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==Overview==
==Overview==
: If left untreated,  % of patients with hypoglycemia may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Common complications of [disease name] include [complication 1], [complication 2], and [complication 3]. Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Natural History==
==Natural History==
* The symptoms of hypoglycemia are usually developed in the first/ second/ third decade of life, and start with symptoms such as [[anxiety]], [[nervousness]], [[tremor]], [[Palpitation|palpitations,]] and sweating. Without treatment, the patient will develop symptoms of adrenergic manifestations such as [[Confusion]], [[amnesia]], [[dizziness]], [[delirium]], [[Diplopia|double vision]], [[slurred speech]], generalized or focal [[Seizure|seizures]] which may eventually lead to death.


==Complications==
==Complications==


=== Neonatal hypoglycemia ===
Complications that can develop as a result of neonatal hypoglycemia are:
 
* Cognitive problems
===== Symptomatic hypoglycemia =====
* Psychomotor retardation
Although it remains uncertain whether timely treatment of hypoglycemia will prevent brain injury and poor developmental outcome,  
* Epilepsy<ref name="pmid12824865">{{cite journal| author=Meissner T, Wendel U, Burgard P, Schaetzle S, Mayatepek E| title=Long-term follow-up of 114 patients with congenital hyperinsulinism. | journal=Eur J Endocrinol | year= 2003 | volume= 149 | issue= 1 | pages= 43-51 | pmid=12824865 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12824865  }}</ref>
 
* Infants with BWS are at increased risk for prematurity and tumors such as hepatoblastoma and Wilm's tumor.<ref name="pmid18000906">{{cite journal| author=Smith AC, Shuman C, Chitayat D, Steele L, Ray PN, Bourgeois J et al.| title=Severe presentation of Beckwith-Wiedemann syndrome associated with high levels of constitutional paternal uniparental disomy for chromosome 11p15. | journal=Am J Med Genet A | year= 2007 | volume= 143A | issue= 24 | pages= 3010-5 | pmid=18000906 | doi=10.1002/ajmg.a.32030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18000906  }}</ref>
recommend that symptomatic neonatal hypoglycemia should be aggressively treated given the potential significant adverse effects based on the available data [1,2,6]
* Prematurity
 
Complications that can develop as a result of hypoglycemia in adults are:
'''Asymptomatic hypoglycemia''' 
* It depends on:
 
This study showed that there was no difference between infants in whom intervention was provided for hypoglycemia compared with those who did not require intervention [8].
 
In contrast, a retrospective observational study of all newborn infants born at a single tertiary United States center reported that children who had experienced transient neonatal hypoglycemia (defined as blood glucose levels <40 mg/dL [2.22 mmol/L]) had lower scores for literacy and math at fourth grade after adjusting for confounding factors 30


'''Preterm infants''' 
* Duration of the attacks
* Age of the patients


controversy exists as to whether asymptomatic hypoglycemia causes neurologic injury and whether glucose concentrations requiring intervention should be lower in preterm than in term infants. 
* Older patients show more complications than younger patients.<ref name="pmid16306561">{{cite journal| author=Zammitt NN, Frier BM| title=Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. | journal=Diabetes Care | year= 2005 | volume= 28 | issue= 12 | pages= 2948-61 | pmid=16306561 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16306561  }}</ref>
* Increased risk of dementia<ref name="pmid23753199">{{cite journal| author=Yaffe K, Falvey CM, Hamilton N, Harris TB, Simonsick EM, Strotmeyer ES et al.| title=Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. | journal=JAMA Intern Med | year= 2013 | volume= 173 | issue= 14 | pages= 1300-6 | pmid=23753199 | doi=10.1001/jamainternmed.2013.6176 | pmc=4041621 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23753199  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24195968 Review in: Evid Based Med. 2014 Apr;19(2):77]</ref>
* Episodes of dizziness increase the risk of falls and fractures.
* Severe hypoglycemia may increase the risk of cardiovascular complications in type 2 diabetes patients.<ref name="pmid23900314">{{cite journal| author=Goto A, Arah OA, Goto M, Terauchi Y, Noda M| title=Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. | journal=BMJ | year= 2013 | volume= 347 | issue=  | pages= f4533 | pmid=23900314 | doi=10.1136/bmj.f4533 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23900314  }}</ref>
* Hypoglycemia can be fatal.


==Prognosis==
==Prognosis==
* The prognosis of hypoglycemia is good with treatment. Without treatment, hypoglycemia may be fatal.
* 4 to 10% of deaths of patients with type 1 diabetes are due to hypoglycemia.<ref name="pmid17901942">{{cite journal| author=Patterson CC, Dahlquist G, Harjutsalo V, Joner G, Feltbower RG, Svensson J et al.| title=Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989. | journal=Diabetologia | year= 2007 | volume= 50 | issue= 12 | pages= 2439-42 | pmid=17901942 | doi=10.1007/s00125-007-0824-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17901942  }}</ref>


==References==
==References==

Revision as of 19:51, 26 July 2017


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

If left untreated,  % of patients with hypoglycemia may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Common complications of [disease name] include [complication 1], [complication 2], and [complication 3]. Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History

Complications

Complications that can develop as a result of neonatal hypoglycemia are:

  • Cognitive problems
  • Psychomotor retardation
  • Epilepsy[1]
  • Infants with BWS are at increased risk for prematurity and tumors such as hepatoblastoma and Wilm's tumor.[2]
  • Prematurity

Complications that can develop as a result of hypoglycemia in adults are:

  • It depends on:
  • Duration of the attacks
  • Age of the patients
  • Older patients show more complications than younger patients.[3]
  • Increased risk of dementia[4]
  • Episodes of dizziness increase the risk of falls and fractures.
  • Severe hypoglycemia may increase the risk of cardiovascular complications in type 2 diabetes patients.[5]
  • Hypoglycemia can be fatal.

Prognosis

  • The prognosis of hypoglycemia is good with treatment. Without treatment, hypoglycemia may be fatal.
  • 4 to 10% of deaths of patients with type 1 diabetes are due to hypoglycemia.[6]

References

  1. ↑ Meissner T, Wendel U, Burgard P, Schaetzle S, Mayatepek E (2003). "Long-term follow-up of 114 patients with congenital hyperinsulinism". Eur J Endocrinol. 149 (1): 43–51. PMID 12824865.
  2. ↑ Smith AC, Shuman C, Chitayat D, Steele L, Ray PN, Bourgeois J; et al. (2007). "Severe presentation of Beckwith-Wiedemann syndrome associated with high levels of constitutional paternal uniparental disomy for chromosome 11p15". Am J Med Genet A. 143A (24): 3010–5. doi:10.1002/ajmg.a.32030. PMID 18000906.
  3. ↑ Zammitt NN, Frier BM (2005). "Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities". Diabetes Care. 28 (12): 2948–61. PMID 16306561.
  4. ↑ Yaffe K, Falvey CM, Hamilton N, Harris TB, Simonsick EM, Strotmeyer ES; et al. (2013). "Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus". JAMA Intern Med. 173 (14): 1300–6. doi:10.1001/jamainternmed.2013.6176. PMC 4041621. PMID 23753199. Review in: Evid Based Med. 2014 Apr;19(2):77
  5. ↑ Goto A, Arah OA, Goto M, Terauchi Y, Noda M (2013). "Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis". BMJ. 347: f4533. doi:10.1136/bmj.f4533. PMID 23900314.
  6. ↑ Patterson CC, Dahlquist G, Harjutsalo V, Joner G, Feltbower RG, Svensson J; et al. (2007). "Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989". Diabetologia. 50 (12): 2439–42. doi:10.1007/s00125-007-0824-8. PMID 17901942.


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