Hypoglycemia vs Hyperglycemia | Endocrine System (Part 3)
Summary
TLDRIn this ICU Advantage lesson, Eddie Watson discusses hypoglycemia and hyperglycemia, focusing on their definitions, causes, symptoms, and treatments. Hypoglycemia, characterized by low blood sugar, can lead to coma or death if untreated. Causes include endogenous factors like tumors, exogenous factors like insulin overuse, and functional causes such as excessive muscle activity. Symptoms range from mild, like tremors and sweating, to severe, including seizures and coma. Treatment involves oral glucose or IV dextrose. Hyperglycemia, often associated with diabetes, increases morbidity and mortality in hospitalized patients. Management includes frequent blood glucose monitoring and insulin therapy, with goals to maintain levels under 180 mg/dL.
Takeaways
- 📚 Eddie Watson introduces the topic of hypoglycemia and hyperglycemia, focusing on irregularities in the body's glucose levels.
- 🔍 Hypoglycemia is defined as blood glucose levels below 60 milligrams per deciliter, and can be life-threatening if untreated.
- 🏥 Causes of hypoglycemia are categorized into endogenous (tumors or metabolic errors), exogenous (medication or alcohol use), and functional (excessive muscle use or hypermetabolic states).
- 🚨 Symptoms of hypoglycemia range from mild (sweating, tremors, tachycardia) to severe (confusion, seizures, coma), and can mimic stroke symptoms.
- 🩺 Diagnosis of hypoglycemia is confirmed with a serum blood sugar value below 60, with more severe symptoms appearing below 20.
- 💊 Treatment for hypoglycemia involves providing glucose, either orally or through IV dextrose, with prevention and patient education being key.
- ⚠️ Hyperglycemia increases morbidity and mortality in hospitalized patients, with 12% of non-diabetic patients developing it.
- 🤒 Causes of hyperglycemia in hospitalized patients include stress from illness, injury, surgery, or diabetes itself.
- 📈 Diabetes is a major cause of hyperglycemia, with type 1 involving insulin production issues and type 2 involving insulin receptor sensitivity.
- 🏩 ICU management of hyperglycemia involves frequent blood glucose monitoring and insulin management, often through continuous IV infusion.
- 📉 The goal for blood glucose levels in ICU patients is less than 180, with adjustments made for conditions like DKA or HHS.
Q & A
What are the main topics covered in Eddie Watson's lesson about the endocrine system?
-The lesson primarily covers the differences between hypoglycemia and hyperglycemia, focusing on irregularities in the body's glucose levels.
What is the chemical formula of glucose?
-The chemical formula of glucose is C6H12O6.
Why is glucose important for the body according to the lesson?
-Glucose is important because it is the primary energy source for the body, and proper regulation of glucose significantly impacts bodily functions.
What is hypoglycemia and how is it defined in the context of blood glucose levels?
-Hypoglycemia is a condition resulting from an imbalance between glucose production and utilization, defined as a blood glucose level less than 60 milligrams per deciliter.
What are the potential severe outcomes of untreated acute hypoglycemia?
-Untreated acute hypoglycemia can lead to coma or even death.
What are the three subcategories of causes for hypoglycemia mentioned in the lesson?
-The three subcategories of causes for hypoglycemia are endogenous causes, exogenous causes, and functional causes.
What are some signs and symptoms of mild hypoglycemia?
-Mild hypoglycemia symptoms include diaphoresis, tremors, tachycardia, paresthesia, pallor, excessive hunger, and anxiety.
How is hypoglycemia diagnosed?
-Hypoglycemia is diagnosed with a serum blood sugar value less than 60, and severe hypoglycemia is indicated by levels less than 20.
What is the primary treatment for hypoglycemia?
-The primary treatment for hypoglycemia is providing glucose, which can be done through oral glucose or complex carbohydrates.
What is hyperglycemia and why is it significant in hospitalized patients?
-Hyperglycemia is a condition where blood glucose levels are too high. It's significant in hospitalized patients because it can increase morbidity and mortality, especially for those without a history of diabetes.
What are the two main forms of diabetes mentioned, and how do they differ?
-Type 1 diabetes involves inadequate insulin production by the pancreas, while Type 2 diabetes involves a lack of sensitivity of insulin receptors in the body.
How is hyperglycemia managed in critically ill patients in the ICU?
-Management of hyperglycemia in critically ill patients involves frequent blood glucose monitoring and insulin management, often through a continuous IV infusion.
Outlines
📚 Introduction to Hypoglycemia and Hyperglycemia
Eddie Watson introduces a lesson on the endocrine system, specifically focusing on the differences between hypoglycemia and hyperglycemia. He explains that these conditions involve irregular glucose levels in the body, either too low (hypoglycemia) or too high (hyperglycemia). Glucose, a simple sugar with the chemical formula C6H12O6, is the primary energy source for the body. Hypoglycemia occurs when there is an imbalance between glucose production and utilization, leading to a deficit that can be dangerous, especially in the ICU setting. The definition of hypoglycemia is a blood glucose level below 60 milligrams per deciliter. The brain relies heavily on glucose, and low levels can lead to coma or death if untreated. Causes of hypoglycemia are categorized into endogenous (tumors or metabolic errors), exogenous (insulin overdose or alcohol use), and functional (excessive muscle use or hypermetabolic states like sepsis).
🚑 Signs, Symptoms, and Treatment of Hypoglycemia
The signs and symptoms of hypoglycemia depend on its severity, ranging from mild with symptoms like diaphoresis, tremors, and tachycardia, to moderate to severe with CNS responses like headache, confusion, and even coma. These symptoms can mimic a stroke, so blood sugar checks are crucial for differential diagnosis. The treatment for hypoglycemia involves providing glucose, either orally or through more advanced methods like glucagon injection or IV dextrose if oral glucose is not sufficient. The goal is to raise blood glucose levels quickly to prevent severe complications.
🏥 Hyperglycemia in Hospitalized Patients
Hyperglycemia is associated with a significant increase in morbidity and mortality in hospitalized patients, especially those without a history of diabetes. Stress responses from acute illness or injury can lead to hyperglycemia due to the release of hormones and cytokines that cause fat and protein catabolism, resulting in elevated glucose levels. Causes of hyperglycemia include hospital-related stressors like surgery or sepsis, and diabetes, which can be type 1 (insulin production issues) or type 2 (insulin receptor sensitivity issues). Management in the ICU involves frequent blood glucose monitoring and insulin management, often through continuous IV infusion. The goal is to balance glucose control to avoid both hyperglycemia and hypoglycemia, with some controversy over the optimal glucose targets.
📈 Conclusion and Upcoming Lessons
Eddie concludes the lesson by emphasizing the importance of identifying and treating hypoglycemia and hyperglycemia in ICU patients. He encourages viewers to like and comment if they found the lesson useful and reminds them to subscribe for notifications on upcoming lessons. The next lesson will focus on the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), which are important distinctions for healthcare providers to understand.
Mindmap
Keywords
💡Endocrine System
💡Hypoglycemia
💡Hyperglycemia
💡Glucose
💡Insulin
💡Glucagon
💡Diabetes
💡ICU
💡DKA
💡HHS
💡Morbidity and Mortality
Highlights
Introduction to the endocrine system lesson series by Eddie Watson.
Explaining the differences between hypoglycemia and hyperglycemia.
Glucose is the primary energy source for the body.
Hypoglycemia results from an imbalance between glucose production and utilization.
Definition of hypoglycemia as blood glucose less than 60 milligrams per deciliter.
Acute hypoglycemia can be fatal if left untreated.
Causes of hypoglycemia are divided into endogenous, exogenous, and functional.
Signs and symptoms of hypoglycemia depend on severity.
Mild hypoglycemia symptoms include diaphoresis, tremors, and tachycardia.
Moderate to severe hypoglycemia can lead to CNS impairment, coma, or death.
Diagnosis of hypoglycemia is based on serum blood sugar levels.
Treatment of hypoglycemia involves giving 10 to 15 grams of glucose.
For severe hypoglycemia, glucagon or IV dextrose may be administered.
Hyperglycemia increases morbidity and mortality in hospitalized patients.
Causes of hyperglycemia include stress responses and diabetes.
Management of critically ill patients with hyperglycemia involves frequent monitoring and insulin management.
Controversy exists over how tight blood glucose levels should be controlled.
Next lesson will cover the differences between DKA and HHS.
Transcripts
[Music]
all right you guys welcome back to the
next lesson in our series in which we
are covering the endocrine system and in
this lesson we're gonna be talking about
the differences between hypoglycemia and
hyperglycemia and for those of you who
don't know my name is Eddie Watson and
this is ICU advantage and if this is
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guys alright so with that out of the way
let's go ahead and begin our lesson here
like I said in this lesson we're gonna
be talking about the differences between
our hypoglycemia and our hyperglycemia
and so what we're really talking about
with this is we're dealing with
irregularities in our body's glucose
level and so our glucose level is either
gonna be too low in the case of
hypoglycemia or it's gonna be too high
in the case of hyperglycemia but it's
really all revolving around this
molecule called glucose here and so
really glucose is just a simple sugar
it's got the chemical formula of c6 h-12
o-6 and it's the most abundant
monosaccharide that's available that
falls within this subcategory that we
often know is carbohydrates and what's
so special about glucose is that it is
the primary energy source for our body
and so the proper regulation and
availability of glucose is gonna have a
significant impact on the way our body
functions and so let's go ahead and move
in and start to talk about our
hypoglycemia and so with hypoglycemia
what we're dealing with is something
that's resulting from the imbalance
between our glucose production and our
glucose utilization so we can almost
think of it like a seesaw
and here we have our production and here
we have our utilization and as we can
see our production is lower than what
we're utilizing therefore we're gonna
find ourselves in a state of a deficit
of this glucose and if this deficit
becomes significant enough that this can
really be one of the more common and
different emergencies that we're going
to encounter especially within the ICU
but really the way that we define this
is if we have a blood glucose that is
less than 60 and that's measured in
milligrams per deciliter and so like we
said over here
glucose is that primary source of energy
for our body and our brain really relies
on this in order to function properly
and so if our blood glucose drops below
normal levels it can have pretty
profound effects and if it gets low
enough it can even lead to coma or
possibly death so the important takeaway
from this is that acute hypoglycemia can
be fatal if it's left untreated so up
next let's talk about some of the causes
for hypoglycemia and there's really
three subcategories that we can divide
these causes up into the first of these
is what we call endogenous the second of
these is what we call exogenous and the
third is what we call functional and so
when we talk about these endogenous
causes what we're really talking about
are either tumors or metabolic errors
and really what happens with these is we
either see an overuse of glucose as a
result or an overproduction of insulin
as a result both of these leading to a
state of having too little glucose now
for hours Aegina scauses these are going
to come from things like either having
excessive insulin and this can either be
from too much intake or the use of some
sort of secreted ogz this can also be as
a result of the use of oral
anti-diabetic s' some drugs can also be
the cause as well as potential
the use of alcohol now when we talk
about the functional causes there's a
couple things that we can talk about
here we can have things like excessive
muscle use so think long continuous
strenuous activity that our muscles are
going to burn up that glucose or even
something like prolonged seizure
activity this can also come from
hypermetabolic states and a really good
example of this is something like sepsis
where the body could be just overly
utilizing glucose or you could also see
this in something like dumping syndrome
so if the body is just not able to
process what is ingested quick enough in
order to get the necessary energy from
it that could also be a functional cause
so like I said these are the things that
could cause hypoglycemia but what are we
gonna expect to see for signs and
symptoms in our patients when they have
hypoglycemia so really our signs and
symptoms are going to be dependent on
how severe the hypoglycemia is we can
either see a mild hypoglycemia or we can
see either a moderate or a severe
hypoglycemia and so when we talk about
the mild hypoglycemia the signs and
symptoms are really going to be a result
of seeing an ADD renner DIC response so
this is where you can think of
epinephrine glucagon glucocorticoids and
growth hormone that are going to be
released as a result of this
hypoglycemia and this is where we're
gonna see these symptoms originated from
so these are things like
diaphoresis tremors or shakiness
tachycardia paresthesia pallor
excessive hunger or even anxiety so
think about things that you would expect
to see with at adrenergic response now
in the moderate severe side what we're
dealing with here is some sort of CNS
response so the central nervous system
and really the result of this is because
our brain is being depleted of glucose
so here you could be seeing headache
mood changes an inability to concentrate
drowsiness confusion impaired judgment
they could also have a staggering gait
or slurred speech double vision they
could even be experiencing psychosis or
things could progress to even like we
talked about seizures or coma and so
we're really going to be seeing those
profound effects as a result of that
impairment of the CNS really the
impairment of our brain and so really
you can think about these symptoms as
being related to that impairment and one
interesting thing to know is that some
of these symptoms will often mimic what
you would see in a patient who is having
a stroke and so this is why when we are
suspecting our patient is possibly
having a stroke one of the things we're
gonna do is check a blood sugar because
if they're hypoglycemic that could be
what's causing these symptoms so how do
we diagnose these patients well we had
kind of hit on it already but our
hallmark definition is gonna be a serum
blood sugar with a value less than 60
now if their blood sugar is in the range
of 20 to 40 that that's when we could
potentially see seizures and for our
severe hypoglycemia if we are less than
20 that's where our patients are
oftentimes going to be in a coma and
puts them at risk of death so these are
the things that you want to be watching
out for you want to be able to recognize
these signs and symptoms because if we
see these and we've run a test on their
blood sugar and we see that they are
hypoglycemic we need to look at what
we're gonna do to treat them and really
our best treatment is going to be our
prevention and this is either going to
come in the form of our monitoring that
we're doing for our patients or in our
recognition as well as our education for
our patients for these signs and
symptoms especially the mild early signs
and symptoms so that they can catch this
and resolve this quicker before
progressing to either a moderate or more
severe hypoglycemia but as far as the
actual treatment that we have available
to them the first primary form of
treatment that we would do is we would
give them 10 to 15 grams of glucose and
so this is going to be some form of oral
glucose this can either come in the form
of a snack that they can take or
oftentimes you'll see things like
glucose gel that you can give to your
patients now if after this initial dose
of glucose they still remain
hypoglycemic you want to repeat this in
10 minutes and from there we want to
follow up with complex carbs so these
are things like milk and cheese so this
is really our best way of being able to
treat these patients but depending on
what's going on with them or how severe
their hypoglycemia is we might not be
able to treat them with oral glucose and
so we need to find some other method of
doing this and so there's two things
that we can do to treat these patients
the first is we can give them 1 to 2
milligrams of glucagon and this is
something that we can give them either
IV intramuscular or even subcutaneously
and this glucagon is going to stimulate
the liver to release glucose now the
other option which I think will
typically see more often in the ICU than
glucagon is going to be administering a
dose of IV dextrose and this is going to
be 25 grams of a d50 solution and this
is going to be done through an IV push
so these are the ways in which we're
going to treat this hypoglycemia and
really the main purpose of this
treatment is to provide the glucose to
these patients that they're desperately
needing all right so let's move on from
here and talk about hyperglycemia so one
thing that's important to know is that
hyperglycemia and diabetes for that
matter that it really carries a
four-fold increase in morbidity and
mortality for our hospitalized patients
and so it's important that we can
prevent these complications for our
patients but it's also important to know
that of our hospitalized patients that
don't have a history of diabetes
12% of them will likely develop some
sort of hyperglycemia while they're
hospitalized and if our patient falls in
this category they have a 18 times
greater mortality when we compare them
to diabetic patients so again it's
really important that we are monitoring
for this and intervening early in order
to prevent this hyperglycemia in our
patients but what makes this difficult
for us is we're dealing with what's a
natural metabolic response to acute
illness or injury so simply the
patient's being in our care are already
going to be higher risk for these
hyperglycemic events and the reason that
we see this is as a result of our stress
response we're gonna have the release of
glucocorticoids catecholamines growth
hormone and other cytokines and all of
this is going to lead to the catabolism
of fat and protein which is going to
lead us to an elevation in our patients
glucose levels so what are some of our
causes for our patients experiencing
hyperglycemia so the first set of things
are things that we're going to see in
our hospitalized patients things like M
eyes strokes surgery trauma pain sepsis
anything that's going to trigger that
stress release in our patients and again
that stress response is going to cause
the release of those biological
mediators and hormones and also with
this the greater the stress that they
experience the more the release and thus
ultimately the higher the glucose level
now the other big cause that I want to
talk about for hyperglycemia is going to
be our diabetes and it's important to
know because this is the fourth most
common comorbidity that we're going to
encounter and when we're dealing with
diabetes what we're dealing with is the
inadequate uptake of glucose by their
body's cells and this is ultimately
going to lead to a state of
hyperglycemia
and the reason for this is going to come
in two different forms something that we
classify as our type 1 diabetes and our
type 2 diabetes so our type 1 diabetes
is primarily dealing with the production
or the secretion of insulin by the
pancreatic beta-cells type 2 diabetes is
different because this is a lack of
sensitivity of our insulin receptors in
our body and so while the cause of this
is different it altima telida the same
thing the inability of those cells to
uptake glucose to use in metabolism so
we're going to talk about some of this a
little bit more in the next lesson but I
do want to hit on how we manage these
patients in the ICU and so really our
management of these critically ill
patients is going to primarily revolve
around two main things first is going to
be our frequent blood glucose monitoring
and the next is going to be our insulin
management and typically this insulin
management is going to be through a
continuous IV infusion and so it is
important to know that there is some
controversy that exists related to how
tight we should really be controlling
our patient's blood glucose levels there
are some studies that show a decrease in
mortality with cardiac surgery patients
if we keep these levels under a hundred
and ten and this is even despite the
increase in the rates of hypoglycemia as
a result but then they also did the same
study and looked at general medical ICU
patients and they saw an increase in
this mortality because of these
hypoglycemic events and so oftentimes
our goal is really going to be to keep
our blood glucose less than 180 and this
management is also going to change
whether our patients are experiencing
diabetic ketoacidosis or DKA or
hyperosmolar hyperglycemic state or HHS
and in fact the next lesson we're going
to talk about the difference between
these two all right so that pretty much
was a good review of the
differences between hypoglycemia and
hyperglycemia and what are some of the
things that we expect to see in these
patients and ultimately how would we
treat them both of these are very common
things that you are going to encounter
and the care of your patients in the ICU
so it's important that you are able to
identify and appropriately monitor and
treat these patients and hopefully after
this lesson you've got a better
understanding in order to be able to do
just that all right and so with that
said that's gonna finish this lesson and
I want to thank you guys so much for
watching like I said I hope that you
found this lesson useful and if you did
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differences between DKA and HHS and what
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thank you so much for watching you guys
have a wonderful day
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