Box 2.38Treatment of hypoglycemia

Medical
DrugAdvantagesDisadvantages/side effects
Glucose (oral liquid/gel or intravenous infusion according to conscious state)Cheap, rapidly effectiveIntravenous infusion requires medical intervention
Oral can be given by relatives
GlucagonStimulation of gluconeogenesisNausea/vomiting
Can be given by relatives subcutaneously or intra- muscularlyMay cause insulin secretion
Effect may be transient
DiazoxideInhibition of insulin secretionHypotension, hair growth
Some peripheral actionsRetention of Na+ and water
Nausea/vomiting Long t1/2 (48 h)
Somatostatin analogInhibition of insulin secretionExpensive, gallstones
e.g. octreotide or lanreotideSome peripheral actionsGut upset
Surgical
ProcedureAdvantages/indicationsDisadvantages/side effects
95% distal pancreatectomyOffers surgical ‘cure’ in PHHIOperative morbidity ~30%*
Operative mortality ~2%
DM later in life ~95%
Adenomectomy orCure for insulinomaOperative morbidity ~30%*
Distal pancreatectomyOperative mortality ~2%
*

This includes fistula in approximately 10%, pancreatitis in approximately 5%, abscess in approximately 3%, wound infection in approximately 3% and hemorrhage or peritonitis in approximately 2%.

95% success in first operations.

Abbreviation: PHHI, persistent hyperinsulinemic hypoglycemia of infancy.

From: Chapter 2, The endocrine pancreas

Cover of Endocrinology
Endocrinology: An Integrated Approach.
Nussey S, Whitehead S.
Copyright © 2001, BIOS Scientific Publishers Limited.

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