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Lavt blodsukker
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Skriv nyt emne   Besvar indlægget    Diabetesdebat -> Type 1
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Peter75
Type 1 diabetes
Type 1 diabetes
Indmeldt: 12. maj 2012
Indlæg: 12
Geografisk sted: København

Indlæg Svarer lige mig selv og måske andre kan drage nytte af det Besvar, med citat
Skrevet: 20/06 2013 22:05

Hej!

Ovenstående indlæg er skrevet af mig for godt ½ år siden. Nu er det ikke for at skabe frygt eller male fanden på væggen men syntes det her er vigtig viden, så undrer mig egentligt over jeg aldrig nogensinde i min 36 årige karierrer med Diabetes 1 har hørt om det. Og at det ejheller er nævnt med et eneste ord her i tråden om lave blodsukre.

Ja altså, at en af følgevirkningerne af neuropati er at kroppens signaler og derved også faresignalerne ved lavt blodsukker svækkes. Det er de såkaldte autonome nerver der her er i spil. Jeg vil tro mange allerførst oplever nedsatte føleevner i tæer, fødder og ben inden symtomer fra de autonome nerver bliver generende, så ro på hvis du ikke har nogen føleforstyrrelser.

De autonome nerver styrer blandt andet: De indre organer, hjertet, blodtrykket og også de alarmer der skal gøre kroppen opmærksomme på systemfejl så som lavt blodsukker.

Hvis jeg skal sige hvordan det er for mig:

Det er nu 2 år siden jeg har rystet på hænderne eller følt det der ubehag jeg førhen fik promte allerede når blodsukkerer nåede ned under 4 mmol. I dag får jeg ingen symtomer what so ever ud over en svag træthed, som indtræder ved blodsukker værdier omkring 2. Nogen gange hvis jeg sidder med noget spændende, kan det godt være jeg slet ikke mærker symtomerne (eller giver andre udefra kommende faktorer skylden), i det hele taget. Men fra den svage træthed indtræder så er der- afhængig af blodsukkerets faldehastighed - alt fra 1 min til 15 min til at få rettet op på situationen. Hvis ikke jeg gør det, er jeg ikke i stand til ved egen kraft at handle.

Godt nok en svær situation, men HVIS nu nogen havde fortalt mig dette noget tidligere ville jeg da mere lægge mig i selen for at undgå specielt nattelige lave blodsukre, som jeg nu er forsvarsløs overfor. Så herfra min opfordring til jer at spørge lægen næste gang hvis I har mistanke.

Men jeg er nu ved at tage konsekvensen og lægge helt om på kost, motion og insulin indtag. Har egentligt været ok reguleret længe, men nu er det så lige nogle andre forholdsregler jeg må tage. Førhen generede daglligt lave blodsukre mig ikke synderligt hvorimod de nu er fatale specielt om natten.

Ked af hvis jeg har skræmt nogen men menigen er kun at hjælpe.

Andre symtomer kan være:

Øget sved tendens - Specielt ved madindtag.
Svingende blodtryk
Høj Hvilepuls og manglende puls stigning ved fysisk aktivitet
Stort blodtryksfald når man rejser sig op (Giver sig udtryk ved svimmelhed og evt kvalme)
Og så selvflølgeligt manglende følesans på tæer eller fødder.
Fodsår.
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Peter75
Type 1 diabetes
Type 1 diabetes
Indmeldt: 12. maj 2012
Indlæg: 12
Geografisk sted: København

Indlæg Her er en tekst der forklarer. Besvar, med citat
Skrevet: 21/06 2013 20:53

Beklager den er på Engelsk. Hvis det har interesse vil jeg meget gerne oversætte den ved lejlighed, men da det er et større arbejde gør jeg det kun hvis det har interesse for nogen.

Hypoglycemic unawareness

Although one expects hypoglycemic episodes to be accompanied by the typical symptoms (e.g., tremor, sweating, palpitations, etc.), this is not always the case. When hypoglycemia occurs in the absence of such symptoms it is called hypoglycemic unawareness. Especially in people with long-standing type 1 diabetes and those who attempt to maintain glucose levels which are closer to normal, hypoglycemic unawareness is common.

In patients with type 1 diabetes mellitus, as plasma glucose levels fall, insulin levels do not decrease - they are simply a passive reflection of the absorption of exogenous insulin. Also, glucagon levels do not increase. Therefore, the first and second defenses against hypoglycemia are already lost in established type 1 diabetes mellitus.[2] Further, the epinephrine response is typically attenuated, i.e., the glycemic threshold for the epinephrine response is shifted to lower plasma glucose concentrations, which can be aggravated by previous incidents of hypoglycemia.

The following factors contribute to hypoglycemic unawareness:

a) there may be autonomic neuropathy

b) the brain may have become desensitized to hypoglycemia

c) the person may be using medicines which mask the hypoglycemic symptoms

a) Autonomic neuropathy: During hypoglycemia, the body normally releases epinephrine [more commonly known as adrenalin] and related substances. This serves two purposes: The β-effect of epinephrine is responsible for the palpitations and tremors, giving the patient warning that hypoglycemia is present. The β-effect of epinephrine also stimulates the liver to release glucose (gluconeogenesis and glycogenolysis). In other words, the epinephrine warns the patient that hypoglycemia is present and signals the liver to release glucose to reverse it. In the absence of epinephrine release, or when it is attenuated (reduced) during hypoglycemia, the patient may not be aware that his/her glucose level is low. This is termed 'hypoglycemic unawareness'. The problem is compounded since, in the absence of an appropriate epinephrine response, the usual responses of glycogenolysis and gluconeogenesis may also be lost or blunted.

Since epinephrine release is a function of the autonomic nervous system, the presence of autonomic neuropathy (i.e., a damaged autonomic nervous system) will cause the epinephrine release in response to hypoglycemia to be lost or blunted. Unfortunately, damage to the autonomic nervous system in the form of autonomic neuropathy is a common complication of long-standing diabetes (especially type 1 diabetes), so the presence of hypoglycemic unawareness may be a sign of autonomic neuropathy, although the autonomic response to hypoglycemia is already impaired in patients with type 1 diabetes mellitus even in the absence of autonomic neuropathy.

Because the autonomic response is, in effect, the body's backup system for responding to hypoglycemia, patients with type 1 diabetes are forced to rely almost exclusively on a backup system for protection, which can unfortunately, deteriorate over time. The reduced autonomic response (including the sympathetic neural norepinephrine and acetylcholine as well as the adrenomedullary epinephrine response) causes the clinical syndrome of hypoglycemia unawareness — loss of the largely neurogenic warning symptoms of developing hypoglycemia.

b) Brain desensitization to hypoglycemia: If a person has frequent episodes of hypoglycemia (even mild ones), the brain becomes "used to" the low glucose and no longer signals for epinephrine to be released during such times. More specifically, there are glucose transporters located in the brain cells (neurons). These transporters increase in number in response to repeated hypoglycemia (this permits the brain to receive a steady supply of glucose even during hypoglycemia). As a result, what was once the hypoglycemic threshold for the brain to signal epinephrine release becomes lower. Epinephrine is not released, if at all, until the blood glucose level has dropped to even lower levels. Clinically, the result is hypoglycemic unawareness.

Since repeated hypoglycemia is common in people with diabetes who strive to keep their glucose levels near normal, the incidence of hypoglycemic unawareness becomes more prevalent in patients who follow 'intensive treatment' protocols.

The most common treatment for this condition is to liberalize the patient's target glucose levels, in an attempt to decrease the frequency of hypoglycemic episodes. Hypoglycemic unawareness will sometimes disappear when the frequency of hypoglycemic episodes has declined, but this is not always the case.

Blood Glucose Awareness Training (BGAT)

Researchers at University of Virginia Health Sciences Center have developed a psychoeducational program that helps patients identify their blood glucose symptoms more accurately, better predict when hypoglycemia is more likely to occur, and then treat hypoglycemia earlier than they might if they were relying exclusively on blunted autonomic symptoms alone. The program, called Blood glucose awareness training (BGAT), is designed to improve the accuracy of patients' detection and interpretation of relevant BG symptoms and other cues. Unfortunately, awareness of these treatments among certified diabetes educators is surprisingly low, and awareness of the program is not even required to attain certification. The reasons for this are multi-faceted, but a frequent criticism is the fact that a disproportionate share of the certification training is dedicated to issues related to the more common type 2 diabetes. Also, BGAT training is more complex, and requires considerable effort on the part of educators, and many may not view it as justified given the proportion of patients who have type 1 diabetes.

An online version of BGAT has been developed and was being tested, but is expected to be functional in the not-too-distant future. It is called BGAThome, and may bring this useful training program to more people in the future.

c) Beta blocker drugs: These medicines are designed to blunt the β-effect of adrenalin and related substances. Hence, if hypoglycemia occurs in someone who is using this type of drug, he/she may not experience the typical adrenergic warning symptoms such as tremor and palpitations. Again, the result is hypoglycemic unawareness. As noted above, beta blockers will also prevent adrenalin from stimulating the liver to make glucose, and therefore may make the hypoglycemia more severe and/or more protracted.[10] Of all the hypoglycemia symptoms, sweating is typically not blocked by beta blockers.[11]
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