HYPOGLYCEMIA – CAUSES AND OCCURRENCES Edited by Everlon Cid Rigobelo Hypoglycemia – Causes and Occurrences Edited by Everlon Cid Rigobelo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Alenka Urbancic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Sean Gladwell, 2011. Used under license from Shutterstock.com First published September, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Hypoglycemia – Causes and Occurrences, Edited by Everlon Cid Rigobelo p. cm. ISBN 978-953-307-657-7 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Section A 1 Chapter 1 A New Therapy of Type 2 Diabetes: DPP-4 Inhibitors 3 Tatjana Ábel Chapter 2 Relationship Between Age and Diabetic Treatment Type on the Frequency of Hyperglycemic Episodes Monitored by Continuous Glucose Monitoring 15 Boby G. Thekadeth, P. Zachariah, Zeenat Parveen, Pavan Patel, Matthew Schoeck, Andrew Mazulis, Lawrence Perlmuter and Sant P. Singh Chapter 3 Development of Mulberry Leaf Extract for Suppressing Postprandial Blood Glucose Elevation 25 Toshiyuki Kimura Chapter 4 Pathogenetic Mechanisms of Exercise-Associated Hypoglycemia: Permanent and Reversible Counterregulatory Failure 37 Pietro Galassetti Part 2 Section B 53 Chapter 5 An Update on Neonatal Hypoglycemia 55 Praveen Kumar and Shiv Sajan Saini Chapter 6 Neonatal Hypoglycemia - Current Concepts 85 Blanca Álvarez Fernández and Irene Cuadrado Pérez Chapter 7 Glucose Infusions into Peripheral Veins in Neonates with Hypoglycemia 103 Outi Tammela and Tarja Vanhatalo VI Contents Part 3 Section C 111 Chapter 8 Drug-Induced Hypoglycemia 113 Kristen Helms and Kristi Kelley Chapter 9 Drugs and Hypoglycemia 131 Marek Pytliak, Viola Vargová and Viola Mechírová Part 4 Section D 149 Chapter 10 Insulinoma – Diagnosis and Treatment 151 Jan Škrha, Jaroslava Dušková, Jan Šváb, Jiřina Hilgertová, Josef Hořejš and Radan Keil Chapter 11 Pancreatogenous Hypoglycemic Syndrome - Insulinoma or Non-Insulinoma Origin (NIPHS) 173 Chen-Hsen Lee, Justin Ging-Shing Won and Hsiao-Shan Tseng Chapter 12 Pancreatic Beta Cell Tumors 187 M. Isabel del Olmo, J. Francisco Merino-Torres, J. Luis Ponce and Angel Moya Part 5 Section E 219 Chapter 13 Hypoglycemia Caused by Septicemia in Pigs 221 Everlon Cid Rigobelo and Fernando Antonio de Ávila Preface Hypoglycemia is a disorder where the glucose serum concentration is usually low. The organism usually keeps the serum glucose concentration in a range of 70 to 110 mL/dL of blood. In hypoglycemia the glucose concentration remains normally lower than 50 mL/dL of blood. Glucose is an essential metabolic substrate of all mammalian cells being the major carbohydrate presented to the cell for energy production and also many other anabolic requirements. This book comprehensively reviews and compiles information on hypoglycemia in 15 chapters which cover occurrence, damages, treatments and preventions, and relevant discussions about the occurrence of hypoglycemia in neonates, drug-induced and caused by infections in animals. This book is written by an international group of authors from America, Europe, Asia and Africa. The editor has tried to arrange the book chapters in an issue order to make it easier for the readers to find what they need. However, the reader can still find different approaches on the same issue in the same Section. Section A, which includes chapters 1-4, mainly presents therapy. It includes some treatment methods and their applications. Section B, which includes chapters 5-7, mainly deals with the occurrence of hypoglycemia in neonates. It shows different approaches to the same issue. Section C, which includes chapters 8-9, covers hypoglycemia associated with drugs. Section D, which includes chapters 10-12, covers hypoglycemia caused by some kinds of cancer. Section E, which includes chapter 13, deals with hypoglycemia caused by septicemia in animals. It shows that the hypoglycemia may be a parameter that could be analyzed for detection of Leptospire infection in pigs. The scientists selected to publish in this book were invited because of their recognized expertise and important contributions in their respective fields of research. Without X Preface these scientists and their dedication and enthusiasm, the publication of this book would not have been possible. I recognize and am very grateful for their efforts and the attempt to decrease the suffering of many people afflicted with this disorder. Hopefully, this book will be of help to many scientists, doctors, pharmacists, chemicals and other experts in a variety of disciplines, both academic and industrial. In addition to supporting research and development, this book should also be suitable for teaching. Finally, I would like to thank my daughter Maria Eduarda and my wife Fernanda for their patience. I extend my apologies for many hours spent on the preparation of my chapter and the editing of this book, which kept me away from them. Prof. Dr. Everlon Cid Rigobelo Laboratory of Microbiology & Hygiene, Campus Experimental de Dracena Animal Science Faculty Dracena Brazil [...]... (2010) Hypoglycemia, diabetes, and cardiovascular events Diabetes Care 33(6): 1389-1394 12 Hypoglycemia – Causes and Occurrences Blonde, L (2009) Current antihyperglycemic treatment strategies for patients with type 2 diabetes mellitus Cleveland Clinic Journal of Medicine 76, S4-11 Tahrani, A A., Piya, M K et al (2010) Glycaemic control in type 2 diabetes: targets and new therapies Pharmacology and therapeutics... diabetes-DPP-4 inhibitors and sulphonylureas Diabetes, Obesity and Metabolism 12: 1-11 14 Hypoglycemia – Causes and Occurrences Brazg, R., Xu, L et al (2007) Effect of adding sitagliptin, a dipeptidyl peptidase-4 inhibitor, to metformin on 24-h glycemic control and ß-cell function in patients with type 2 diabetes Diabetes, Obesity and Metabolism 9: 186-193 2 Relationship Between Age and Diabetic Treatment... reactive oxygen species (ROS), which in turn accelerate the micro- and macrovascular complications of diabetes It is *1P Zachariah, Zeenat Parveen, Pavan Patel, Matthew Schoeck, Andrew Mazulis, Lawrence Perlmuter and Sant P.Singh Rosalind Franklin University of Medicine and ScienceVA Med Ctr, North Chicago, IL USA 16 Hypoglycemia – Causes and Occurrences also possible that neglecting these variations in... was found to have repaired the amount of beta and alpha cells and also alpha/beta cell rate to a significantly greater degree as compared to glipizide therapy The effect of sitagliptin therapy (50mg/day) on beta cell function in patients with type 2 diabetes (n=28) taking metformin was analyzed in a double- 10 Hypoglycemia – Causes and Occurrences blind randomized placebo-controlled study (Brazg, Xu... his/her previous antidiabetic medication, and are there any complications present (e.g nephropathy) A good glycemic control reduces the rates of diabetes-associated microvascular and possibly macrovascular complications Reduction of the associated risk 4 Hypoglycemia – Causes and Occurrences factors, including those related to excessive weight, high blood pressure and dyslipidemia are also necessary to... Both in monotherapy and in combination (with metformin, sulfonylurea, 6 Hypoglycemia – Causes and Occurrences thiazolidinediones, or insulin) they effectively reduce HbA1c levels (by 0.6% to 1.1%) (Ahrén 2011) This effect has proven to be dependent of diabetes duration and baseline HbA1c values as well Greater reductions in HbA1c are seen in subjects with higher baseline levels and they are more effective... 3.2 Hypoglycemia Intensive glucose control increases the risk of developing hypoglycemia In the Diabetes Control and Complications Trial (DCCT) the rate of severe hypoglycemia was 65% and 35% in the arms of intensive and conventional insulin therapy respectively (Keen 1994; The Diabetes Control and Complications Trial Research Group 1997) In the UK Diabetes Prospective Study the episodes of major hypoglycemia. .. Relationship between Age Group and % Time Hyperglycemic Relationship Between Age and Diabetic Treatment Type on the Frequency of Hyperglycemic Episodes Monitored by Continuous Glucose Monitoring Fig 2 Percentage of time spent in hyperglycemia as a function of age during the time interval from 12 am to 6 am (A) and from 6 am to 6 pm (B) 19 20 Hypoglycemia – Causes and Occurrences Multiple linear regressions... visits, and hospitalizations (Desouza, 2003; Leese, 2003; Schwartz, 2008; Whitmer, 2009) Hypoglycemia- associated autonomic failure is another major complication that diabetic individuals go through when their glucose levels are not properly regulated In this complication, antecedent hypoglycemia causes both defective glucose counter-regulation and hypoglycemia unawareness (by reducing autonomic and neurogenic... of hypoglycemia (5.2%) was found in the group of sitagliptin therapy as compared to the control group (12.1%) that could be attributed primarily to sulfonylurea therapy 3.3 Body weight There is no increase of body weight during treatment with DPP-4 inhibitors, and even a reduction of it is possible during a combined therapy with metformin (Monami, Iacomelli et al 2010) 8 Hypoglycemia – Causes and Occurrences . HYPOGLYCEMIA – CAUSES AND OCCURRENCES Edited by Everlon Cid Rigobelo Hypoglycemia – Causes and Occurrences Edited by Everlon Cid. inhibitors, and even a reduction of it is possible during a combined therapy with metformin (Monami, Iacomelli et al. 2010). Hypoglycemia – Causes and Occurrences 8 The safety and tolerability. Drug-Induced Hypoglycemia 113 Kristen Helms and Kristi Kelley Chapter 9 Drugs and Hypoglycemia 131 Marek Pytliak, Viola Vargová and Viola Mechírová Part 4 Section D 149 Chapter 10 Insulinoma – Diagnosis