How to approach hypoglycemia in non-diabetic patients ? (A case based approach)

How to approach hypoglycemia in non-diabetic patients ? (A case based approach) by Dr. Om J Lakhani
00:00 🗃️ Introduction of the topic and the first case
The video discusses hypoglycemia in non-diabetic patients, using real-life cases for illustration.
The first case is a 40-year-old male experiencing symptoms typically before lunch and after lunch, with blood sugar level testing at 62 during these symptomatic periods.
01:55 🔎 Differentiating hypoglycemia in diabetic and non-diabetic patients
A key distinction made between hypoglycemia in diabetic and non-diabetic patients, with diabetic hypoglycemia typically being more straightforward.
Differentiating actual hypoglycemia from anxiety-induced symptoms is critical in non-diabetic patients.
Criteria for diagnosing non-diabetic hypoglycemia discussed, based on the "Whipple triad".
04:43 ⏰ Identifying the nature of hypoglycemia: fasting vs. postprandial
Consideration of the timing of hypoglycemia symptoms is essential, distinguishing between fasting and postprandial situations.
The speaker analyzes the first case's typical symptoms, identifying it as postprandial hypoglycemia.
06:09 🧪 Description of the necessary steps in diagnosing hypoglycemia
The necessity of capturing a "critical sample" of blood during a hypoglycemia episode is emphasized.
The speaker discusses the importance of testing blood glucose, C-peptide, insulin, and cortisol levels in this "critical sample".
09:14 🍲 Explaining the mixed meal stimulation test
For postprandial hypoglycemia, a sample is ideally captured by inducing hypoglycemia through a 'mixed meal' that the patient typically eats.
The speaker advises sending the critical sample for glucose, C-peptide, insulin, and cortisol testing.
12:56 🛠️ Discussion on the diagnosis and management of Postprandial Syndrome
Speaker elaborates on Postprandial Syndrome, a common form of post-meal hypoglycemia, as a diagnosis of exclusion.
Usage of acarbose is highlighted to help delay glucose absorption and blunt insulin peak, which is beneficial in managing this condition.
The importance of avoiding excessive sweet consumption due to more robust insulin release is mentioned.
19:30 🍬 Dietary advice for patients
The importance of small, less sugary meals for preventing hypoglycemia in patients.
Emphasizes the counterproductive cycle of hypoglycemic patients consuming more sugar to alleviate their symptoms which in turn triggers more robust insulin release and more hypoglycemia.
20:28 💉 Insulin-independent hypoglycemia cases
Discusses cases of insulin autoimmune syndrome, also known as Hirata syndrome, where antibodies against insulin cause hypoglycemia.
Presents cases where certain medications trigger this condition - particularly carbazol, methol, cidor, alpha lipoic acid, and Pento prasm.
22:47 🚺 Case of a 25-year-old woman with hypoglycemia
Presents the symptoms of the patient, which included infertility, weight loss, and hypoglycemia.
Discusses the diagnosis of the patient with central hypothyroidism and adrenal insufficiency due to pituitary disorder.
27:11 💊 Management of adrenal insufficiency
Explains that adrenal insufficiency is more common than perceived and often presents with hypoglycemia and hyponatremia.
Lists various causes of adrenal insufficiency and describes its management
31:17 📊 Distinguishing between different types of hypoglycemia
Discusses the importance of distinguishing between insulin-dependent and insulin-independent hypoglycemia during critical sample testing.
Briefly explains the process of diagnosing insulinoma as a cause of insulin-dependent hypoglycemia.
33:25 👶 Case of a pregnant woman with severe hypoglycemia
Presents the symptoms and critical condition of the patient, with a blood glucose level of 26.
Discusses the diagnosis process and the use of dota exendin scan to detect insulinoma, leading to immediate surgery and the patient's recovery.
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[@druzmash]

Wow! Amazing case presentation. Great job.

[@gajendrasinghgaur6331]

Un believable ❤

[@vatoloco2116]

Engaging and Lovely case scenarios and discussion. Would love to see more. Thank you.

[@EndocrinologyIndia]

Thank you

[@sathishkumar-qs3ce]

Excellent management of cases ... keep the great work going.. all the best

[@EndocrinologyIndia]

Thank you so much

[@EndocrinologyIndia]

🎯 Key Takeaways for quick navigation: 00:00 🗃️ *Introduction of the topic and the first case * - The video discusses hypoglycemia in non-diabetic patients, using real-life cases for illustration. - The first case is a 40-year-old male experiencing symptoms typically before lunch and after lunch, with blood sugar level testing at 62 during these symptomatic periods. 01:55 🔎 *Differentiating hypoglycemia in diabetic and non-diabetic patients* - A key distinction made between hypoglycemia in diabetic and non-diabetic patients, with diabetic hypoglycemia typically being more straightforward. - Differentiating actual hypoglycemia from anxiety-induced symptoms is critical in non-diabetic patients. - Criteria for diagnosing non-diabetic hypoglycemia discussed, based on the "Whipple triad". 04:43 ⏰ *Identifying the nature of hypoglycemia: fasting vs. postprandial* - Consideration of the timing of hypoglycemia symptoms is essential, distinguishing between fasting and postprandial situations. - The speaker analyzes the first case's typical symptoms, identifying it as postprandial hypoglycemia. 06:09 🧪 *Description of the necessary steps in diagnosing hypoglycemia* - The necessity of capturing a "critical sample" of blood during a hypoglycemia episode is emphasized. - The speaker discusses the importance of testing blood glucose, C-peptide, insulin, and cortisol levels in this "critical sample". 09:14 🍲 *Explaining the mixed meal stimulation test* - *For postprandial hypoglycemia, a sample is ideally captured by inducing hypoglycemia through a 'mixed meal' that the patient typically eats. * - *The speaker advises sending the critical sample for glucose, C-peptide, insulin, and cortisol testing.* 12:56 🛠️ *Discussion on the diagnosis and management of Postprandial Syndrome* - *Speaker elaborates on Postprandial Syndrome, a common form of post-meal hypoglycemia, as a diagnosis of exclusion. * - *Usage of acarbose is highlighted to help delay glucose absorption and blunt insulin peak, which is beneficial in managing this condition. * - *The importance of avoiding excessive sweet consumption due to more robust insulin release is mentioned. * 19:30 🍬 *Dietary advice for patients* - The importance of small, less sugary meals for preventing hypoglycemia in patients. - Emphasizes the counterproductive cycle of hypoglycemic patients consuming more sugar to alleviate their symptoms which in turn triggers more robust insulin release and more hypoglycemia. 20:28 💉 *Insulin-independent hypoglycemia cases* - Discusses cases of insulin autoimmune syndrome, also known as Hirata syndrome, where antibodies against insulin cause hypoglycemia. - Presents cases where certain medications trigger this condition - particularly carbazol, methol, cidor, alpha lipoic acid, and Pento prasm. 22:47 🚺 *Case of a 25-year-old woman with hypoglycemia* - Presents the symptoms of the patient, which included infertility, weight loss, and hypoglycemia. - Discusses the diagnosis of the patient with central hypothyroidism and adrenal insufficiency due to pituitary disorder. 27:11 💊 *Management of adrenal insufficiency* - Explains that adrenal insufficiency is more common than perceived and often presents with hypoglycemia and hyponatremia. - Lists various causes of adrenal insufficiency and describes its management 31:17 📊 *Distinguishing between different types of hypoglycemia* - Discusses the importance of distinguishing between insulin-dependent and insulin-independent hypoglycemia during critical sample testing. - Briefly explains the process of diagnosing insulinoma as a cause of insulin-dependent hypoglycemia. 33:25 👶 *Case of a pregnant woman with severe hypoglycemia* - Presents the symptoms and critical condition of the patient, with a blood glucose level of 26. - Discusses the diagnosis process and the use of dota exendin scan to detect insulinoma, leading to immediate surgery and the patient's recovery. Made with HARPA AI

[@Sana123sana]

How common is Insulin Autoimmune Syndrome in India?

[@EndocrinologyIndia]

It is a rare condition

[@drsanjaykumar3448]

Thyroid hormone increases conversion of active cortisol to inactive cortisone so cortisol is replaced before starting thyroxine

[@EndocrinologyIndia]

Yes , true