Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The acute management of hypoglycemia involves
the rapid delivery of a source of easily absorbed sugar. Regular soda, juice,
lifesavers, table sugar, and the like are good options. In general, 15 grams
of glucose is the dose that is given, followed by an assessment of symptoms and a blood glucose
check if possible. If after 10 minutes there is no improvement, another 10-15
grams should be given. This can be repeated up to three times. At that point, the
patient should be considered as not responding to the therapy and an ambulance
should be called.
The equivalency of 10-15 grams of glucose (approximate servings) are:
Four lifesavers
4 teaspoons of sugar
1/2 can of regular soda or juice
Many people like the idea of treating
hypoglycemia with cake, cookies, and brownies. However, sugar in the form of
complex carbohydrates or sugar combined with fat and protein are much too slowly
absorbed to be useful in the acute treatment of hypoglycemia.
Once the acute episode has been treated, a healthy, long-acting carbohydrate
to maintain blood sugars in the appropriate range should be consumed. Half a
sandwich is a reasonable option.
If the hypoglycemic episode has progressed to the point at which the patient
cannot or will not take anything by mouth, more drastic measures will be needed.
In many cases, a family member or roommate can be trained in the use of
glucagon. Glucagon causes a rapid release of glucose stores from the liver. It
is an injection given intramuscularly to a patient who cannot take glucose by
mouth. A response is usually seen in minutes and lasts for about 90 minutes.
Again, a long-acting source of glucose should thereafter be consumed to maintain
blood sugar levels in the safe range. If glucagon is not available and the
patient is not able to take anything by mouth, emergency services (for example 911) should be called
immediately. An intravenous route of glucose administration should be
established as soon as possible.
With a history of recurrent hypoglycemic episodes, the first step in
treatment is to assess whether the hypoglycemia is related to medications or
insulin treatment. Patients with a consistent pattern of hypoglycemia may
benefit from a medication dose adjustment. It is important that patients check blood
glucose values multiple times a day to help define whether there is a pattern
related to meals or medications.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Hypothermia is having a body core temperature of less than 35 C or 95 F. Most causes of hypothermia are preventable. Risk factors for hypothermia include age, mental status, medical conditions, and medications. Symptoms of hypothermia generally depend upon the severity of the condition. Treatment depends upon the severity of hypothermia. If not treated early, hypothermia can lead to cardiac arrest, coma, or death.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Drowning is a common cause of death and disability worldwide. In the US, it is the third most common cause of accidental death. Brain damage, pneumonia, ARDS, hypothermia, and spine fractures are complications of drowning. At times, there are discussions of wet vs. dry, or salt vs. fresh water drownings. Children and young adults are at most risk for drowning accidents. Medical emergencies in the water may lead to drowning (such as seizures, hypoglycemia, sudden cardiac death, or heart attack). Treatment of a drowning victim depends up on the severity of the injury. Prevention is the key to prevent drowning.
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