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Diabetes

Addisonian crisis: Everything you need to know

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Often recognized as an adrenal crisis or acute adrenal insufficiency is the Addisonian crisis. It is a rare and potentially lethal condition in which the adrenal glands stop functioning correctly and the body does not have enough cortisol.

Cortisol is a hormone that contributes to a number of bodily functions. They include the conservation of blood sugar, the management of the immune system, the regulation of blood pressure, the control of some of the body’s electrolytes, and the control of levels of stress.

In the early morning and after meals, the levels of cortisol are highest and in the early sleep stages, the lowest at night.

Weakness, intense tiredness, and decreases in blood pressure can be caused by low cortisol levels. However, much of the time, the human body is able to regulate the amount of cortisol it produces.

What is Addisonian crisis?

An Addisonian crisis happens when enough cortisol is not released by the adrenal glands, which are located at the top of each kidney. When the body becomes stressed due to certain factors or stimuli, the adrenal glands can fail to produce cortisol efficiently.

If a person can not maintain their cortisol levels, an Addisonian crisis is a dangerous occurrence and can be fatal. According to one study published in The Journal of Clinical Endocrinology & Metabolism, despite being a highly treatable condition, the mortality rate associated with an Addisonian crisis is around 6 percent.

Confusion, dizziness, and nausea are all symptoms of an Addisonian crisis.
Confusion, dizziness, and nausea are all symptoms of an Addisonian crisis.

Symptoms of an Addisonian crisis include:

  • extreme tiredness and weakness
  • confusion, psychosis, and slurred speech
  • dizziness and feeling faint
  • nausea, vomiting, loss of appetite, and stomach pain
  • fever, chills, and sweating
  • sudden lower back or leg pain
  • dangerously low blood pressure
  • fast heart rate
  • skin reactions, including rashes
  • loss of consciousness

A further potential symptom of the Addisonian crisis is convulsions. The muscles of the body contract and relax rapidly and regularly, resulting in trembling without control.

Causes and causes of vulnerability

People with a condition called Addison’s disease, especially if their condition is not well controlled or not diagnosed, are at the highest risk of developing Addison’s disease.

Addison’s disease is an endocrine condition where the adrenal glands, like cortisol and aldosterone, do not generate enough of the hormones the body requires.

Addison’s disease affects 110-144 out of every 1 million people in developing countries, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The NIDDK also estimated that up to 80% of Addison’s cases are autoimmune disorders, conditions where healthy tissues are believed to be diseased by the body’s immune system and cells, tissues and organs are targeted.

Other possible Addisonian crisis causes are:

  • traumatic physical events, such as a car accident or injury leading to physical shock
  • severe dehydration
  • infections, including stomach viruses and the flu
  • surgery, especially when it involves the adrenal glands
  • pituitary gland not working properly
  • general anesthesia
  • severe allergic reactions
  • low blood sugar levels in people with diabetes
  • long-term steroid use or abruptly stopping steroid medications
  • pregnancy complications
  • emotional trauma

423 individuals with adrenal insufficiency were asked to report on variables that caused their adrenal crisis events in a 2015 survey.

A total of 20 percent of individuals said that gastrointestinal infection, fever, or emotional tension are causes. Other stressful events were identified by about 7 percent of the study participants.

Those who had an adrenal crisis previously were at the greatest risk of another crisis. No additional risk factors were reported by the researchers in the report.

Emergency treatment for Addisonian crisis

A doctor preparing drip
Emergency treatment will be focused on providing intravenous corticosteroids and rehydrating the person.

An Addisonian crisis typically begins with symptoms such as nausea, vomiting, stomach pain, diarrhea, and loss of appetite, encountered by a person. The person will experience chills, sweating, and fever as the crisis worsens.

Extreme dehydration inevitably follows if the condition remains untreated, leading to signs of shock or convulsions. Low blood sugar or low blood pressure can also occur in certain people.

For an Addisonian crisis, it is necessary for individuals to go to an emergency department right away, as it needs immediate medical treatment.

By doing blood tests to check cortisol levels, a physician may make an initial diagnosis. However, making a diagnosis of an Addisonian crisis is not straightforward. For long periods, people may also go undiagnosed and stay undiagnosed until an emergency occurs.

Administered corticosteroids in the veins will prevent adrenal levels from being dangerously low. Other important elements of Addisonian crisis care are:

  • rehydrating the person
  • balancing their electrolyte levels
  • getting blood sugar and blood pressure levels back to normal

The amount of time that people need to spend in a situation in the hospital depends on the individual’s seriousness, underlying causes, and general health.

A case of Addisonian crisis in an emergency department setting

The Journal of Clinical Endocrinology & Metabolism published on a case in which a 20-year-old man with extreme weakness and low blood pressure who had advanced for 3 months came into the emergency room.

Two months before, he had seen his doctor with symptoms of fever, loss of stamina, exhaustion, and dizziness. His doctor diagnosed him with a bacterial infection, and after spending several days in the hospital, his symptoms went away and he was treated with saline.

He reported no known health conditions when he went to the emergency room for the crisis, but had lost over 15 pounds in the 3 months before he began having symptoms. However, he did mention that his skin had been darkening for the past 3 years.

The following health concerns were uncovered by testing:

  • anemia
  • fast heart rate
  • low blood pressure
  • low sodium levels
  • high potassium
  • low cortisol levels

After therapy with saline infusion and hydrocortisone, a medical source of cortisol, the man improved.

Hyperthyroidism was the possible cause of his Addisonian crisis incident, a condition in which too much thyroid hormone is released by the thyroid gland.

The man was doing well two years later, and was being treated with hydrocortisone and fludrocortisone. He led a pretty normal life, and he didn’t have another adrenal crisis. He was taking hyperthyroid medicine, and he handled the condition well.

Prevention of a crisis

Taking medication as directed by a doctor can help prevent further crises.
Taking medication as directed by a doctor can help prevent further crises.

They should continue to get annual checkups once someone has had an Addisonian crisis.

The following measures to help avert a crisis should also be taken by people:

  • learn to watch out for the symptoms of adrenal insufficiency
  • manage triggering conditions
  • take daily oral steroids as directed
  • have emergency glucocorticoids on hand
  • know how much extra medication to take if they have stressors or become ill

As soon as they encounter symptoms, a person can administer an emergency injection and not wait until they are too tired, sick, or confused.

If they have had the injection, it is necessary for the person to call their doctor immediately. Emergency injections are intended primarily for symptom stabilization and are not a replacement for medical treatment.

Outlook

If diagnosed correctly and treated quickly, a person who has had an Addisonian crisis will make a full recovery. Anyone who has adrenal insufficiency can live a largely healthy and active life with ongoing and consistent care.

An Addisonian crisis could result in shock, coma, seizure, and likely death if untreated. Complications and the possibility of another Addisonian crisis can be restricted by:

  • taking all prescribed treatments
  • having a hydrocortisone injection kit on hand at all times
  • keeping a medication condition identification bracelet or card for emergency situations

Alzheimer's / Dementia

Uses of vitamin B-12 level test: Normal ranges, and results

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The amount of vitamin B-12 in the blood or urine is measured in a vitamin B-12 level test to determine the body’s overall vitamin B-12 reserves.

Vitamin B-12 is required for a variety of body functions, including neuron function, DNA and red blood cell formation.

Treatment is required if a person’s vitamin B-12 levels fall outside of the usual range. Vitamin B12 deficiency can cause neurological symptoms as well as fatigue, constipation, and weight loss. B-12 levels that are too high could indicate liver disease, diabetes, or another condition.

Continue reading to learn more about B-12 testing and what the results indicate.

Purpose of a vitamin B-12 level test

worried lady

The vitamin B-12 level test determines the amount of vitamin B-12 in your body. Doctors can use the data to see if low vitamin B-12 levels are causing symptoms.

If a person exhibits any of the following symptoms, a doctor may recommend a vitamin B-12 level test:

Vitamin B-12 insufficiency

Vitamin B-12 deficiency is thought to affect up to 15% of people in the United States, according to research. The following are signs and symptoms of a deficiency:

  • fast heartbeat
  • numbness and tingling in the hands and feet
  • poor memory
  • a sore mouth or tongue
  • confusion
  • dementia
  • depression
  • difficulty maintaining balance

Vitamin B-12 deficiency in infants can cause them to underachieve. They may have mobility issues in addition to developmental delays.

Pernicious anaemia

A vitamin B-12 level test may be required for people who have signs of low iron. Pernicious anaemia is caused by a lack of vitamin B-12 absorption, resulting in poor red blood cell causes.

It usually affects the elderly or people who are deficient in intrinsic factor. Intrinsic factor is a gastric material that binds to vitamin B-12 and allows it to be absorbed by the body.

The following are signs and symptoms of pernicious anaemia:

  • pale skin
  • weakness
  • weight loss
  • constipation
  • fatigue
  • loss of appetite

High levels of folate in the blood

The level of folic acid in the blood is known as serum folate. High levels of serum folate might disguise the signs and symptoms of vitamin B-12 deficiency, exacerbating the neurological symptoms.

They can also make you more susceptible to anaemia.

Symptoms of other illnesses

Vitamin B-12 levels that are unusually high can be a symptom of liver disease, diabetes, or certain types of leukaemia. The findings of a vitamin B-12 test may be used by a doctor to help them make a diagnosis.

Risk factors

Vitamin B-12 deficiency is more common in some people than in others, especially those with low stomach acid or other digestive problems. Stomach acid helps the body absorb vitamin B-12 more effectively by separating it from meals.

Low vitamin B-12 levels are more common in the following groups of people than in others:

  • people with conditions that reduce vitamin B-12 absorption, including celiac disease and Crohn’s disease
  • people who have had gastric bypass surgery
  • those who are breast-feeding
  • people who are taking medicines such as chloramphenicol, proton pump inhibitors, or H2 blockers
  • older adults
  • children
  • vegans and vegetarians
  • people with diabetes

How does the B-12 vitamin level test work?

Vitamin B-12 status is normally determined by a blood test, but home urine tests are now available. Vitamin B-12 levels can be checked as part of a routine blood test by a doctor.

Although fasting is not required before a B-12 test, it may be necessary if the doctor is utilising the test to check at other blood components.

It is important that patients inform their doctors about any medications or supplements they are taking, as some may have an impact on the outcome.

Acknowledging the results

The following are possible results:

  • Low. Vitamin B-12 levels below 200 pg/mL are considered low. This indicates that you may have a vitamin B-12 deficiency, pernicious anaemia, or an overactive thyroid. Neurological symptoms are common in people who have low vitamin B-12 levels.
  • High. Anything over 900 pg/mL is considered excessively high vitamin B-12 status. This result could indicate problems with the liver or kidneys, diabetes, or certain types of leukaemia.

Because the ranges of results differ from one laboratory to the next, it’s important to talk to a doctor about the results and what they signify.

To rule out vitamin B-12 deficiency, the doctor may measure levels of methylmalonic acid (MMA) and other chemicals. These lab results aid in the early detection of vitamin B-12 deficiency.

Vitamin B-12 deficiency treatment

Vitamin B-12 injections are frequently required by people who have low amounts of the vitamin. These shots are more successful at boosting vitamin B-12 levels than supplements, especially when people have medical issues that make supplements difficult to absorb.

High doses of vitamin B-12 supplements may help some people improve their B-12 status. Supplements are sold in the form of capsules or liquids in pharmacies, supermarkets, health food stores. It may also be beneficial to consume extra vitamin B-12-rich foods.

Treatment for high vitamin B-12 levels

There is no upper limit on vitamin B-12 consumption because high amounts do not cause problems. Having naturally high levels of vitamin B-12 in the body, on the other hand, could be cause for alarm, since it could indicate a serious underlying condition. Doctors will focus on treating the underlying medical condition rather than the vitamin B-12 levels.

Vitamin B-12  foods.

Eggs are rich in vitamin B-12.
Vitamin B-12 is abundant in eggs.

Although low vitamin B-12 levels are frequently caused by absorption problems and other medical conditions, some people may be deficient because they do not acquire enough vitamin B-12 through their food. This is especially true for vegans and vegetarians who have been vegetarian for a long time.

Vitamin B-12-rich foods include:

  • fortified plant-based dairy alternatives
  • fortified breakfast cereals
  • fortified nutritional yeast
  • fish and seafood
  • meat
  • eggs
  • dairy products

Vitamin supplements can help vegans and strict vegetarians make up for dietary deficiencies. Older persons should seek to achieve their vitamin B-12 needs through fortified meals and vitamin supplements, as supplements are simpler for their bodies to absorb than naturally occurring vitamin B-12.

Vitamin B-12 dietary recommendations

Vitamin B-12 is required in 2.4 micrograms (mcg) per day for adults and adolescents over the age of 14. During pregnancy, this rises to 2.6 mcg, and breast-feeding raises it to 2.8 mcg.

Conclusion

Vitamin B-12 is an essential nutrient that is necessary for good health. The status of a person’s vitamin B-12 is determined by a vitamin B-12 level test. This test may be recommended by a doctor to people who have symptoms of a deficiency or who are at risk of having low vitamin B-12 levels in their bodies.

Vitamin B-12 deficiency can be avoided by eating a well-balanced diet that includes many sources of the vitamin on a daily basis, or by taking supplements. If they have trouble absorbing vitamin B-12 from food, oral supplements or injections can help them avoid symptoms and consequences.

Sources:

  • https://academic.oup.com/qjmed/article/106/6/505/1538806
  • https://labtestsonline.org/tests/methylmalonic-acid
  • https://www.medicalnewstoday.com/articles/322286
  • https://academic.oup.com/nutritionreviews/article-abstract/71/2/110/1940320
  • https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
  • https://www.hsph.harvard.edu/nutritionsource/b-12-deficiency/

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Diabetes

Symptoms, stages, causes, and treatment of diabetic nephropathy

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Diabetic nephropathy is a type of kidney disease that affects people who have diabetes for a long time. It happens when a person’s kidneys are damaged by high blood glucose levels.

Diabetic nephropathy is a type of chronic kidney disease caused by diabetes. The kidneys aid in the regulation of fluid and salt levels in the body, which is critical for blood pressure control and cardiovascular health.

When a person has diabetes, whether type 1 or type 2, or gestational diabetes, their bodies are unable to use or manufacture insulin properly. Gestational diabetes is a kind of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life.

High blood sugar levels are a symptom of diabetes. High glucose levels can harm several parts of the body over time, including the cardiovascular system and the kidneys. Diabetic nephropathy is the term for the kidney damage that occurs as a result of diabetes.

Diabetic nephropathy is a leading cause of chronic kidney disease and end-stage renal disease in people with diabetes (ESRD). The kidneys in ESRD are no longer able to satisfy the demands of daily life. Kidney failure can occur as a result of ESRD, which can be life-threatening.

This page examines how diabetes affects the kidneys, as well as the treatment options and ways to prevent the risk.

Definition

alzheimer’s patients

Because nephropathy is caused by damage caused by high blood glucose levels, it can affect people with any kind of diabetes.

High blood glucose levels have an effect on the arteries in the body, and the kidneys filter the blood that passes through them.

According to the authors of a 2016 study, 20–40 percent of people with diabetes suffer renal disease.

A person’s tests may reveal one or both of the following:

High levels of albumin in the urine: When the kidneys are in good shape, the urine should include no albumin protein.

A low glomerular filtration rate (GFR): The kidneys’ primary role is to filter the blood. Their ability to do so is hampered by kidney disease. The kidneys should ideally function at 100% or have a GFR of 100Trusted Source. A doctor will not diagnose renal disease unless the GFR is 60 percent or higher. Kidney disease affects 15–60% of the population. Kidney failure is indicated by a percentage of less than 15%.

The end stage of renal disease is ESRD. In the United States, diabetic nephropathy is the most common cause of ESRD. Diabetes is responsible for 40–50% of all occurrences of ESRD, according to Trusted Source. Dialysis will be required if a person has ESRD.

Controlling blood sugar levels can help to lower the risk. Whether you have type 1 or type 2 diabetes, you can lower your risk of diabetic nephropathy by doing the following:

  • blood glucose levels should be monitored and kept within the target range
  • consuming a nutritious, low-sugar, low-salt diet
  • exercising on a regular basis
  • adhering to a treatment plan that may include the use of insulin or other drugs
  • keeping a healthy weight is important.

What is chronic kidney disease? Find out more here.

Causes

Kidney damage puts a strain on these critical organs, preventing them from functioning normally.

When this occurs:

  • the kidneys cannot maintain healthy fluid levels in the body
  • the kidneys cannot remove waste products from the blood
  • the body starts to lose protein through the urine

Diabetic nephropathy takes time to develop. According to one study, 15 years after a diabetes diagnosis, a third of people have high levels of albumin in their urine. Only about half of these people will acquire complete nephritis.

Kidney disease is uncommon in people who have had diabetes for less than ten years, according to statistics. Also, if a person does not get nephropathy 20–25 years after diabetes begins, they have a low probability of developing it later.

Diabetic nephropathy is less likely if a diabetic’s blood glucose levels are well controlled.

Because of the damage to blood vessels, high blood glucose levels raise the risk of high blood pressure. Hypertension, or high blood pressure, can aggravate kidney disease.

Other potential dangers

Other aspects to consider are:

Smoking: A relationship between smoking and increased levels of inflammation may cause kidney injury. While the exact link between smoking and diabetes is unknown, people appear to have a higher risk of diabetes, as well as hypertension and kidney disease.

Age: Kidney disease, particularly a low GFR, is more common in people over the age of 65.

Sex: The condition is more common in men than in women.

Ethnicity, race, or both: African Americans, Native Americans, and Asian Americans are more likely to have it.

Conditions of health: Obesity, chronic inflammation, high blood pressure, insulin resistance, and high blood lipids (fats) are all risk factors for kidney disease.

Some of these risks are or appear to be contributing factors to diabetes or complications.

Diabetic nephropathy is distinct from diabetic neuropathy, a condition that affects the nerve system.

Stages and symptoms

A person with diabetic nephropathy may not experience any symptoms in the early stages. Changes in blood pressure and fluid balance in the body, on the other hand, may already be evident. Waste materials can accumulate in the blood over time, causing symptoms.

Stages

Depending on the GFR, which also measures the proportion of functional kidney function, a clinician may divide renal disease into phases.

Stage 1: Kidney damage is present, but kidney function is normal and the GFR is 90 percent or higher.

Stage 2: Kidney impairment, with some function loss and a GFR of 60–89%.

Stage 3: Mild to severe function loss, with a GFR of 30–59%.

Stage 4: Severe impairment of function with a GFR of 15–29%.

Stage 5: Kidney failure with a GFR of less than 15%.

Symptoms

A person may not detect any symptoms in the early stages. They may feel sick and exhibit the following symptoms at stage 4 or 5:

  • fatigue due to lack of oxygen in the blood
  • nausea or vomiting
  • a metallic taste in the mouth
  • swollen ankles, feet, lower legs, or hands due to water retention
  • darker urine due to blood in the urine
  • shortness of breath

Cardiovascular disease is a complication of late-stage renal disease.

Following a diabetic treatment plan and getting frequent health checks can help a person with diabetes maintain their blood sugar levels, lower their risk of kidney problems, and detect problems early.

A urine test is used to check for proteins in the urine during screening. Protein in the urine, on the other hand, does not always indicate kidney disease; it could also be the result of a urinary tract infection.

Treatment

Diabetic nephropathy can be delayed or prevented with early treatment.

The major goal of treatment is to keep blood glucose and blood pressure under control. This may entail the administration of drugs.

Drug treatment

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can help to control blood pressure, protect renal function, and avoid future damage.

In individuals with CKD associated with type 2 diabetes, Kerendia (finerenone) is a prescription drug that can minimize the risk of persistent GFR decline, end-stage renal disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure.

In addition, because people with kidney disease generally have low vitamin D levels, a doctor may give vitamin D or a statin to lower cholesterol levels.

For people with type 2 diabetes and CKD, the American College of Cardiology issued guidelines in 2018 supporting the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs). These medications may lower the risk of CKD progression, heart attacks, or both.

Dietary changes

If you have kidney disease, your doctor may advise you to track the following nutrients:

Water: Although necessary, drinking too much water or fluid can lead to edema and high blood pressure.

Sodium: Because it is a salt component, it might elevate blood pressure.

Protein: Protein can cause waste to build up in the blood, putting extra strain on the kidneys in people who have kidney disease.

Phosphorus: This can be found in a variety of protein and dairy sources. Phosphorus overload can weaken bones and put strain on the kidneys.

Potassium: Potassium levels in people with kidney disease can be greater than they should be, which can harm nerve cells.

Keeping blood sugar levels in check

This is critical for reducing the risk of diabetes complications such as renal disease, cardiovascular disease, and diabetic neuropathy, a nerve system disorder.

These disorders can also lead to additional difficulties. Blood sugar control can also help prevent these problems from arising.

Late-stage treatment options

Diabetic nephropathy can proceed to end-stage renal disease (ESRD), which necessitates dialysis or a kidney transplant. They will very certainly require dialysis for the remainder of their lives or until a kidney donation becomes available.

Dialysis

Kidney dialysis is a process that separates waste items from the blood and removes them from the body using a machine. Dialysis is used to replace a healthy kidney.

Dialysis comes in a variety of forms:

Hemodialysis: Blood is drawn from the body by a needle in the forearm and transported to a dialysis machine via a tube. The blood is filtered outside the body by the machine, then returned through a tube and needle.

Depending on the choice selected, a person may need to do this three to seven times a week and spend two to ten hours per session.

Dialysis can be done at a dialysis facility or at home, and in some cases, overnight alternatives are available. People are increasingly able to incorporate dialysis into their work and personal routines because to flexible choices.

Peritoneal dialysis: The peritoneum, or lining of the abdomen, is used to filter blood inside the body.

  • Dialysis fluid enters the abdomen by a catheter in continuous ambulatory peritoneal dialysis (CAPD). Before draining out, the fluid lingers inside for several hours, filtering waste materials. It takes 30–40 minutes to drain.
  • Continuous cycler-assisted peritoneal dialysis (CCPD), also known as automated peritoneal dialysis, involves a person sleeping linked to a dialysis machine for 8–10 hours. The fluid drainage is controlled by the machine.

Peritoneal dialysis can be done at home, at work, or while traveling. It provides flexibility and gives the individual some control over their condition. If a person is going to travel, for example, they will need to learn how to operate the essential equipment and make sure they have all of the necessary materials.

Kidney transplant

If diabetic nephropathy has progressed to the point where a kidney transplant is necessary and a qualified donor is available, a doctor may propose it. It may take some time to find a donor.

Because a person can live with only one functioning kidney, some people offer to donate a kidney to a loved one.

The individual who receives the kidney, on the other hand, may find that their body rejects the new organ. The body has the best chance of accepting a kidney donation from a family member.

To lessen the risk of the new kidney being rejected by the body, the individual who has had a kidney transplant will need to take medicine. This can have some negative consequences, such as raising the risk of infection.

Financial help

Many people can get financial assistance. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Medicare and Medicaid normally cover kidney failure treatment.

If all of the following apply, a person can acquire Medicare for ESRD at any age:

  • Their kidneys are no longer functional.
  • They require dialysis on a regular basis or have had a kidney transplant.
  • They have worked for Social Security, the Railroad Retirement Board, or as a government employee for the required amount of time.
  • They are receiving Social Security or Railroad Retirement payments or are eligible for them.
  • They are the dependent kid or spouse of someone who fits one of the aforementioned criteria.

The individual should discuss their options with their insurance provider or their doctor.

Prevention

Controlling blood sugar and blood pressure is the greatest strategy for someone with diabetes to lower their risk of diabetic nephropathy.

This can be aided by making the following lifestyle changes:

  • checking blood glucose levels regularly
  • following any treatment plan their doctor suggests
  • limiting stress where possible
  • eating a nutritious diet that is high in fiber and low in sugar, processed carbohydrates, and salt
  • exercising regularly
  • limiting alcohol intake
  • avoiding tobacco

Learning as much as possible about diabetes and related consequences, such as kidney disease, can make a person feel more confident and in charge of their condition and prevention options.

The National Kidney Disease Education Program of the National Institute of Diabetes and Digestive and Kidney Diseases provides a downloadable record of test results that can assist a person maintain track of their kidney testing and development.

Outlook

The outlook for diabetic nephropathy people will be determined by how well they manage their blood sugar and blood pressure levels, as well as the stage at which they are diagnosed. The sooner therapy begins, the better the outlook.

Diabetic nephropathy can be slowed or stopped with treatment. People with diabetes should have their blood pressure checked as recommended by their doctor and take precautions to prevent kidney disease from worsening.

Sources:

  • https://www.nejm.org/doi/full/10.1056/NEJMoa2025845
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/choosing-treatment
  • https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/eating-right
  • https://www.kidney.org/atoz/content/gfr
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297507/
  • https://www.medicalnewstoday.com/articles/319686
  • https://www.ahajournals.org/doi/10.1161/JAHA.116.003280
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/kidney-transplant
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206379/
  • https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis
  • https://www.medicare.gov/information-for-my-situation/signing-up-for-medicare-if-you-have-esrd
  • https://www.jwatch.org/fw114803/2018/11/27/sglt2-inhibitors-glp-1ras-recommended-type-2-diabetes-and

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Blood / Hematology

Exercise-induced hypoglycemia: Things to know

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The medical name for low blood sugar during or after exercise is exercise-induced hypoglycemia (EIH). The condition can cause itself in a variety of ways, including weakness, shakiness, and extreme exhaustion.

The body’s major source of energy is glucose. The body requires more energy during activity and hence uses more glucose. EIH is caused by an increase in the desire for glucose. Other factors could also be at play.

The symptoms, causes, treatment, and prevention of EIH are all covered in this article. It also covers if EIH is an indication of diabetes and when EIH should be treated.

When to ask assistance

If blood glucose levels go too low, hypoglycemia can be fatal. If you have one or more of the following symptoms, you should get medical help right away:

  • loss of consciousness
  • confusion
  • symptoms that persist despite resting or consuming more food
  • seizure

If people commonly develop EIH or hypoglycemia at other times, they should see a doctor. If the person has diabetes, this could indicate that they are taking too much insulin or that their diabetes medicine dosage is inaccurate.

What is EIH?

Exercise-induced hypoglycemia

Hypoglycemia is a condition in which the blood glucose level is insufficient to supply the body’s energy requirements. Hypoglycemia is defined as a blood glucose level of less than 70 milligrams per deciliter (mg/dl) according to doctors. Most people, however, do not experience hypoglycemia symptoms until their blood glucose levels fall below 55 mg/dl.

Carbohydrates are broken down into glucose by the body. The glucose then enters the bloodstream, prompting the pancreas to produce insulin in response. Insulin aids glucose entry into the body’s cells, allowing it to be used as fuel.

Because active muscles require more fuel, exercise raises glucose demand. Exercise may also make a person more insulin sensitive, which means the insulin works more efficiently and lowers blood glucose levels faster. These factors, when combined, can cause in EIH.

If a person has the following characteristics, they are more prone to develop EIH:

  • have insulin sensitivity or take insulin
  • already have low blood glucose, such as from hunger or from diabetes medication
  • do an intense workout that demands more energy

Symptoms of EIH

Glucose fuels the majority of major bodily activities. As a result, EIH symptoms can vary. The following are some probable signs and symptoms:

  • weakness
  • confusion
  • anxiety
  • fainting
  • shaking
  • dizziness

Hypoglycemia that lasts for a long time or is severe might be fatal. It could result in the following:

Causes

Exercise increases the body’s energy demands, causing it to respond by burning more glucose. People with low glucose levels or those whose bodies metabolize glucose quickly can develop hypoglycemia.

EIH can be caused by a number of reasons, including:

  • exercising immediately after a meal
  • being sick
  • drinking too much alcohol without food
  • using insulin or other diabetes medications
  • not eating enough, or fasting
  • not consuming enough carbohydrates

Exercise causes a significant increase in insulin, which eliminates glucose from the blood, in certain people. Even if a person is well-nourished and does not take blood glucose-lowering drugs, this rise might cause hypoglycemia.

If a person has persistent EIH, a doctor may prescribe medicine to help them recover. Most people, however, can solve the problem by making proper lifestyle modifications.

Is EIH a sign of diabetes?

EIH is not always a symptom of diabetes. Exercise by itself can significantly lower blood glucose levels. People with diabetes, on the other hand, have increased risk factors for hypoglycemia.

Hyperglycemia, or high blood glucose, is a complication of untreated diabetes. If people who take diabetes drugs take more than they need, they are more likely to develop hypoglycemia. It’s also possible that you’re not getting enough nourishment to match your exercise level.

Also, if people with diabetes take diabetic medicine while fasting or commencing a restrictive diet, they may develop hypoglycemia.

Treatment for EIH

Mild EIH normally does not necessitate therapy. In many cases, the condition arises as a result of a person not eating enough food before exercising. Individuals should consume a carbohydrate-rich meal 1–2 hours before a workout to avoid EIH.

Chronic EIH might occasionally indicate a problem with insulin manufacturing. A doctor may administer diazoxide to treat low blood sugar in people who have chronic EIH.

A doctor may consider removing a portion of the pancreas to reduce insulin production in rare circumstances.

Prevention in people with diabetes

People who take diabetic drugs to control their blood glucose levels should check their blood glucose levels before exercising, according to the American Diabetes Association (ADA). If their blood glucose level is below 100 mg/dl, they should consume 15–20 grams (g) of carbs to raise it.

Among the possibilities are:

  • 4 glucose tablets
  • 1 glucose gel tube
  • 1 tablespoon of honey or sugar
  • 4 ounces (oz) of soda or juice

The American Diabetes Association recommends that a person recheck their blood glucose after 15 minutes. If the blood sugar level stays below 100 mg/dl, they should eat another 15 g carbohydrate portion. They should do this every 15 minutes until their blood glucose level reaches at least 100 mg/dl.

Anaerobic exercise, such as high intensity interval training (HIIT), may reduce the incidence of hypoglycemia in people with diabetes, according to a 2019 review. Short bursts of intensive activity are followed by a rest and then another brief burst of intense activity in HIIT.

Prevention in people without diabetes

People without diabetes can usually avoid EIH by doing the following:

  • avoiding drinking alcohol before a workout
  • eating regular meals throughout the day
  • gradually building up to new exercise routines to give the body time to adapt

Stop and take a break if you start to feel unsteady or dizzy throughout your workout. They should drink 4 oz (113 g) of juice or eat a slice of toast before continuing their workout.

Conclusion

Hypoglycemia occurs when blood glucose levels fall too low to meet a person’s body’s energy needs. Hypoglycemia that happens during or after exercise is known as EIH. The condition can affect both people and non-diabetics.

Diabetes patients are more likely to develop EIH, especially if they use insulin or other blood glucose-controlling drugs. In such circumstances, a person should consult a doctor to see whether their drug amounts can be adjusted.

EIH is most commonly caused by not eating enough before exercising or not giving the body enough time to acclimatize to a new exercise schedule in people who do not have diabetes. If a person continues to have regular EIH despite following the necessary precautions, they should seek medical advice to establish the underlying cause.

Sources:

  • https://www.diabetes.org/healthy-living/fitness/getting-started-safely/blood-glucose-and-exercise
  • https://www.frontiersin.org/articles/10.3389/fendo.2019.00326/full
  • https://drc.bmj.com/content/6/1/e000578.abstract
  • https://www.medicalnewstoday.com/articles/exercise-induced-hypoglycemia-what-to-know
  • https://www.cdc.gov/diabetes/basics/insulin-resistance.html
  • https://www.ncbi.nlm.nih.gov/books/NBK534841/
  • https://www.hormone.org/diseases-and-conditions/diabetes/non-diabetic-hypoglycemia
  • https://www.frontiersin.org/articles/10.3389/fendo.2020.00578/full

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