Southern medical journal
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Southern medical journal · Feb 2007
ReviewPhysiological and behavioral aspects of glycemic control and hypoglycemia in diabetes.
Homeostatic mechanisms that maintain blood glucose concentration within a narrow physiologic range are complex and redundant. Elaborate feedback loops involving insulin, glucagon, sympathoadrenal mediators, growth hormone, amylin, and incretins normally operate synchronously to keep blood glucose within a narrow set point. Individuals with diabetes have defects in glucose homeostatic pathways, including the counterregulatory pathways that oppose hypoglycemia and ensure sufficient glucose is available to serve the brain's metabolic needs. ⋯ Focusing on the practical implications, we review the endocrinological principles underlying normal glucose homeostasis and the defects in regulation and counterregulation, including hypoglycemia unawareness, that occur with diabetes. Iatrogenic and behavioral factors that contribute to hypoglycemia risk and nocturnal hypoglycemia are discussed. A companion manuscript reviews the clinical symptoms and fundamentals of hypoglycemia prevention, recognition, and management.
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Southern medical journal · Feb 2007
Clostridium difficile: association with thrombocytosis and leukocytosis.
Apart from leukocytosis, few laboratory markers suggestive of Clostridium difficile infections have been described. ⋯ The presence of thrombocytosis may be helpful to improve the pretest probability for C difficile infections.