Low Blood Sugar

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Low Blood Sugar (Hypoglycemia)

What is Hypoglycemia?

It is a condition where the blood sugar becomes abnormally low. It is a medical Emergency, to be treated immediately. If not, brain damage or death can occur.

What level of blood sugar produces Hypoglycemia?

Blood sugar level below 55 mg\dl produces symptoms.

What produces Hypoglycemia?

Hypoglycemia usually happen in diabetic patients on insulin and or on oral drugs and it happen when they skip meals or eat food very much latter than normal time. Over dose of anti-diabetic drugs can also lower blood sugar.

In non-diabetic people abnormal over work without enough food, excessive drinking alcohol without food (binge) and on fasting for long period can produce hypoglycemia.

Conditions like pituitary insufficiency, liver failure, Addison’s disease, and tumours of pancreas can also produce hypoglycemia.

What are the symptoms of hypoglycemia?

Patients may have excessive sweating, hunger, palpitation (feeling fast heart beats), anxiety, dizziness, weakness, confusion and may have pale skin.

In severe cases patient may have seizures, can become violent and go in for hypoglycemic coma

What investigation to be done for low blood sugar?

Urgent capillary or blood glucose estimation to be done.

What is the treatment for hypoglycemia?

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If the patient is conscious give oral glucose or sugar. Soft drinks with sugar or fruit juice can be given. Glucose tablets or hard sugar candy can be given.

Do not give food or fluids to unconscious patients as they may aspirate (choke).

If the patient is unconscious, shift to a hospital. Intra venous Glucose 10% or 25% can be given.

How to prevent Hypoglycemia?

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Not to skip meals and to take small frequent food (once in 3 hours).

Take documents of their diabetic treatment always with them.

Check blood sugar level often and adjust the dose of drugs according to the physician’s advice.

Diabetic patients should carry glucose tablets or candy with them always to be taken in emergency like hypoglycemia.

Diabetes

Diabetes, cause of diabetes,symptoms of diabetes

Diabetes  (Diabetes mellitus)

What is Diabetes?

Diabetes is a disease in which the person has high level of blood sugar (glucose).
Diabetes is on the rise and now becoming an important health problem to the whole world.

What is the cause of diabetes?

Diabetes is caused mainly due to the slowly changing life style from manual work to highly automated industries, migration of people from villages to cities, environmental changes, and increased inactivity leading to obesity. Consumption of high caloric-high fat diet and Jung food are major factors that produces diabetes. Heredity also plays a role.

Types:

Type 1 Diabetes: Juvenile diabetes, also known as insulin dependent or child hood onset diabetes .Here the beta cells of the pancreas does not produce insulin.
Our digestive system change the carbohydrates and sugar we eat to simple sugar called glucose, which can be used as energy by the cells. Insulin is necessary to push glucose from blood into the cells of our body.
Type 1 diabetes may be congenital (heredity) or our immune system may destroy the beta cells of pancreas which produce insulin. It is usually diagnosed in children and young adults.

Type 2 Diabetes: Here the insulin production is slowly reduced and the secreted insulin may not be enough to reduce glucose level or the cells are unable to recognize the insulin and use it (insulin resistance).

Gestational diabetes: It affects some female when they are pregnant. Their children are at risk of becoming diabetic. Their children may be overweight at birth.

Pre-diabetics: When Persons blood glucose level is little higher than normal but not up to diabetic level (fasting blood glucose 100-120 mg\d}.

What are the symptoms?

Frequent urination (polyuria), Frequent thirst and hunger, tiredness and fatigue, non-healing wounds, Numbness or burning sensation of hands and feet, Giddiness, Loss of memory .loss of vision, Weight gain or weight loss.

What test to do?

Hb A1C: Hb A1C is called glycosylated haemoglobin, a form of haemoglobin that is attached to glucose. It is a blood test which shows the average blood glucose level in the past 3 months.
Normal: Below 5.7 %.
Pre-diabetic: 5.7 % – 6.4 %.
Diabetic: above 6.5 %.

Fasting blood glucose: Blood glucose values measured in Empty stomach. Normal value: Below 110 mg\dl or below 6.1 m mol \ l.

Post- prandial blood glucose: Blood glucose level measured 2 hours after food. Normal value: Below 140 mg\ dl or below 7.8 m mol \ l.

Oral glucose tolerance test: Here 75 grams of glucose is given orally and blood glucose levels measured at the end of one hour and at the end of two hours. Fasting blood glucose: 110 mg\ dl or 6.1 m mol \ l 1 hour: 10 m mol \ l or 180 mg \ dl 2 hours: 7.8 m mol \ l or 140 mg \ dl.

Complications

Diabetes can affect any part of the body.amputation
• Peripheral neuropathy
• Loss of vision, diabetic retinopathy
• Hearing loss
• Loss of blood supply to legs
• Gangrene of foot may lead to amputation.
• Reduced sexual libido and impotency.
• Arterial diseases and stroke.
• Diabetic keto-Acidosis; (DKA). If the body cannot get enough insulin, it breaks down fat cells. This produces chemical called ketones, leading to DKA, a life threatening condition.

Treatment

The main treatment of diabetes is Diet Control, Daily Exercise and Drugs.

Diet
Eat more vegetables and fruits. It is better if they are more colourful.
Eat high fibre cereals legumes and whole grains.
Have lot of fish, skin less chicken, milk and eggs.
Reduce the intake of carbohydrates, deep fried foods, sugary drinks and packaged foods.

Daily exercise
Daily exercise like yoga, brisk walking. Taichi, Cycling or swimming has to be followed.

Drugs
Type 1 Diabetes: Injection Insulin is the main line of treatment for type 1 diabetes.
Type 2 Diabetes: Oral anti diabetics can be given.
Drugs that stimulate insulin secretion like Glibenclamide, Glipizide, Gliclazide and Glimepiride may be given.
Drugs that delays absorption of carbohydrates from intestine like acarbose and voglibose can be given.
Biguanides like Metformin to reduce hepatic glucose production can be given. Thiaolidinediones like pioglitazone which increase the insulin sensitivity may be given.
These drugs can be given alone or in combinations.
In some type 2 diabetics injection insulin is necessary.

PREVENTION:

Healthy foods, healthy body weight, active life with moderate physical activity and proper sleep can prevent diabetes. Avoiding smoking, avoiding mental stress and reduced alcohol intake can also helps in preventing Diabetes.

Heart Attack

heart attack

Heart Attack (Myocardial Infarction)

What is Heart Attack?

Sudden pain or discomfort in the chest due to sudden loss of blood supply to the heart, results from blockage of the coronary arteries (blood vessel supplying blood to the heart).

What produces Heart Attack?

Blockage of blood supply to the heart occurs due to sudden spasm of the blood vessel or blood clot blocking the arteries or thickening of the arterial wall due to atherosclerosis (gradual deposition of fat on inner walls of blood vessels).

The symptoms felt by the patient.

The patient may have sudden pain under the sternum with excessive sweating. The pain may be of crushing type and may be felt in the left arm, neck, jaw or shoulder. Patient may have breathlessness and the patient may collapse. 20% of the patients may not feel the pain (Diabetic patients and elderly patients).

What to do?

  • Call the ambulance and shift the patient to coronary care unit of a hospital.
  • Make the patient sit in comfortable position.
  • Ask the patient, if he is already on medication for heart attack. Give him nitro-glycerine or isosorbide dinitrate tablet to keep under the tongue.
  • Make him chew or swallow aspirin tablet (avoid, if the patient is allergic of aspirin or having peptic ulcer.
  • If the patient is unconscious, give cardio pulmonary resuscitation or give chest compression at the rate of about 100 per minute until the arrival of medical team.

Investigations to be done.

  • ECG: (Electro cardiogram) ST elevation or depression may be seen. Q waves can be seen.
  • Echo cardiogram can be done to test the function of the heart and note regional wall motion abnormalities.
  • Cardiac troponin  and creatinine kinase test in blood, which may be elevated.
  • Coronary angiogram after the patient becomes stable to diagnose the site of blockage.

Treatment given.

  • Drugs like nitrates to dilate blood vessels.
  • Injection Morphine to reduce pain.
  • Oxygen through nasal mask.
  • Intravenous thrombolysis.
  • Injection streplokinase or urokinase can be given to dissolve the clot.
  • Coronary Angioplasty with stent insertion can be done.
  • Coronary artery bypass grafting can be done.

Prevention.

  • Stop smoking
  • Life style modification
  • Low fat Diet
  • Exercise

Post infarction care.

  • Psychological counselling for anxiety and depression.
  • Rehabilitation programs include exercise training, counselling occupational therapy to make the patient live independently.