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Physiological Reviews Oct 2007Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon, the... (Review)
Review
Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon, the gene which is expressed in these cells. The current knowledge regarding regulation of proglucagon gene expression in the gut and in the brain and mechanisms responsible for the posttranslational processing are reviewed. GLP-1 is released in response to meal intake, and the stimuli and molecular mechanisms involved are discussed. GLP-1 is extremely rapidly metabolized and inactivated by the enzyme dipeptidyl peptidase IV even before the hormone has left the gut, raising the possibility that the actions of GLP-1 are transmitted via sensory neurons in the intestine and the liver expressing the GLP-1 receptor. Because of this, it is important to distinguish between measurements of the intact hormone (responsible for endocrine actions) or the sum of the intact hormone and its metabolites, reflecting the total L-cell secretion and therefore also the possible neural actions. The main actions of GLP-1 are to stimulate insulin secretion (i.e., to act as an incretin hormone) and to inhibit glucagon secretion, thereby contributing to limit postprandial glucose excursions. It also inhibits gastrointestinal motility and secretion and thus acts as an enterogastrone and part of the "ileal brake" mechanism. GLP-1 also appears to be a physiological regulator of appetite and food intake. Because of these actions, GLP-1 or GLP-1 receptor agonists are currently being evaluated for the therapy of type 2 diabetes. Decreased secretion of GLP-1 may contribute to the development of obesity, and exaggerated secretion may be responsible for postprandial reactive hypoglycemia.
Topics: Animals; Diabetes Mellitus; Gastrointestinal Tract; Glucagon-Like Peptide 1; Glucagon-Like Peptide-1 Receptor; Humans; Hypoglycemia; Obesity; Proglucagon; Receptors, Glucagon
PubMed: 17928588
DOI: 10.1152/physrev.00034.2006 -
Diabetologia May 2021Hypoglycaemia (blood glucose concentration below the normal range) has been recognised as a complication of insulin treatment from the very first days of the discovery... (Review)
Review
Hypoglycaemia (blood glucose concentration below the normal range) has been recognised as a complication of insulin treatment from the very first days of the discovery of insulin, and remains a major concern for people with diabetes, their families and healthcare professionals today. Acute hypoglycaemia stimulates a stress response that acts to restore circulating glucose, but plasma glucose concentrations can still fall too low to sustain normal brain function and cardiac rhythm. There are long-term consequences of recurrent hypoglycaemia, which are still not fully understood. This paper reviews our current understanding of the acute and cumulative consequences of hypoglycaemia in insulin-treated diabetes.
Topics: Animals; Blood Glucose; Brain; Diabetes Mellitus; Humans; Hypoglycemia; Insulin
PubMed: 33550443
DOI: 10.1007/s00125-020-05366-3 -
Archivos Argentinos de Pediatria Oct 2019Hypoglycemia can lead to long-term neurological morbidity. Currently, there is no consensus regarding the value that we should consider as a safe limit, and it remains... (Review)
Review
Hypoglycemia can lead to long-term neurological morbidity. Currently, there is no consensus regarding the value that we should consider as a safe limit, and it remains one of the most controversial issues in the management of the newborn. After reading this review we will be able to understand which children require evaluation of blood glucose within the first days of life. Routine glucose detection in healthy term infants is not an evidence-based clinical practice, and should only be reserved for children who are at risk of suffering from it. This review aims to unify the criteria in the management and care of newborns who experience hypoglycemia, therefore, the Committee on Fetal-Neonatal Studies (CEFEN) in collaboration with a group of neonatologists have prepared the following review.
Topics: Diagnostic Errors; Evidence-Based Medicine; Glucose; Glycogen; Humans; Hypoglycemia; Infant, Newborn
PubMed: 31833338
DOI: 10.5546/aap.2019.S195 -
Journal of Diabetes Science and... May 2020Hypoglycemia in inpatients with diabetes remains the most common complication of diabetes therapies. Hypoglycemia is independently associated with increased morbidity... (Review)
Review
Hypoglycemia in inpatients with diabetes remains the most common complication of diabetes therapies. Hypoglycemia is independently associated with increased morbidity and mortality, increased length of stay, increased readmission rate, and increased cost. This review describes the importance of reporting and addressing inpatient hypoglycemia; it further summarizes eight strategies that aid clinicians in the prevention of inpatient hypoglycemia: auditing the electronic medical record, formulary restrictions and dose-limiting strategies, hyperkalemia order sets, electronic glucose management systems, prediction tools, diabetes self-management, remote surveillance, and noninsulin medications.
Topics: Biomarkers; Blood Glucose; Diabetes Mellitus; Glycemic Control; Hospitalization; Humans; Hypoglycemia; Hypoglycemic Agents; Inpatients; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 32389071
DOI: 10.1177/1932296820918540 -
The Journal of Pediatrics Aug 2015
Topics: Blood Glucose; Child; Child, Preschool; Endocrinology; Humans; Hypoglycemia; Infant; Infant, Newborn; Pediatrics; Societies, Medical
PubMed: 25957977
DOI: 10.1016/j.jpeds.2015.03.057 -
Frontiers in Endocrinology 2023Neonatal hypoglycemia affects up to 15% of all newborns. Despite the high prevalence there is no uniform definition of neonatal hypoglycemia, and existing guidelines... (Review)
Review
Neonatal hypoglycemia affects up to 15% of all newborns. Despite the high prevalence there is no uniform definition of neonatal hypoglycemia, and existing guidelines differ significantly in terms of when and whom to screen for hypoglycemia, and where to set interventional thresholds and treatment goals. In this review, we discuss the difficulties to define hypoglycemia in neonates. Existing knowledge on different strategies to approach this problem will be reviewed with a focus on long-term neurodevelopmental outcome studies and results of interventional trials. Furthermore, we compare existing guidelines on the screening and management of neonatal hypoglycemia. We summarize that evidence-based knowledge about whom to screen, how to screen, and how to manage neonatal hypoglycemia is limited - particularly regarding operational thresholds (single values at which to intervene) and treatment goals (what blood glucose to aim for) to reliably prevent neurodevelopmental sequelae. These research gaps need to be addressed in future studies, systematically comparing different management strategies to progressively optimize the balance between prevention of neurodevelopmental sequelae and the burden of diagnostic or therapeutic procedures. Unfortunately, such studies are exceptionally challenging because they require large numbers of participants to be followed for years, as mild but relevant neurological consequences may not become apparent until mid-childhood or even later. Until there is clear, reproducible evidence on what blood glucose levels may be tolerated without negative impact, the operational threshold needs to include some safety margin to prevent potential long-term neurocognitive impairment from outweighing the short-term burden of hypoglycemia prevention during neonatal period.
Topics: Female; Infant, Newborn; Humans; Child; Blood Glucose; Hypoglycemia; Infant, Newborn, Diseases; Fetal Diseases; Disease Progression
PubMed: 37361517
DOI: 10.3389/fendo.2023.1179102 -
The Journal of Clinical Endocrinology... Aug 2018Hypoglycemia, occurring after bariatric and other forms of upper gastrointestinal surgery, is increasingly encountered by clinical endocrinologists. The true frequency... (Review)
Review
CONTEXT
Hypoglycemia, occurring after bariatric and other forms of upper gastrointestinal surgery, is increasingly encountered by clinical endocrinologists. The true frequency of this condition remains uncertain, due, in part, to differences in the diagnostic criteria and in the affected populations, as well as relative lack of patient and physician awareness and understanding of this condition. Postbariatric hypoglycemia can be severe and disabling for some patients, with neuroglycopenia (altered cognition, seizures, and loss of consciousness) leading to falls, motor vehicle accidents, and job and income loss. Moreover, repeated episodes of hypoglycemia can result in hypoglycemia unawareness, further impairing safety and requiring the assistance of others to treat hypoglycemia.
OBJECTIVE
In this review, we summarize and integrate data from studies of patients affected by hypoglycemia after Roux-en-Y gastric bypass (RYGB) surgery, obtained from PubMed searches (1990 to 2017) and reference searches of relevant retrieved articles. Whereas hypoglycemia can also be observed after sleeve gastrectomy and fundoplication, this review is focused on post-RYGB, given the greater body of published clinical studies at present.
OUTCOME MEASURES
Data addressing specific aspects of diagnosis, pathophysiology, and treatment were reviewed by the authors; when not available, the authors have provided opinions based on clinical experience with this challenging condition.
CONCLUSIONS
Hypoglycemia, occurring after gastric bypass surgery, is challenging for patients and physicians alike. This review provides a systematic approach to diagnosis and treatment based on the underlying pathophysiology.
Topics: Gastrectomy; Gastric Bypass; Humans; Hypoglycemia; Laparoscopy; Obesity, Morbid
PubMed: 30101281
DOI: 10.1210/jc.2018-00528 -
Best Practice & Research. Clinical... Jun 2016Intensive glycaemic control reduces the diabetic microvascular disease burden but iatrogenic hypoglycaemia is a major barrier preventing tight glycaemic control because... (Review)
Review
Intensive glycaemic control reduces the diabetic microvascular disease burden but iatrogenic hypoglycaemia is a major barrier preventing tight glycaemic control because of the limitations of subcutaneous insulin preparations and insulin secretagogues. Severe hypoglycaemia is uncommon early in the disease as robust physiological defences, particularly glucagon and adrenaline release, limit falls in blood glucose whilst associated autonomic symptoms drive patients to take action by ingesting oral carbohydrate. With increasing diabetes duration, glucagon release is progressively impaired and sympatho-adrenal responses are activated at lower glucose levels. Repeated hypoglycaemic episodes contribute to impaired defences, increasing the risk of severe hypoglycaemia in a vicious downward spiral. Managing hypoglycaemia requires a systematic clinical approach with structured insulin self-management training and support of experienced diabetes educators. Judicious use of technologies includes insulin analogues, insulin pump therapy, continuous glucose monitoring, and in a few cases islet cell transplantation. Some individuals require specialist psychological support.
Topics: Blood Glucose; Disease Management; Glucagon; Humans; Hypoglycemia; Insulin
PubMed: 27432075
DOI: 10.1016/j.beem.2016.06.004 -
Obesity Research & Clinical Practice 2016Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal... (Review)
Review
Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Physicians should be aware of this complication to ensure timely and effective treatment of post-RYGB patients, who present to them with hypoglycemic symptoms. Possible causes of hypoglycemia in these patients include late dumping syndrome, nesidioblastosis and rarely insulinoma. Systematic evaluation including history, biochemical analysis, and diagnostic testing might help in distinguishing among these diagnoses. Continuous glucose monitoring is also a valuable tool, revealing the episodes in the natural environment and can also be used to monitor treatment success. Treatment should begin with strict low carbohydrate diet, followed by medication therapy. Therapy with diazoxide, acarbose, calcium channel blockers and octreotide have been proven to be beneficial, but the response apparently is highly variable. When other treatment options fail, surgical options can be considered.
Topics: Bariatric Surgery; Humans; Hyperinsulinism; Hypoglycemia; Obesity, Morbid
PubMed: 26522879
DOI: 10.1016/j.orcp.2015.07.003 -
Frontiers in Endocrinology 2021Hypoglycemia is the result of defects/impairment in glucose homeostasis. The main etiological causes are metabolic and/or endocrine and/or other congenital disorders.... (Review)
Review
Hypoglycemia is the result of defects/impairment in glucose homeostasis. The main etiological causes are metabolic and/or endocrine and/or other congenital disorders. Despite hypoglycemia is one of the most common emergencies in neonatal age and childhood, no consensus on the definition and diagnostic work-up exists yet. Aims of this review are to present the current age-related definitions of hypoglycemia in neonatal-pediatric age, to offer a concise and practical overview of its main causes and management and to discuss the current diagnostic-therapeutic approaches. Since a systematic and prompt approach to diagnosis and therapy is essential to prevent hypoglycemic brain injury and long-term neurological complications in children, a comprehensive diagnostic flowchart is also proposed.
Topics: Child; High-Throughput Nucleotide Sequencing; Humans; Hypoglycemia
PubMed: 34408725
DOI: 10.3389/fendo.2021.684011