Hypoglycemia & Hyperglycemia Dave Joffe, BSPharm, CDE, FACA

Objectives: Define & assess blood sugar values Causes of hypoglycemia & hyperglycemia including normal causes and medically induced causes. Recognition of hypoglycemia & hyperglycemia Treatment of both hypoglycemia & hyperglycemia depending on the severity of the presentation. The bodies response to changes in blood sugar

We Have an Epidemic of Diabetes !! mil mil

Source: 2007–2009 National Health Interview Survey estimates projected to the year 2010.

Genes Environment Insulin Resistance + Beta-cell Failure Relative Deficiency in Insulin Type 2 Diabetes Adapted from Kahn CR. Diabetes. 1994;43:1066–1084. Pathogenesis of Type 2 Diabetes Beta Cell Failure and Insulin Resistance

Adapted from Kendall D, Bergenstal R. © International Diabetes Center. Glucose (mg/dL) Relative Function (%) Years of diabetes Insulin resistance Insulin level Fasting glucose Beta-cell failure Postmeal glucose At risk for diabetes Natural History of Type 2 Diabetes Progression: Beta Cell Failure and Insulin Resistance Pre Diabetes IFG IGT

Type 2 Diabetes Increased Hepatic Glucose Production Increased Glucagon Secretion Impaired Incretin Effect 1.Decreased secretion of GLP-1 2.Impaired response to GIP Increased Gastric Emptying Rate Other Aspects of Type 2 Diabetes Pathophysiology Decreased Amylin Secretion

Glycemic Goals for all Patients EuglycemicADAAACE/ACEIDF A1C %< 7%<= 6.5%<6.5% FBG (mg/dl)<10070 – 130< hppBG (mg/dl) <140< 180 (bedtime: < 140) <140<145

BP and Lipid Goals ADAAACE/ACEIDF BP (mmHg)<130/80 LDL ( mg/dL)< 100 or <70 < 95 HDL ( mg/dL)> 40 (M) or >50 (F) > 39 TG ( mg/dL)< 150 < 200

Relationship Between A1C and Average Blood Glucose A1C (%) Average BG (mg/dL) High Risk for Complications Increasing Risk for Complications Good Control Less Risk for Complications Normal Range Low Risk for Complications Data from Diabetes Control and Complications Trial (DCCT). QUALITY OF PATIENT CARE US Average 9.3 US Average 245mg/dl ACE Goal 6.5