Hypoglycemia, Malnutrition and Body Composition

Khanimov, Israel; Shimonov, Mordechai; Wainstein, Julio; Leibovitz, Eyal

doi:10.1007/5584_2020_526

Cited by 9 publications

(6 citation statements)

References 108 publications

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“…A previous study of DKD patients found that nephrogenic loss of albumin might induce a compensatory increase in hepatic albumin synthesis that increases the turnover for albumin [32] which suggested that a higher level of serum albumin may indicate more severe kidney disease and poorer glycemic control. Experimental and observational studies have reported that albumin could bind ghrelin and indicated a role for albumin in appetite regulation [33, 34], suggesting that high serum albumin might be related to malnutrition status and higher risk of hypoglycemia [35]. Given no significant association was observed between albumin and cardiovascular events, the correlation between albumin and LBGI found in our study may only suggest that both albumin and LBGI are indicators of malnutrition status.…”

Section: Discussionmentioning

confidence: 49%

Low Blood Glucose Index Associated with Cardiovascular Events in Diabetic Hemodialysis Patients

He,

Xuan,

Zhu

et al. 2023

Blood Purif

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Introduction: Blood glucose monitoring was vitally important in diabetic kidney disease (DKD) patients for preventing complications and improving survival rates. The associations between glycemic variability and blood biochemical indicators were underestimated in patients with DKD undergoing hemodialysis. Therefore, we primarily aimed to investigate the glycemic variability and 1-year risk of cardiovascular disease events in diabetic hemodialysis patients. And we secondarily aimed to explore the association between glycemic variability and blood biochemical indicators. Methods: In total, 27 patients were included in the final analysis. Continuous glucose monitoring (CGM) was used to evaluate glucose variability for 14 days. Patients were divided into two groups by the cutoff level of time in range (TIR; >70% or ≤70%). The three-point major adverse cardiovascular event (3P MACE) was recorded within 1 year. Results: After 1 year of follow-up, 4 patients in the high-TIR group and 3 patients in the low-TIR group had 3p MACE. Higher low blood glucose index (LBGI) level in diabetic hemodialysis patients increased the risk of 3p MACE outcomes (HR = 2.37, p = 0.018). And the level of albumin was positively associated with LBGI (β = 0.51, p = 0.036). The plasma levels of albumin, glycosylated hemoglobin, and hemoglobin were positively associated with other CGM parameters. Conclusion: LBGI during 14 days was positively associated with the risk of cardiovascular events in diabetic hemodialysis patients.

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Section: Discussionmentioning

confidence: 49%

Low Blood Glucose Index Associated with Cardiovascular Events in Diabetic Hemodialysis Patients

He,

Xuan,

Zhu

et al. 2023

Blood Purif

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“…12 Measuring C-reactive protein (CRP) levels may aid in diagnosing those diseases. 13 The association between renal function and hypoglycaemia was documented in all our previous studies, 14,15 as well as other interventional 16 and non-interventional 17 studies among patients with DM. Here we wanted to quantify the effect of renal function on incident hypoglycaemia, compare the role of renal function in patients with DM to that of patients without DM, and attempt to isolate laboratory markers that may suggest possible mechanisms for such an association.…”

Section: Introductionmentioning

confidence: 58%

Association between estimated GFR and incident hypoglycaemia during hospitalization

et al. 2021

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Background: Kidney function is a significant factor associated with increased incidence of hypoglycaemia, especially among patients with diabetes mellitus (DM). We here quantified the association between elevated creatinine and incident hypoglycaemia among patients admitted to internal medicine departments, with and without DM.Methods: This is a retrospective cohort analysis study. Included were all patients discharged from internal medicine units between 2010 and 2013. Patients were excluded if creatinine levels rose or dropped more than 0.3 mg/dL during hospitalization. The CKD-EPI equation was used to calculate glomerular filtration rate (eGFR).Logistic regression analysis (backward LR method) was used to study the association between eGFR and hypoglycaemia incidence.Results: Included were 39 316 patients (mean age 68.0 ± 18.0 years, 49.3% males, 25.9% with DM, eGFR 69.5 ± 24.9 mL/min/1.73 m 2 ). Among study participants, 6.5% had at least one hypoglycaemic event. Logistic regression modelling showed that eGFR was inversely associated with incident hypoglycaemia (OR 0.988, 95% CI 0.986-0.990, p < .001). Results were similar for patients with and without DM. Estimated GFR was negatively correlated with admission CRP levels for patients with (r = À.143, p < .001) and without DM (r = À.166, p < .001). Estimated GFR was also positively correlated with admission serum albumin levels for both patients with (r = .304, p < .001) and without DM (r = .354, p < .001).Conclusion: Among non-critically-ill patients hospitalized in internal medicine departments, reduced eGFR is associated with increased risk of hypoglycaemia. Glucose monitoring for all inpatients with CKD is suggested, regardless of DM status.

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“…These interventions may lead to nutritional deficiencies and dumping syndrome as a consequence of interference with the digestive system [2]. Additionally, specific bariatric procedures are known to be linked with infrequent hypoglycemic episodes arising from abnormalities in islet cells, a condition often referred to as nesidioblastosis [2,8].…”

Section: Discussionmentioning

confidence: 99%

Sugar Swing After Surgery: Hyperinsulinemic Hypoglycemia With Possible Nesidioblastosis After Roux-en-Y Gastric Bypass Surgery

Workneh,

Mehta,

Grover

2023

Cureus

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Bariatric surgery is a procedure performed to achieve weight loss and manage obesity. However, it can result in various complications including post-surgical hypoglycemia. Nesidioblastosis is a rare hypoglycemic syndrome marked by diffuse hyperplasia of pancreatic β cells with distinct histologic features. Recent case reports have indicated an association of nesidioblastosis with certain bariatric procedures, often specifically linked to Roux-en-Y gastric bypass (RYGB) surgery.In this case report, we describe a 78-year-old male with a complex medical history who presented with altered mental status and severe hypoglycemia (13 mg/dL), despite having no history of diabetes or use of hypoglycemic medications. The patient's clinical condition improved after receiving a 50% intravenous dextrose injection and subsequently placed on a 10% dextrose infusion. Adrenal insufficiency was ruled out with normal cortisol level, and tests for β-hydroxybutyrate, dehydroepiandrosterone (DHEA) sulfate, and hypoglycemia panels were all negative. However, further investigations were significant for elevated serum insulin, C-peptide, and proinsulin levels. The patient then underwent an abdominal computed tomography (CT) scan, which revealed a grossly normal liver, spleen, pancreas, and adrenal glands, along with evidence of prior gastric bypass surgery. Further evaluation confirmed a history of Roux-en-Y gastric bypass surgery, which was performed to address morbid obesity and obstructive sleep apnea. Following the procedure, the patient began experiencing hypoglycemic episodes. Subsequently, the patient was diagnosed with hyperinsulinemic hypoglycemia with possible nesidioblastosis. This diagnosis was made based on severe recurrent postprandial hypoglycemia, accompanied by elevated endogenous insulin production, and a pancreas that appeared grossly normal on imaging. The patient was treated with acarbose to prevent carbohydrate-driven blood sugar and insulin spikes, octreotide to inhibit insulin secretion, and dietary guidance to avoid high glycemic index foods. This case emphasizes the potential link between bariatric surgeries and metabolic disturbances, underscoring the importance of identifying uncommon hypoglycemic syndromes.

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Hypoglycemia, Malnutrition and Body Composition

Cited by 9 publications

References 108 publications

Low Blood Glucose Index Associated with Cardiovascular Events in Diabetic Hemodialysis Patients

Low Blood Glucose Index Associated with Cardiovascular Events in Diabetic Hemodialysis Patients

Association between estimated GFR and incident hypoglycaemia during hospitalization

Sugar Swing After Surgery: Hyperinsulinemic Hypoglycemia With Possible Nesidioblastosis After Roux-en-Y Gastric Bypass Surgery

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