in GH responses to GHRH alone, and the alteration of baseline responses by the use of somatostatin inhibitors both make GHRH a relatively poor tool for gaging the endogenous activity of the GH axis. Other tests, such as insulin-induced hypoglycemia, have so far proven to be better

Pharmacology Mechanism of Action

Several lines of evidence indirectly support an interaction of growth hormone secre-tagogues and somatostatin. Stimulation of GH by the secretagogues is synergistic with GHRH (29-32). Coadministration of atropine with GHRP-6 completely inhibits the stimulation of GH secretion, whereas coadministration with pyridostigmine increases GH secretion, as does insulin-induced hypoglycemia (33). To explain these data, these authors propose that somatostatin tone was increased by atropine, a cholinergic receptor antagonist, and decreased by pyridostigmine and hypoglycemia. They conclude that GHRP-6 induced GH secretion is dependent upon somatostatin tone, but does not act through mediating somatostatin release. In explaining the results of GHRP-6 infusion in healthy male volunteers, Huhn et al. (34) have suggested that growth hormone secretagogues act as functional somatostatin antagonists. Several other investigators have provided indirect data to support this hypothesis. Maccario et al. (35)...

Dose treatment of drug extravasation

Children 0.05-0.1 mg kg dose IV IM given 1-2 hrs before procedure, repeat prn every 2-4 hr until hypertension is controlled max dose 5 mg. Dose (hypertension crisis) adult 5-20 mg IV. Adverse effects may cause hypotension, reflex tachycardia, cerebrovascular spasm, arrhythmias, stimulation of gastrointestinal tract, hypoglycemia. Comments use with caution in renal impairment, coronary or cerebral arteriosclerosis.

Gh Treatment Of Patients With Abdominal Obesity

Hormone Transition Photoshot

GH exerts direct insulin-antagonistic effects even after the administration of physiologic doses of GH. GH has been considered to be the principal factor in the decrease in insulin sensitivity observed in the early morning, the so-called dawn phenomenon (109) and the insulin resistance following hypoglycemia (110). Thus, our observation of increased insulin sensitivity during prolonged GH treatment is unexpected although not inexplicable. This improvement could be explained by the decrease in visceral adipose tissue mass induced by GH, followed by a decrease in FFA exposure to the liver counteracting the insulin-antagonistic effects of GH. Alternatively, as the major site of glucose disposal is in the skeletal muscle (111), the possibility has to be considered that the improvement in GDR in response to the more prolonged GH treatment might also be an effect of increased glucose transport in the skeletal muscle, possibly mediated through the IGF-1 receptor (71) and an increased...

Growth Hormone and Age Related Osteoporosis

Because both GHD and normal aging are associated with decreases in bone density, it has been hypothesized that reduced GH secretion may account in part for age-related loss of bone mass (24). However, a causal relationship between GHD and osteoporosis has not been established. Nocturnal serum GH peaks average 20 ng mL in 30-yr-old men, but this value declines steadily to 3 ng mL by age 80 (24). These values are reflected in the fall of IGF-1 levels, which also occurs with aging (24). Because aging is associated with numerous physiological and hormonal changes, it has been difficult to determine definitively the degree to which the age-related decline in GH levels is responsible for bone loss. Bone density peaks at age 30, then declines progressively. In men, 25 of trabecular bone is lost by age 75 (25). One study of women with osteoporosis and vertebral compression fractures showed no difference in the GH response to insulin-induced hypoglycemia in these patients compared to...

Diabetes Mellitus

Acute complications diabetic ketoacidosis hyperglycemic, hyperosmolar, nonketotic state hyperglycemia hypoglycemia 3. Evidence of autonomic neuropathy impotence, hypertension, neurogenic bladder, lack of sweating, orthostatic hypotension, resting tachycardia, absent variation in heart rate with deep breathing, painless myocardial ischemia, gastroparesis (vomiting, diarrhea, abdominal distention), asymptomatic hypoglycemia, prolonged QT interval, and sudden death syndrome.

Clinical Summary

S was 45 years old at the time of his death. He had smoked cigarettes for 25 years, had hypertension, and was a known non-insulin dependent diabetic (type II) controlled with oral hypoglycemic drugs. He was moderately obese, weighing 105 kg and 175 cm length (BMI 34 kg m2). He also had a history of illicit intravenous drug use with scarred veins in the antecubital fossa. He had clinical evidence of diabetic neuropathy, and peripheral vascular disease (intermittent claudication and sexual dysfunction). He was admitted to the hospital because of complaints of indigestion and progressive discomfort radiating to both arms. The presumptive diagnosis was acute inferior wall myocardial infarction, and he was treated with tissue plasminogen activator (TPA). The patient slowly became clinically stable after his creatine kinase (CK) peaked at 1555 U L. On medication, and 3 days later, he had a low level stress exercise ECG, which was negative for ischemia. He was discharged home with a plan...

Treatment General

All alternatives to co-trimoxazole are less effective. In cases of intolerability or history of sulfonamide allergy, intravenous pentamidine is recommended as the drug of second choice. An induction therapy is administered over the first few days (200-300 mg in 500 ml 5 glucose or NaCl), and half the dose can then be given from day 6. This treatment is toxic. The main problems include severe decompensation of electrolyte and blood glucose levels (both hyper- and hypoglycemia are possible), pancreatitis, arrhythmia and possible renal failure. Initially, daily monitoring of blood glucose, electrolytes and renal parameters is necessary. In very mild cases, inhalative treatment with daily pentamidine inhalations (300 mg daily for three weeks) can be attempted (Arasteh 1990). Instead of pentamidine, we have had better experience with atovaquone suspension (better than the tablets used in the past ) or with a combination of clindamycin and primaquine. However, data on these regimens is only...

Case Example

A 51-year-old woman was transferred from a small community emergency department for subspecialty evaluation. The patient had presented to that facility the previous night complaining of headache and fever for three days with a sudden loss of vision in her left eye. During our evaluation, the patient reported that one week earlier, she fell, striking the left side of her face and sustaining several small abrasions. She denied other facial trauma. Further history revealed a general malaise and gradual weight loss for about one month's duration. She also admitted to falling occasionally in the past. Her past medical history included non-insulin-dependent diabetes mellitus for several years. She was non-compliant with her oral hypoglycemic medication. She denied other past medical history.

Figure

Nutritional state seems to play a role in control of GH. For example, more GH is released during periods of protein deficiency and abnormally low blood glucose concentration. Conversely, when blood protein and glucose concentrations increase, growth hormone secretion decreases. Apparently, the hypothalamus is able to sense changes in the concentrations of certain blood nutrients, and it releases (GHRH) in response to some of them.

Baylaurel Leaf

Therapeutic Uses and Folklore ancient Greeks considered bay leaf holy. For Italians, it signifies good luck and protection. Bay leaf helps relieve pain in joints, chest, womb, and stomach. It also eases cramps and earaches. Bay leaf aids digestion by stimulating gastric secretion. Recent data show its hypoglycemic function to control diabetes and to have antiulcer activity. It has also been shown to have strong antimicrobial activity against pathogens in the gastrointestinal tract.

Cranial Irradiation

The deleterious effects of cranial irradiation on GH secretion are an unfortunate and common morbidity for individuals with a variety of neoplastic and hematologic diseases. The initial studies detailing the hypothalamic-pituitary effects of cranial irradiation exposure were performed with male rhesus monkeys (40 Gray), demonstrating a blunted GH secretory response to insulin hypoglycemia and a decrease in GH pulse frequency and amplitude. Doubling the dose of insulin (0.1-0.2 units kg) normalized the GH response, suggesting an intact, but altered or reset hypothalamic sensitivity for influencing GH secretion (Figs. 1 and 2) (46).

Clinical Application

In Addison disease, the adrenal cortex does not secrete hormones sufficiently due to immune system attack (autoimmunity) or an infection such as tuberculosis. Signs and symptoms include decreased blood sodium, increased blood potassium, low blood glucose level (hypo-glycemia), dehydration, low blood pressure, frequent infections, fatigue, nausea and vomiting, loss of appetite, and increased skin pigmentation. Some sufferers experience salt cravings one woman reported eating bowls and bowls of salty chicken noodle soup, with pickles and briny pickle juice added Without treat In a negative feedback system, a low concentration of blood glucose stimulates release of glucagon from the alpha cells. When blood glucose concentration returns toward normal, glucagon secretion decreases. This mechanism prevents hypoglycemia from occurring at times when glucose concentration is relatively low, such as between meals, or when glucose is being used rapidly during periods of exercise, for example.

Obesity

The GH response to a variety of provocative stimuli (insulin-hypoglycemia, arginine, opiates, glucagon, levodopa and GHRH), is diminished in obese subjects (52). One study evaluating spontaneous GH secretory dynamics in obese men (body mass index BMI > 42) demonstrated a reduction in endogenous GH half-life relative to control subjects (BMI < 31), a daily production rate of GH 4.1-fold less compared with controls and a threefold decrease in GH secretory burst frequency despite preservation of the GH ultradian rhythm (52). This principle applies to children as well.

Tromethamine THAM

Clearance rapidly excreted by kidneys. Contraindications anuria, uremia, chronic respiratory acidosis (neonates). Adverse effects apnea, hypoglycemia, hypokalemia, alkalosis, transient hypocalcemia, venospasm, tissue necrosis from infiltration Comments use caution in renal impairment 1 mEq THAM 3.3 mL 120 mg tromethamine avoid infusion via umbilical catheters.

Seizure

Prodrome (visual changes, paresthesias), stroke, migraine headaches, fever, chills. Diabetes (hypoglycemia), family history of epilepsy. Factors that May Precipitate Seizures Fatigue, sleep deprivation, infection, hyperventilation, head trauma, alcohol or drug withdrawal, cocaine meningitis, high fever, uremia, hypoglycemia, theophylline toxicity, stroke.

Kari Or Curry Leaf

Therapeutic Uses and Folklore the leaves, root, and bark are used as medicinal aids in India. The leaves are used to help blood circulation and menstrual problems. The fresh leaves are taken to cure dysentery, and an infusion made of roasted leaves stops vomiting. It is also recommended for relieving kidney pains. Recent studies have shown that it has a hypoglycemic action, thereby a possible treatment for diabetes, as well as found to prevent formation of free radicals. It is shown to prevent rancidity of ghee (or clarified butter).

Analysis

These 3 cases have one clinical manifestation in common syncope. Syncope is defined as temporary loss of consciousness and postural tone. It differs from fainting in the quality and duration of the event. It usually occurs when the patient is in an upright position and there is a sudden reduction of cerebral blood flow. Additional syncope-triggering circumstances include hypotension with impaired vasoconstrictor mechanisms, hypovolemia, reduced cardiac output, reduction of venous return, arrhythmia and cerebral ischemia. Other causes of syncope are those that affect the metabolism of the brain such as hypoxia, hyperventilation, anemia and hypoglycemia.

Labor and delivery

Diabetes management during labor requires good control of blood sugar while avoiding hypoglycemia. Many patients require no insulin during labor. Blood sugar should be checked every 1-2 hours during labor. Dextrose will need to be given intravenously if the patient's blood sugar falls below 70 mg dL. Short-acting regular insulin may need to be given intrave nously for blood sugars rising above 140 mg dL (7.8 mmol L). Plasma glucose should be maintained at 100 to

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