Hypoglycemia and Hyperglycemia-The course is designed for the basic understanding of anatomical structures and physiological functions of human body, musculoskeletal system, digestive system, respiratory system; cardiovascular system; urinary system, endocrine system, reproductive system, nervous system, hematologic system, sensory organs, integumentary system, and immune system.The aim of the course is to acquire knowledge and skills regarding anatomy and physiology.

Hypoglycemia and Hyperglycemia

	Hypoglycemia	Hyperglycemia
Definition	Hypoglycemia means when there is blood glucose level below the lower limit of normal range. It is developed when the blood glucose level falls < 65 mg/dl (3.5 mmol/L).	Hyperglycemia is a condition when the blood glucose level is raised above normal.
Causes	Overdose of insulin/Oral hypoglycemic drugs. Addison’s disease. Hyperplasia of the B-cell of pancreas. Severe malnutrition. Insulinoma (insulin secreting tumor).	Diabetes mellitus Pancreatic diseases eg. pancreatitis, hemochromatosis, pancreatectomy etc. Endocrine disorders eg. thyrotoxicosis, cushing syndrome, acromegaly, pheochromocytoma etc. Impaired glucose tolerance Pregnancy Drugs eg. Corticosteroids, thiazide diuretics etc
Clinical Seatures	Confusion Drowsiness Inability to concentrate. Fainting Convulsion/seizures Coma	Polyuria Polydipsia. Polyphagia Nocturia. Dryness of mouth. Glycosuria
Treatment	Prompt administration of sugar by mouth or parenteral I/V glucose solution Treatment of the cause.	Low carbohydrate diet. Regular exercise Drugs e.g. insulin or oral hypoglycemic drugs

Insulin

Definition of Insulin:

Insulin is a protein hormone synthesized in the B-cells of islets of langerhans of pancreas. It is crucial for normal regulation of glucose, lipid and protein metabolism.

Carbohydrate metabolism	↑ Glucose uptake by the different cells. ↑ Glycogenesis ↑ Glycolysis. Gluconeogenesis. Glycogenolysis.
Protein metabolism	↑ Amino acid uptake by the cells. ↑ Protein synthesis in the ribosome. Protein breakdown/ catabolism.
Fat metabolism	↑ Lipo genesis/ Fatty acid synthesis. ↑ Triglyceride deposition. Ketone body formation. Lipolysis.
Others	↑ Cell growth. ↑ K’ uptake by the cells. Activation of Lipoprotein lipase Inhibition of Hormone-sensitive lipase.

Gestational diabetes mellitus (GDM)

The diabetes which first detected or onset occurs during pregnancy is called GDM. It is also called pregnancy induced glucose intolerance. It is usually recognized during 2 or 3 trimester of pregnancy.

Risk factors for GDM:

Positive family history of DM.
Having a previous birth of an overweight baby of 4 kg or more.
Persistent glycosuria.
Obesity.
Age over 30 years.

Complications or Hazards:

risk of developing DM later on.
↑ incidence of fetal macrosomia (fetus is of high birth weight & large organs).
Birth trauma.
Polyhydramnios.
Recurrence of GDM in subsequent pregnancies.

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Diagnosis of GDM: It is diagnosed by OGTT.
According to “American Diabetic Association”, the criteria for the diagnosis of GDM are as follows

Time	Normal	Impaired glucose tolerance	Diabetes
Fasting	< 110mg / dl	>= 110and < 126mg / dl	>= 126mg / dl
2 hour after oral glucose	< 140mg / dl	>= 140and < 200mg / dl	>= 200mg / dl

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Anatomy and Physiology for Nursses and Midwifery | Diploma in Nursing Science and Midwifery

Hypoglycemia and Hyperglycemia | CHAPTER 6 | Anatomy and Physiology