Hypoglycemia vs Hyperglycemia | Endocrine System (Part 3)

Summary

In 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

00:00

📚 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).

05:01

🚑 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.

10:03

🏥 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.

15:04

📈 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.

Keywords

💡Endocrine System

The endocrine system is a collection of glands that produce and secrete hormones directly into the bloodstream to regulate various bodily functions. In the context of the video, the endocrine system is relevant as it includes the pancreas, which plays a critical role in regulating blood glucose levels through the secretion of insulin and glucagon.

💡Hypoglycemia

Hypoglycemia refers to a condition where blood glucose levels are abnormally low. The video defines it as a blood glucose level less than 60 milligrams per deciliter. It is a critical issue in the ICU, as untreated hypoglycemia can lead to coma or death. The video discusses the causes, symptoms, and treatments for hypoglycemia.

💡Hyperglycemia

Hyperglycemia is the opposite of hypoglycemia, where blood glucose levels are higher than normal. It is associated with a significant increase in morbidity and mortality in hospitalized patients, as mentioned in the script. The video discusses the importance of monitoring and managing hyperglycemia, especially in critically ill patients.

💡Glucose

Glucose is a simple sugar and the primary energy source for the body. Its chemical formula is C6H12O6. The video emphasizes the importance of glucose regulation, as irregular levels can lead to either hypoglycemia or hyperglycemia, impacting the body's function significantly.

💡Insulin

Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels by promoting the uptake of glucose into cells. The video discusses insulin in the context of hypoglycemia, where an overproduction or excessive intake can lead to low blood glucose levels.

💡Glucagon

Glucagon is a hormone that raises blood glucose levels by stimulating the liver to convert stored glycogen into glucose. The video mentions glucagon as a treatment option for hypoglycemia, where it can be administered to stimulate the liver to release glucose.

💡Diabetes

Diabetes is a chronic condition characterized by high blood sugar levels over a prolonged period. The video distinguishes between Type 1 and Type 2 diabetes, explaining that both can lead to hyperglycemia due to either insufficient insulin production or insulin resistance.

💡ICU

ICU stands for Intensive Care Unit, a specialized hospital unit for treating critically ill patients. The video script is part of a series educating about the endocrine system with a focus on ICU settings, highlighting the importance of understanding and managing blood glucose levels in critical care.

💡DKA

DKA stands for Diabetic Ketoacidosis, a serious complication of diabetes where the body produces high levels of blood acids called ketones. The video script mentions that the next lesson will cover DKA, indicating its relevance in understanding glucose regulation disorders.

💡HHS

HHS stands for Hyperosmolar Hyperglycemic State, another serious complication of diabetes characterized by very high blood glucose levels without the presence of ketones. Similar to DKA, HHS is mentioned as a topic for a future lesson, emphasizing the importance of differentiating between these conditions.

💡Morbidity and Mortality

Morbidity refers to the state of being diseased, while mortality refers to the state of being subject to death. In the video, it is mentioned that hyperglycemia can lead to a four-fold increase in morbidity and mortality among hospitalized patients, emphasizing the seriousness of blood glucose imbalances.

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

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lesson we're gonna take a look at the

differences between DKA and HHS and what

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of heart failure all right you guys

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