Hypoglycemia, Malnutrition and Body Composition
Hypoglycemia is one of the most significant factors to affect prognosis, and is detrimental to patients regardless of diabetes mellitus (DM) status. The classical paradigms dictate that hypoglycemia is a result of overtreatment with glucose lowering agent
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Hypoglycemia, Malnutrition and Body Composition Hypoglycemia, Malnutrition and Body Composition I. Khanimov, M. Shimonov, J. Wainstein, and Eyal Leibovitz Abstract
Hypoglycemia is one of the most significant factors to affect prognosis, and is detrimental to patients regardless of diabetes mellitus (DM) status. The classical paradigms dictate that hypoglycemia is a result of overtreatment with glucose lowering agents (iatrogenic hypoglycemia), or, as among patients without DM, this condition is attributed to disease severity. New information shows that hypoglycemia occurs among patients that have a tendency for it. Incident hypoglycemia is very prevalent in the hospital setting, occurring in 1:6 patients with DM and in 1:17 patients without DM (Leibovitz E, Khanimov I, Wainstein J, Boaz I. Khanimov Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel M. Shimonov Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Diabetes Unit, Edith Wolfson Medical Center, Holon, Israel J. Wainstein Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Surgery “A”, Edith Wolfson Medical Center, Holon, Israel E. Leibovitz (*) Department of Internal Medicine “A”, Yoseftal Hospital, Eilat, Israel e-mail: [email protected]
M; Diabetes Metab Syndr Clin Res Rev. 13:222–226, 2019). One of the major factors associated with incidence of hypoglycemia is the nutritional status on hospital admission and during the hospitalization. Assessment of nutritional status using questionnaires and biomarkers might be helpful in determining risk of hypoglycemia. Moreover, administration of oral nutritional supplements was shown to decrease this risk. It is also well known that a high burden of comorbidities is associated with an increased risk of hypoglycemia. For example, kidney disease, whether acute or chronic, was shown to increase the risk for hypoglycemia, as well as some endocrine disorders. In this review we elaborate on specific findings that are characteristic of patients at risk for developing hypoglycemia, as well as treatment aimed at preventing its occurrence. Keywords
Albumin · Body composition · Cholesterol · Diabetes mellitus · Hypoglycemia · Malnutrition · Muscle glucose metabolism · NRS-2002 · Nutrition · ONS
I. Khanimov et al.
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Introduction
Hypoglycemia can be defined as serum glucose level equal or under 70 mg/dL ( 3.9 mmol/L) (Seaquist et al. 2013a; Cryer 2009), and is usually accompanied by specific clinical presentation as sweating, trembling, warmness, weakness, and drowsiness (Hepburn et al. 1991). Among patients with diabetes mellitus, and in accordance with the International Hypoglycemia Study Group guidelines, a serum glucose under 54 mg/ dL ( 3.0 mmol/L), is sufficiently low to indicate serious, clinically important hypoglycemia (International Hypoglycaemia Study Group IHS 2017). For decades, it was assumed that serum glucose level is mos
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