Abstract
Background and objectives: Hypoglycemia in the body is controlled by counter regulatory hormones. Serum cortisol is one among them not subjected to extensive study, in Type 2 diabetes mellitus cases. Cortisol responses among non diabetics and type 1 diabetics have been studied to a certain extent. The primary objective of our study was to identify the serum cortisol levels in hypoglycemic patients with or without type 2 diabetes and to find out the correlation between the mean cortisol responses in the two groups. Methodology: A total population of 51 symptomatic hypoglycemic patients meeting Whipple's criteria were studied in the ER of a medical college hospital at Kochi. Forty patients were diabetic and 11 non diabetic. Previous history, present illness, comorbidities, medical history and reasons for hypoglycemia were considered. Laboratory investigations on RFT, 7 AM serum cortisol and RBS were made and the results analysed applying standard statistical methods and SPSS II software. Results and discussion: Male female ratio in the diabetic and non diabetic groups was 3:1 and 10:1 respectively. Hypoglycemia was more among males, especially in the diabetic group due to decreased food intake(49%) or concurrent illness(51%),the mean age being 65.7 years in these cases. Hypoglycemia was more frequent in those on sulfonylurea (61.9%), and in habitual insulin users (42.5%). In non diabetic patients, hypoglycemia was caused by renal failure(27.27%), insulinoma(27.27%) or sepsis(18.18%). The mean serum cortisol among the diabetic group was subnormal(17.47), and in the non diabetic group it was 28.56. Age, sex, serum creatinine, GCS, period of stay and condition at discharge showed no correlation with serum cortisol levels. RBS, period of stay and condition at discharge showed no correlation with diabetic status. Conclusion: Diabetic patients with acute symptomatic hypoglycemia demonstrated a subnormal serum cortisol response as compared to non diabetic hypoglycemic patients.
Highlights
Hypoglycemia is a major cause of mortality/morbidity all over the world, drug induced in patients with diabetes, or may be due to other reasons in the non diabetic populations
Based on a previous study[3] on the serum cortisol levels in diabetic/non diabetic patients with hypoglycemia, a mean of 2.2 mcg/dl ± 0.5 was obtained in diabetic cases and a mean of 4 mcg/dl ± 0.7 was obtained in the non diabetic cases [3]
Hypoglycemia was more common among the males and the elderly diabetic population, caused due to decreased food intake (49%) and concurrent illness(51%)
Summary
Hypoglycemia is a major cause of mortality/morbidity all over the world, drug induced in patients with diabetes, or may be due to other reasons in the non diabetic populations. Serum cortisol increased in response to prolonged hypoglycemia in normal individuals [1] and in patients with chronic diabetic complications[2]. The objective of this study was to estimate the serum cortisol levels in hypoglycemic diabetic/non diabetic patients after a single cortisol response at the time of hypoglycemia, and to find out the correlation between the mean cortisol responses in both these groups. The primary objective of our study was to identify the serum cortisol levels in hypoglycemic patients with or without type 2 diabetes and to find out the correlation between the mean cortisol responses in the two groups. Conclusion: Diabetic patients with acute symptomatic hypoglycemia demonstrated a subnormal serum cortisol response as compared to non diabetic hypoglycemic patients
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