The simultaneous development of diabetic ketoacidosis (DKA) and thyroid storm (TS) is a rare but potentially lifethreatening condition that requires immediate and targeted treatment. However, their combined diagnosis poses a serious challenge because of the similarities between their clinical manifestations. To date, only a few dozen cases have been described; most of which have been linked to the progression of thyrotoxicosis or uncontrolled hyperglycemia as contributing factors. We present the case of a 37-year-old woman with type 1 diabetes mellitus and Graves’ disease who presented with both TS and DKA. She was initially admitted to the emergency department as a suspected case of stroke. Severe hypoglycemia significantly lowered her alertness to TS and probably provoked a sharp hyperthyroid decompensation, thereby leading to subsequent DKA development.
We report the first case of hypoglycemia and lactic acidosis caused by the therapeutic doses of venlafaxine. A 19-year-old female patient had presyncope and she was taking venlafaxine 75 mg once a day because of major depression for a week and she had no history of any other drug use or disease. The blood gas analysis revealed hypoglycemia and lactic acidosis. Patient was treated with dextrose infusion and oral diet. Although hypoglycemia and lactic acidosis have been reported in overdose of venlafaxine in the literature, these effects were observed in therapeutic doses.
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The post-marketing safety of venlafaxine: a real-world two-decade pharmacovigilance study using the FAERS database Santosh Chokkakula, Hualiang Yang, Abeer A. Al-Masri, Yiquan Zhang, Bommireddy Naveen, Bing Yang Frontiers in Pharmacology.2026;[Epub] CrossRef
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The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.
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Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients’ contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians’ factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%–7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%–8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%–9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.
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Korean J Fam Med 2019;40(4):212-219. Published online July 20, 2019
Background We assessed the frequency and severity of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylurea monotherapy or sulfonylurea+metformin.
Methods We conducted a retrospective, observational, cross-sectional study in 2011 and 2012 including patients with type 2 diabetes mellitus aged ≥30 years who were treated with ≥6 months of sulfonylurea monotherapy or sulfonylurea+metformin at 20 university-affiliated hospitals in Korea. At enrollment, glycated hemoglobin (HbA1c) was assessed; participants completed self-reported questionnaires describing hypoglycemia incidents over the past 6 months. A review of medical records up to 12 months before enrollment provided data on demographics, disease history, comorbidities, laboratory results, and drug usage.
Results Of 726 enrolled patients, 719 were included (55.6% male); 31.7% and 68.3% were on sulfonylurea monotherapy and sulfonylurea+metformin, respectively. Mean±standard deviation age was 65.9±10.0 years; mean HbA1c level was 7.0%±1.0%; 77.8% of patients had hypertension (89.4% used antihypertensive medication); 60.5% had lipid disorders (72.5% used lipid-lowering medication); and 52.0% had one or more micro- or macrovascular diseases. Among patients with A1c measurement (n=717), 56.4% achieved therapeutic goals (HbA1c <7.0%); 42.4% (305/719) experienced hypoglycemia within 6 months of enrollment; and 38.8%, 12.9%, 12.7%, and 3.9% of patients experienced mild, moderate, severe, and very severe hypoglycemia symptoms, respectively. Several reported hypoglycemia frequency as 1–2 times over the last 6 months. The mean number of very severe hypoglycemia episodes was 3.5±5.5.
Conclusion Among type 2 diabetes mellitus patients treated with sulfonylurea-based regimens, glycemic levels were relatively well controlled but hypoglycemia remained a prevalent side effect.
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Increasing Individual Target Glucose Levels to Prevent Hypoglycemia in Patients with Diabetes Juyoung Shin, Hyunah Kim, Hun-Sung Kim, Churlmin Kim, Whan-Seok Choi Korean Journal of Family Medicine.2021; 42(4): 269. CrossRef
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Exercise Strategies to Prevent Hypoglycemia in Patients with Diabetes Ah Reum Jung, Hyunah Kim, Hun-Sung Kim, Churlmin Kim, Whan-Seok Choi Korean Journal of Family Medicine.2021; 42(2): 91. CrossRef
Background The clinical guideline for prehospital blood glucose measurement in hypoglycemia presenting with mental change has not been sure, maybe it has depended on individual decision. Therefore we was going to find out whether the difference of the vital sign between hypoglycemia and non hypoglycemia can give important message or not. Methods: Retrospective study was carried out from Jan 2004 to Dec 2005. The patients with mental change were divided into hypoglycemic group and non hypoglycemic group. Then we compared the difference of vital sign (Blood pressure, respiration rate, heart rate) based on paramedic run reports and medical records. Results: 66 person in hypoglycemic group were aged 60.92⁑16.90 on average. And 67 person in non hypoglycemia were 58.53⁑16.58. The difference of blood pressure, respiration rate is not significantly but only body temperature makes significant difference(P=0.014). Furthermore it was inclined that the lower body temperature was more likely in hypoglycemia(P＜0.001). Compared with over 36.0oC, probability of hypoglycemia in less than or equal to 36.0oC of temperature was more (OR: 54.28, 95% CI: 18.956∼155.464). Conclusion: The body temperature gives more significant information in Prehospital blood glucose measurements for hypoglycemic patients with mental change is not absolutely, but recommended in less than 36.0oC. (J Korean Acad Fam Med 2007;28:542-546)
Background : Many patients with Type I Diabetes Mellitus treated by insulin therapy were observed their blood sugar dropped even after meal. The ecology and treatment for this phenomenon was unknown. A clinical research making an approach to treat this phenomenon is inevitable.
Methods : 9 patients whose blood sugar dropped right after meal (from 15 minutes to 1 hour) were selected among 58 IDDM(Insulin Dependant Diabetes Mellitus) patients admitted in Daejon Sungsim hospital from March 1999 to Feb. 2000. The subjects were consist of 6 female and 3 male, average age was 57.2. Blood samples were taken from their capillaries and measured by Super Glucocard Ⅱ glucometer. Insulin was injected 30 minutes before breakfast and 50% glucose 30 ml was taken orally 15 minutes after the insulin injection. Breakfast was taken 15 minutes after the glucose taken. Blood sugar was measured 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 120 minutes and 2 hours after a breakfast.
Results : Though average blood sugar dropped after breakfast was 44.5 ㎎/㎗, average blood sugar after taken 50% glucose 30 ml was 114.1 ㎎/㎗. 2 patients had good effect among 3 male patients and every 6 female patients had good effect.
Conclusion : Taking 50% glucose 30 ml in oral 15 minutes after insulin injection improved the IDDM patient's blood sugar drop right after meal.
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