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On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| What is (are) Hashimoto's Disease ? | Hashimotos disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease. An autoimmune disease is a disorder in which the bodys immune system attacks the bodys own cells and organs. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.
In Hashimotos disease, the immune system attacks the thyroid gland, causing inflammation and interfering with its ability to produce thyroid hormones. Large numbers of white blood cells called lymphocytes accumulate in the thyroid. Lymphocytes make the antibodies that start the autoimmune process.
Hashimotos disease often leads to reduced thyroid function, or hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid doesnt make enough thyroid hormone for the bodys needs. Thyroid hormones regulate metabolismthe way the body uses energyand affect nearly every organ in the body. Without enough thyroid hormone, many of the bodys functions slow down. Hashimotos disease is the most common cause of hypothyroidism in the United States.1
More information is provided in the NIDDK health topic, Hypothyroidism. |
On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| What is (are) Hashimoto's Disease ? | The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on either side of the windpipe.
The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce and store hormones and release them into the bloodstream. The hormones then travel through the body and direct the activity of the bodys cells.
The thyroid makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.
Thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain, regulates thyroid hormone production. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary decreases TSH production. |
On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| What are the symptoms of Hashimoto's Disease ? | Many people with Hashimotos disease have no symptoms at first. As the disease slowly progresses, the thyroid usually enlarges and may cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in the throat, though it is usually not painful. After many years, or even decades, damage to the thyroid causes it to shrink and the goiter to disappear.
Not everyone with Hashimotos disease develops hypothyroidism. For those who do, the hypothyroidism may be subclinicalmild and without symptoms, especially early in its course. With progression to hypothyroidism, people may have one or more of the following symptoms:
- fatigue - weight gain - cold intolerance - joint and muscle pain - constipation, or fewer than three bowel movements a week - dry, thinning hair - heavy or irregular menstrual periods and problems becoming pregnant - depression - memory problems - a slowed heart rate |
On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| How to diagnose Hashimoto's Disease ? | Diagnosis begins with a physical exam and medical history. A goiter, nodules, or growths may be found during a physical exam, and symptoms may suggest hypothyroidism. Health care providers will then perform blood tests to confirm the diagnosis. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. Diagnostic blood tests may include the
- TSH test. The ultrasensitive TSH test is usually the first test performed. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Generally, a TSH reading above normal means a person has hypothyroidism. - T4 test. The T4 test measures the actual amount of thyroid hormone circulating in the blood. In hypothyroidism, the level of T4 in the blood is lower than normal. - antithyroid antibody test. This test looks for the presence of thyroid autoantibodies, or molecules produced by a persons body that mistakenly attack the bodys own tissues. Two principal types of antithyroid antibodies are - anti-TG antibodies, which attack a protein in the thyroid called thyroglobulin - anti-thyroperoxidase (TPO) antibodies, which attack an enzyme called thyroperoxidase in thyroid cells that helps convert T4 to T3. Having TPO autoantibodies in the blood means the bodys immune system attacked the thyroid tissue in the past. Most people with Hashimotos disease have these antibodies, although people whose hypothyroidism is caused by other conditions do not.
A health care provider may also order imaging tests, including an ultrasound or a computerized tomography (CT) scan.
- Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images; a patient does not need anesthesia.
- The images can show the size and texture of the thyroid, as well as a pattern of typical autoimmune inflammation, helping the health care provider confirm Hashimotos disease. The images can also show nodules or growths within the gland that suggest a malignant tumor.
- CT scan. CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. In some cases of Hashimotos disease, a CT scan is used to examine the placement and extent of a large goiter, and to show a goiters effect on nearby structures.
More information is provided in the NIDDK health topic, Thyroid Tests. |
On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| What are the treatments for Hashimoto's Disease ? | Treatment generally depends on whether the thyroid is damaged enough to cause hypothyroidism. In the absence of hypothyroidism, some health care providers treat Hashimotos disease to reduce the size of the goiter. Others choose not to treat the disease and simply monitor their patients for disease progression.
Hashimotos disease, with or without hypothyroidism, is treated with synthetic thyroxine, which is man-made T4. Health care providers prefer to use synthetic T4, such as Synthroid, rather than synthetic T3, because T4 stays in the body longer, ensuring a steady supply of thyroid hormone throughout the day. The thyroid preparations made with animal thyroid are not considered as consistent as synthetic thyroid (Levothyroxine) and rarely prescribed today.
Health care providers routinely test the blood of patients taking synthetic thyroid hormone and adjust the dose as necessary, typically based on the result of the TSH test. Hypothyroidism can almost always be completely controlled with synthetic thyroxine, as long as the recommended dose is taken every day as instructed. |
On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| What to do for Hashimoto's Disease ? | Iodine is an essential mineral for the thyroid. However, people with Hashimotos disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodinesuch as seaweed, dulse, or kelpmay cause or worsen hypothyroidism. Read more in Iodine in diet at www.nlm.nih.gov/medlineplus/ency/article/002421.htm.
Women need more iodine when they are pregnantabout 220 micrograms a daybecause the baby gets iodine from the mothers diet. Women who are breastfeeding need about 290 micrograms a day. In the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through prenatal vitamins.3 Pregnant women should choose iodized saltsalt supplemented with iodineover plain salt and take prenatal vitamins containing iodine to ensure this need is met.
To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements such as iodine, with their health care provider. Tips for talking with health care providers are available through the National Center for Complementary and Integrative Health. |
On this page: Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid. Rarely, the disease can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. In people with Hashimoto’s disease Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body—even the way your heart beats. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. The number of people who have Hashimoto’s disease in the United States is unknown. However, the disease is the most common cause of hypothyroidism, which affects about 5 in 100 Americans.1 Hashimoto’s disease is 4 to 10 times more common in women than men.2 Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50.3 Your chance of developing Hashimoto’s disease increases if other family members have the disease. You are more likely to develop Hashimoto’s disease if you have other autoimmune disorders, including4 Many people with Hashimoto’s disease develop hypothyroidism. Untreated, hypothyroidism can lead to several health problems, including5
Left untreated, hypothyroidism can also cause problems during pregnancy. Many people with Hashimoto’s disease have no symptoms at first. As the disease progresses, you may have one or more of the symptoms of hypothyroidism. Some common symptoms of hypothyroidism include
Hashimoto’s disease causes your thyroid to become damaged. Most people with Hashimoto’s disease develop hypothyroidism. Rarely, early in the course of the disease, thyroid damage may lead to the release of too much thyroid hormone into your blood, causing symptoms of hyperthyroidism.3 Your thyroid may get larger and cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in your throat, though it is usually not painful. After many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear. Researchers don’t know why some people develop Hashimoto’s disease, but a family history of thyroid disease is common. Several factors may play a role, including2 Hypothyroidism can also be caused by Doctors diagnose Hashimoto’s disease based on You probably won’t need other tests to confirm you have Hashimoto’s disease. However, if your doctor suspects Hashimoto’s disease but you don’t have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimoto’s disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules—small lumps in the thyroid gland. How your doctors treat Hashimoto’s disease usually depends on whether the thyroid is damaged enough to cause hypothyroidism. If you don’t have hypothyroidism, your doctor may choose to simply check your symptoms and thyroid hormone levels regularly. The medicine levothyroxine, which is identical to the natural thyroid hormone thyroxine (T4), is the recommended way to treat hypothyroidism. Prescribed in pill form for many years, this medicine is now also available as a liquid and in a soft gel capsule.2 These newer formulas may be helpful to people with digestive problems that affect how the thyroid hormone pill is absorbed. Some foods and supplements can affect how well your body absorbs levothyroxine. Examples include grapefruit juice, espresso coffee, soy, and multivitamins that contain iron or calcium.1,6 Taking the medicine on an empty stomach can prevent this from happening. Your doctor may ask you to take the levothyroxine in the morning, 30 to 60 minutes before you eat your first meal. Your doctor will give you a blood test about 6 to 8 weeks after you begin taking the medicine and adjust your dose if needed. Each time you change your dose, you’ll have another blood test. Once you’ve reached a dose that’s working for you, your doctor will likely repeat the blood test in 6 months and then once a year. Never stop taking your medicine or take a higher dose without talking with your doctor first. Taking too much thyroid hormone medicine can cause serious problems, such as atrial fibrillation or osteoporosis.5 Your hypothyroidism can be well-controlled with thyroid hormone medicine, as long as you take the medicine as instructed by your doctor and have regular follow-up blood tests. The thyroid uses iodine, a mineral in some foods, to make thyroid hormones. However, if you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine—such as kelp, dulse, or other kinds of seaweed, and certain iodine-rich medicines—may cause hypothyroidism or make it worse. Taking iodine supplements can have the same effect. Talk with members of your health care team about However, if you are pregnant, you need to take enough iodine because the baby gets iodine from your diet. Too much iodine can cause problems as well, such as a goiter in the baby. If you are pregnant, talk with your doctor about how much iodine you need. Researchers are looking at other ways in which diet and supplements—such as vitamin D and selenium—may affect Hashimoto’s disease.2 However, no specific guidance is currently available.3 The NIDDK conducts and supports clinical trials in many diseases and conditions, including endocrine diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about Hashimoto’s disease and improve health care for people in the future. Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on Hashimoto’s disease at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association [published correction appears in Endocrine Practice. 2013;19(1):175]. Endocrine Practice. 2012;18(6):988–1028. doi: 10.4158/EP12280.GL [2] Ragusa F, Fallahi P, Elia G, et al. Hashimotos' thyroiditis: epidemiology, pathogenesis, clinic, and therapy. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 [3] Mincer DL, Jialal I. Hashimoto thyroiditis. In: StatPearls. StatPearls Publishing; August 10, 2020. https://pubmed.ncbi.nlm.nih.gov/29083758/ [4] Ruggeri RM, Trimarchi F, Giuffrida G, et al. Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176(2):133–141. doi: 10.1530/EJE-16-0737 [5] Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550–1562. doi: 10.1016/S0140-6736(17)30703-1 [6] Burch HB. Drug effects on the thyroid. New England Journal of Medicine. 2019;381(8):749–761. doi: 10.1056/NEJMra1901214
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
The NIDDK would like to thank:Leonard Wartofsky, M.D., M.A.C.P., MedStar Georgetown University Hospital
| What to do for Hashimoto's Disease ? | - Hashimotos disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, is an autoimmune disease. - Hashimotos disease often leads to reduced thyroid function, or hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid doesnt make enough thyroid hormone for the bodys needs. - Hashimotos disease is the most common cause of hypothyroidism in the United States. Many people with Hashimotos disease have no symptoms at first. As the disease slowly progresses, the thyroid usually enlarges and may cause the front of the neck to look swollen. The enlarged thyroid, called a goiter, may create a feeling of fullness in the throat, though it is usually not painful. - Not everyone with Hashimotos disease develops hypothyroidism. For those who do, the hypothyroidism may be subclinicalmild and without symptoms, especially early in its course. - Hashimotos disease is much more common in women than men. Although the disease often occurs in adolescent or young women, it more commonly appears between 30 and 50 years of age. - Hashimotos disease, with or without hypothyroidism, is treated with synthetic thyroxine, which is man-made T4. - Women with Hashimotos disease should discuss their condition with their health care provider before becoming pregnant. - Pregnant women should choose iodized saltsalt supplemented with iodineover plain salt and take prenatal vitamins containing iodine. - People should discuss their use of dietary supplements, such as iodine, with their health care provider. |
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| What is (are) Monogenic Forms of Diabetes: Neonatal Diabetes Mellitus and Maturity-onset Diabetes of the Young ? | NDM is a monogenic form of diabetes that occurs in the first 6 months of life. It is a rare condition occurring in only one in 100,000 to 500,000 live births. Infants with NDM do not produce enough insulin, leading to an increase in blood glucose. NDM can be mistaken for the much more common type 1 diabetes, but type 1 diabetes usually occurs later than the first 6 months of life. In about half of those with NDM, the condition is lifelong and is called permanent neonatal diabetes mellitus (PNDM). In the rest of those with NDM, the condition is transient and disappears during infancy but can reappear later in life; this type of NDM is called transient neonatal diabetes mellitus (TNDM). Specific genes that can cause NDM have been identified. More information about each type of NDM is provided in the appendix.
Symptoms of NDM include thirst, frequent urination, and dehydration. NDM can be diagnosed by finding elevated levels of glucose in blood or urine. In severe cases, the deficiency of insulin may cause the body to produce an excess of acid, resulting in a potentially life-threatening condition called ketoacidosis. Most fetuses with NDM do not grow well in the womb and newborns are much smaller than those of the same gestational age, a condition called intrauterine growth restriction. After birth, some infants fail to gain weight and grow as rapidly as other infants of the same age and sex. Appropriate therapy improves and may normalize growth and development. |
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| What is (are) Monogenic Forms of Diabetes: Neonatal Diabetes Mellitus and Maturity-onset Diabetes of the Young ? | MODY is a monogenic form of diabetes that usually first occurs during adolescence or early adulthood. However, MODY sometimes remains undiagnosed until later in life. A number of different gene mutations have been shown to cause MODY, all of which limit the ability of the pancreas to produce insulin. This process leads to the high blood glucose levels characteristic of diabetes and, in time, may damage body tissues, particularly the eyes, kidneys, nerves, and blood vessels. MODY accounts for about 1 to 5 percent of all cases of diabetes in the United States. Family members of people with MODY are at greatly increased risk for the condition.
People with MODY may have only mild or no symptoms of diabetes and their hyperglycemia may only be discovered during routine blood tests. MODY may be confused with type 1 or type 2 diabetes. People with MODY are generally not overweight and do not have other risk factors for type 2 diabetes, such as high blood pressure or abnormal blood fat levels. While both type 2 diabetes and MODY can run in families, people with MODY typically have a family history of diabetes in multiple successive generations, meaning that MODY is present in a grandparent, a parent, and a child. Unlike people with type 1 diabetes who always require insulin, people with MODY can often be treated with oral diabetes medications. Treatment varies depending on the genetic mutation that has caused the MODY. More information about each type of MODY is provided in the appendix. |
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| What is (are) Monogenic Forms of Diabetes: Neonatal Diabetes Mellitus and Maturity-onset Diabetes of the Young ? | Testing for monogenic diabetes involves providing a blood sample from which DNA is isolated. The DNA is analyzed for changes in the genes that cause monogenic diabetes. Abnormal results can determine the gene responsible for diabetes in a particular individual or show whether someone is likely to develop a monogenic form of diabetes in the future. Genetic testing can also be helpful in selecting the most appropriate treatment for individuals with monogenic diabetes. Prenatal testing can diagnose these conditions in unborn children.
Most forms of monogenic diabetes are caused by dominant mutations, meaning that the condition can be passed on to children when only one parent is affected. In contrast, if the mutation is a recessive mutation, a disease gene must be inherited from both parents for diabetes to occur. For recessive forms of monogenic diabetes, testing can indicate whether parents or siblings without disease are carriers for recessive genetic conditions that could be inherited by their children.
If you suspect that you or a member of your family may have a monogenic form of diabetes, you should seek help from health care professionals-physicians and genetic counselors-who have specialized knowledge and experience in this area. They can determine whether genetic testing is appropriate, select the genetic tests that should be performed, and provide information about the basic principles of genetics, genetic testing options, and confidentiality issues. They also can review the test results with the patient or parent after testing, make recommendations about how to proceed, and discuss testing options for other family members. |
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| What to do for Monogenic Forms of Diabetes: Neonatal Diabetes Mellitus and Maturity-onset Diabetes of the Young ? | - Mutations in single genes can cause rare forms of diabetes. - Genetic testing can identify many forms of monogenic diabetes. - A physician evaluates whether genetic testing is appropriate. - A correct diagnosis aided by genetic testing can lead to optimal treatment. - Recent research results show that people with certain forms of monogenic diabetes can be treated with oral diabetes medications instead of insulin injections. |
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| What is (are) What I need to know about Diarrhea ? | Diarrhea is frequent, loose, and watery bowel movements. Bowel movements, also called stools, are body wastes passed through the rectum and anus. Stools contain what is left after your digestive system absorbs nutrients and fluids from what you eat and drink. If your body does not absorb the fluids, or if your digestive system produces extra fluids, stools will be loose and watery. Loose stools contain more water, salts, and minerals and weigh more than solid stools.
Diarrhea that lasts a short time is called acute diarrhea. Acute diarrhea is a common problem and usually lasts only 1 or 2 days, but it may last longer. Diarrhea that lasts for at least 4 weeks is called chronic diarrhea. Chronic diarrhea symptoms may be continual or they may come and go.
*See the Pronunciation Guide for tips on how to say the words in bold type. |
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| What causes What I need to know about Diarrhea ? | Causes of diarrhea include
- bacteria from contaminated food or water - viruses that cause illnesses such as the flu - parasites, which are tiny organisms found in contaminated food or water - medicines such as antibiotics - problems digesting certain foods - diseases that affect the stomach, small intestine, or colon, such as Crohns disease - problems with how the colon functions, caused by disorders such as irritable bowel syndrome
Sometimes no cause can be found. As long as diarrhea goes away within 1 to 2 days, finding the cause is not usually necessary. |
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| What are the symptoms of What I need to know about Diarrhea ? | In addition to passing frequent, loose stools, other possible symptoms include
- cramps or pain in the abdomenthe area between the chest and hips - an urgent need to use the bathroom - loss of bowel control
You may feel sick to your stomach or become dehydrated. If a virus or bacteria is the cause of your diarrhea, you may have fever and chills and bloody stools.
Dehydration
Being dehydrated means your body does not have enough fluid to work properly. Every time you have a bowel movement, you lose fluids. Diarrhea causes you to lose even more fluids. You also lose salts and minerals such as sodium, chloride, and potassium. These salts and minerals affect the amount of water that stays in your body.
Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.
Signs of dehydration in adults are
- being thirsty - urinating less often than usual - having dark-colored urine - having dry skin - feeling tired - feeling dizzy or fainting
Signs of dehydration in babies and young children are
- having a dry mouth and tongue - crying without tears - having no wet diapers for 3 hours or more - having sunken eyes, cheeks, or soft spot in the skull - having a high fever - being more cranky or drowsy than usual
Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released. |
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| How to diagnose What I need to know about Diarrhea ? | To find the cause of diarrhea, the health care provider may
- perform a physical exam - ask about any medicines you are taking - test your stool or blood to look for bacteria, parasites, or other signs of disease or infection - ask you to stop eating certain foods to see whether your diarrhea goes away
If you have chronic diarrhea, your health care provider may perform other tests to look for signs of disease. |
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| What are the treatments for What I need to know about Diarrhea ? | Diarrhea is treated by replacing lost fluids, salts, and minerals to prevent dehydration.
Taking medicine to stop diarrhea can be helpful in some cases. Medicines you can buy over the counter without a prescription include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate). Stop taking these medicines if symptoms get worse or if the diarrhea lasts more than 2 days. If you have bloody diarrhea, you should not use over-the-counter diarrhea medicines. These medicines may make diarrhea last longer. The health care provider will usually prescribe antibiotics instead.
Over-the-counter medicines for diarrhea may be dangerous for babies and children. Talk with the health care provider before giving your child these medicines. |
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| What to do for What I need to know about Diarrhea ? | To prevent dehydration when you have diarrhea, it is important to drink plenty of water, but you also need to drink fluids that contain sodium, chloride, and potassium.
- Adults should drink water, fruit juices, sports drinks, sodas without caffeine, and salty broths. - Children should drink oral rehydration solutionsspecial drinks that contain salts and minerals to prevent dehydration. These drinks include Pedialyte, Naturalyte, Infalyte, and CeraLyte. These drinks are sold in most grocery stores and drugstores.
- bananas - plain rice - boiled potatoes - toast - crackers - cooked carrots - baked chicken without the skin or fat
If a certain food is the cause of diarrhea, try to avoid it.
- drinks with caffeine, such as coffee and cola - high-fat or greasy foods, such as fried foods - foods with a lot of fiber, such as citrus fruits - sweet foods, such as cakes and cookies
During or after an episode of diarrhea, some people have trouble digesting lactose, the sugar in milk and milk products. However, you may be able to digest yogurt. Eating yogurt with active, live bacterial cultures may even help you feel better faster.
When babies have diarrhea, continue breastfeeding or formula feeding as usual.
After you have had diarrhea caused by a virus, problems digesting lactose may last up to 4 to 6 weeks. You may have diarrhea for a short time after you eat or drink milk or milk products. |
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| How to prevent What I need to know about Diarrhea ? | Two types of diarrhea can be preventedrotavirus diarrhea and travelers diarrhea.
Rotavirus Diarrhea
Two vaccines, RotaTeq and Rotarix, protect against rotavirusa common virus that causes diarrhea in babies and children. RotaTeq is given to babies in three doses at 2, 4, and 6 months of age. Rotarix is given in two doses. The first dose is given when the baby is 6 weeks old, and the second is given at least 4 weeks later but before the baby is 24 weeks old. To learn more about rotavirus vaccines, talk with your childs health care provider. You can also find more information at the Centers for Disease Control and Prevention rotavirus vaccination webpage at www.cdc.gov/vaccines/vpd-vac/rotavirus.
RotaTeq and Rotarix only prevent diarrhea caused by rotavirus. Children who have been vaccinated may still get diarrhea from another cause.
Travelers Diarrhea
People may develop travelers diarrhea while visiting developing areas of the world such as Latin America, Africa, and southern Asia. Travelers diarrhea is caused by eating food or drinking water that contains harmful bacteria, viruses, or parasites.
You can prevent travelers diarrhea by being careful:
- Do not drink tap water, use tap water to brush your teeth, or use ice cubes made from tap water. - Do not eat or drink unpasteurized milk or milk products. - Do not eat raw fruits and vegetables unless they can be peeled and you peel them yourself. - Do not eat raw or rare meat and fish. - Do not eat meat or shellfish that is not hot when served to you. - Do not eat food sold by street vendors.
You can drink bottled water, carbonated soft drinks, and hot drinks such as coffee and tea.
Before traveling outside the United States, talk with your health care provider. Your health care provider may suggest taking medicine with you. In some cases, taking antibiotics before traveling can help prevent travelers diarrhea. And early treatment with antibiotics can shorten an episode of travelers diarrhea. |
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| What to do for What I need to know about Diarrhea ? | - Diarrhea is frequent, loose, and watery bowel movements. - Acute diarrhea is a common problem. It usually lasts only 1 or 2 days, but it may last longer. - Being dehydrated means your body does not have enough fluid to work properly. Dehydration can be serious, especially for children, older adults, and people with weakened immune systems. - Diarrhea is treated by replacing lost fluids, salts, and minerals. - See your health care provider if you have signs of dehydration, diarrhea for more than 2 days, severe pain in your abdomen or rectum, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry. - Take your child to a health care provider right away if your child has signs of dehydration, diarrhea for more than 24 hours, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry. - Two types of diarrhea can be prevented rotavirus diarrhea and travelers diarrhea. |
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| What is (are) Treatment Methods for Kidney Failure: Peritoneal Dialysis ? | Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Doctors call this lining the peritoneum. A doctor will place a soft tube, called a catheter, in your belly a few weeks before you start treatment.
When you start peritoneal dialysis, dialysis solutionwater with salt and other additivesflows from a bag through the catheter into your belly. When the bag is empty, you can disconnect your catheter from the bag and cap it so you can move around and do your normal activities. While the dialysis solution is inside your belly, it soaks up wastes and extra fluid from your body. After a few hours, you drain the used dialysis solution into a drain bag. You can then dispose of the used dialysis solution, which is now full of wastes and extra fluid, in a toilet or down the drain of a sink or bathtub. Then you start over with a fresh bag of dialysis solution.
The process of first draining the used dialysis solution and then replacing it with fresh solution is called an exchange. Most people do four to six exchanges every day, or during the night using a machine that moves the fluid in and out. The process goes on continuously, so you always have dialysis solution in your belly soaking up wastes and extra fluid from your body. For the best results from peritoneal dialysis, it is important that you perform all of your exchanges as your doctor instructs. |
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| What is (are) Treatment Methods for Kidney Failure: Peritoneal Dialysis ? | The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysisalso called CAPDand automated peritoneal dialysiswhich doctors sometimes call APD or continuous cycler-assisted peritoneal dialysis. After learning about the types of peritoneal dialysis, you can choose the type that best fits your schedule and lifestyle. If one schedule or type of peritoneal dialysis does not suit you, you can talk with your doctor about trying another type.
- Continuous ambulatory peritoneal dialysis does not require a machine. You can do it in any clean, well-lit place. The time period that the dialysis solution is in your belly is called the dwell time. With continuous ambulatory peritoneal dialysis, the dialysis solution stays in your belly for a dwell time of 4 to 6 hours, or more. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. Usually, you change the dialysis solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up and perform exchanges during the night. - Automated peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five times during the night while you sleep. In the morning, you begin one exchange with a daylong dwell time. You may do an additional exchange around the middle of the afternoon without the cycler to increase the amount of waste removed and reduce the amount of fluid left behind in your body.
If you weigh more than 175 pounds or if your peritoneum filters wastes slowly, you may need a combination of continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. For example, some people use a cycler at night and perform one exchange during the day. Your health care team will help you determine the best schedule for you. |
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| What are the treatments for Treatment Methods for Kidney Failure: Peritoneal Dialysis ? | Your health care team will perform several tests to tell if your dialysis exchanges are removing enough wastes. These tests are especially important during the first weeks of treatment to determine whether your schedule is adequate.
Peritoneal Equilibration Test
For a peritoneal equilibration test, a dialysis nurse takes samples of your blood and dialysis solution during a 4-hour exchange. The peritoneal equilibration test measures how much dextrose your body absorbs from a bag of dialysis solution. The peritoneal equilibration test also measures how much urea and creatininewaste products of normal muscle and protein breakdownmove from your blood into the dialysis solution.
Clearance Test
For a clearance test, you will collect the used dialysis solution from a 24-hour period. A dialysis nurse takes a blood sample during the same 24-hour period. Your doctor or nurse compares the amount of urea in the used solution with the amount in your blood to see how much urea was removed. For the first months or even years of peritoneal dialysis treatment, you may still produce small amounts of urine. If you produce more than 100 milliliters (3 ounces) of urine per day, you will also collect your urine to measure its urea content.
From the measurements of used solution, blood, and, if available, urine, your health care team can determine your urea clearancea measurement doctors call your Kt/Vand your creatinine clearance rate. These measurements will show whether you are using the right peritoneal dialysis schedule and doses. If your dialysis schedule is not removing enough wastes, your doctor will make adjustments. More information is provided in the NIDDK health topic, Peritoneal Dialysis Dose and Adequacy. |
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| What to do for Treatment Methods for Kidney Failure: Peritoneal Dialysis ? | Eating the right foods can help you feel better while on peritoneal dialysis. Talk with your dialysis centers dietitian to find a meal plan that works for you. Your dietary needs will depend on your treatment and other factors such as your weight and activity level. Staying healthy with CKD requires watching what is in your diet:
- Protein is in foods from animals and plants. Protein provides the building blocks that maintain and repair muscles, organs, and other parts of your body. Peritoneal dialysis can remove proteins from your body, so eat high-quality, protein-rich foods such as meat, fish, and eggs. However, many high-protein foods also contain phosphorous, which can weaken your bones. Talk with your dietitian about ways to get the protein you need without getting too much phosphorous. - Phosphorus is a mineral that helps your bones stay healthy and your blood vessels and muscles work. Phosphorus is a natural part of foods rich in protein, and food producers often add it to many processed foods. Phosphorus can weaken your bones and make your skin itch if you consume too much. Peritoneal dialysis may not remove enough phosphorus from your body, so you will probably need to limit or avoid high-phosphorus foods such as milk and cheese, dried beans, peas, colas, nuts, and peanut butter. You may also need to take a pill called a phosphate binder that keeps phosphorus in your food from entering your bloodstream. - Fluid includes water and drinks such as fruit juice and milk and water in foods such as fruits, vegetables, ice cream, gelatin, soup, and ice pops. You need water for your body to function properly; however, too much can cause swelling and make your heart work harder. Over time, having too much fluid in your body can cause high blood pressure and congestive heart failure. Peritoneal dialysis might cause you to have either too much or too little fluid, depending on the strength of the solution you use. Your diet can also influence whether you have too much or too little fluid. Your dietitian will help you determine how much liquid you need to consume each day. - Sodium is a part of salt. Many canned, packaged, frozen, and fast foods contain sodium. Sodium is also a part of many condiments, seasonings, and meats. Too much sodium makes you thirsty, which makes you drink more liquid. Try to eat fresh foods that are naturally low in sodium, and look for products that say low sodium on the label, especially in canned and frozen foods. - Potassium is a mineral that helps your nerves and muscles work the right way. Peritoneal dialysis can pull too much potassium from your blood, so you may need to eat more high-potassium foods such as bananas, oranges, potatoes, and tomatoes. However, be careful not to eat too much potassium. Your dietitian will help you choose the right amount. - Calories are units for measuring the energy provided by foods and drinks. Eating foods with too many calories, such as oily and sugary foods, can make you gain weight. Your body can absorb the dextrose from your dialysis solution, which can increase your calorie intake. You may find you need to take in fewer calories to prevent weight gain. Your dietitian can help you create and follow a diet to stay at a healthy weight. - Supplements help provide some of the vitamins and minerals that may be missing from your diet. Peritoneal dialysis also removes some vitamins from your body. Your doctor may prescribe a vitamin and mineral supplement that scientists have designed specifically for people with CKD and kidney failure. Never take vitamin and mineral supplements that you can buy over the counter. They may be harmful to you. Talk with your doctor before taking any medicine, including vitamin and mineral supplements, that he or she has not prescribed for you.
You may have a difficult time changing your diet at first. Eating the right foods will help you feel better. You will have more strength and energy. More information is provided in the NIDDK health topic, Make the Kidney Connection: Food Tips and Healthy Eating Ideas. |
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| What to do for Treatment Methods for Kidney Failure: Peritoneal Dialysis ? | - Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. - The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. - The most common problem with peritoneal dialysis is peritonitis, a serious abdominal infection. - When dialysis solution stays in the body too long, it becomes so full of wastes and extra fluid that it cannot absorb any more from the body. The process may even reverse, letting some wastes and extra fluid back into the body. - Eating the right foods can help you feel better while on peritoneal dialysis. Talk with your dialysis centers dietitian to find a meal plan that works for you. |
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| What is (are) Anemia in Chronic Kidney Disease ? | Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food. With anemia, red blood cells carry less oxygen to tissues and organsparticularly the heart and brainand those tissues and organs may not function as well as they should. |
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| What is (are) Anemia in Chronic Kidney Disease ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine.
Healthy kidneys produce a hormone called erythropoietin (EPO). A hormone is a chemical produced by the body and released into the blood to help trigger or regulate particular body functions. EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. |
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| What causes Anemia in Chronic Kidney Disease ? | When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs.
Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food:
- iron - vitamin B12 - folic acid
These nutrients are necessary for red blood cells to make hemoglobin, the main oxygen-carrying protein in the red blood cells.
If treatments for kidney-related anemia do not help, the health care provider will look for other causes of anemia, including
- other problems with bone marrow - inflammatory problemssuch as arthritis, lupus, or inflammatory bowel diseasein which the bodys immune system attacks the bodys own cells and organs - chronic infections such as diabetic ulcers - malnutrition |
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| What are the symptoms of Anemia in Chronic Kidney Disease ? | The signs and symptoms of anemia in someone with CKD may include
- weakness - fatigue, or feeling tired - headaches - problems with concentration - paleness - dizziness - difficulty breathing or shortness of breath - chest pain
Anyone having difficulty breathing or with shortness of breath should seek immediate medical care. Anyone who has chest pain should call 911. |
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| What are the complications of Anemia in Chronic Kidney Disease ? | Heart problems are a complication of anemia and may include
- an irregular heartbeat or an unusually fast heartbeat, especially when exercising. - the harmful enlargement of muscles in the heart. - heart failure, which does not mean the heart suddenly stops working. Instead, heart failure is a long-lasting condition in which the heart cant pump enough blood to meet the bodys needs. |
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| How to diagnose Anemia in Chronic Kidney Disease ? | A health care provider diagnoses anemia based on
- a medical history - a physical exam - blood tests
Medical History
Taking a medical history is one of the first things a health care provider may do to diagnose anemia. He or she will usually ask about the patients symptoms.
Physical Exam
A physical exam may help diagnose anemia. During a physical exam, a health care provider usually examines a patients body, including checking for changes in skin color.
Blood Tests
To diagnose anemia, a health care provider may order a complete blood count, which measures the type and number of blood cells in the body. A blood test involves drawing a patients blood at a health care providers office or a commercial facility. A health care provider will carefully monitor the amount of hemoglobin in the patients blood, one of the measurements in a complete blood count.
The Kidney Disease: Improving Global Outcomes Anemia Work Group recommends that health care providers diagnose anemia in males older than age 15 when their hemoglobin falls below 13 grams per deciliter (g/dL) and in females older than 15 when it falls below 12 g/dL.2 If someone has lost at least half of normal kidney function and has low hemoglobin, the cause of anemia may be decreased EPO production.
Two other blood tests help measure iron levels:
- The ferritin level helps assess the amount of iron stored in the body. A ferritin score below 200 nanograms (ng) per liter may mean a person has iron deficiency that requires treatment.2 - The transferrin saturation score indicates how much iron is available to make red blood cells. A transferrin saturation score below 30 percent can also mean low iron levels that require treatment.2
In addition to blood tests, the health care provider may order other tests, such as tests for blood loss in stool, to look for other causes of anemia. |
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| What are the treatments for Anemia in Chronic Kidney Disease ? | Depending on the cause, a health care provider treats anemia with one or more of the following treatments:
Iron
The first step in treating anemia is raising low iron levels. Iron pills may help improve iron and hemoglobin levels. However, for patients on hemodialysis, many studies show pills do not work as well as iron given intravenously.2
Erythropoietin
If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. A health care provider, often a nurse, injects the patient with EPO subcutaneously, or under the skin, as needed. Some patients learn how to inject the EPO themselves. Patients on hemodialysis may receive EPO intravenously during hemodialysis.
Studies have shown the use of EPO increases the chance of cardiovascular events, such as heart attack and stroke, in people with CKD. The health care provider will carefully review the medical history of the patient and determine if EPO is the best treatment for the patients anemia. Experts recommend using the lowest dose of EPO that will reduce the need for red blood cell transfusions. Additionally, health care providers should consider the use of EPO only when a patients hemoglobin level is below 10 g/dL. Health care providers should not use EPO to maintain a patients hemoglobin level above 11.5 g/dL.2 Patients who receive EPO should have regular blood tests to monitor their hemoglobin so the health care provider can adjust the EPO dose when the level is too high or too low.2 Health care providers should discuss the benefits and risks of EPO with their patients.
Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions. In some people, iron supplements and EPO will improve the symptoms of anemia.
Red Blood Cell Transfusions
If a patients hemoglobin falls too low, a health care provider may prescribe a red blood cell transfusion. Transfusing red blood cells into the patients vein raises the percentage of the patients blood that consists of red blood cells, increasing the amount of oxygen available to the body.
Vitamin B12 and Folic Acid Supplements
A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia. Using vitamin supplements can treat low levels of vitamin B12 or folic acid and help treat anemia. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements, with their health care provider.
Read more about vitamin B12 and folic acid on the MedlinePlus website at www.nlm.nih.gov/medlineplus. Read more about complementary and alternative medicine at www.nccam.nih.gov. |
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| What to do for Anemia in Chronic Kidney Disease ? | A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. Some of these foods are high in sodium or phosphorus, which people with CKD should limit in their diet. Before making any dietary changes, people with CKD should talk with their health care provider or with a dietitian who specializes in helping people with kidney disease. A dietitian can help a person plan healthy meals.
Read more about nutrition for people with CKD on the National Kidney Disease Education Program website.
The following chart illustrates some good dietary sources of iron, vitamin B12, and folic acid.
Food Serving Size Iron Vitamin B12 Folic Acid Recommended Daily Value 18 mg 6 mcg 400 mcg 100 percent fortified breakfast cereal cup (1 oz) 18 mg 6 mcg 394 mcg beans, baked 1 cup (8 oz) 8 mg 0 mcg 37 mcg beef, ground 3 oz 2 mg 2 mcg 8 mcg beef liver 3 oz 5 mg 67 mcg 211 mcg clams, fried 4 oz 3 mg 1 mcg 66 mcg spinach, boiled 1 cup (3 oz) 2 mg 0 mcg 115 mcg spinach, fresh 1 cup (1 oz) 1 mg 0 mcg 58 mcg trout 3 oz 0 mg 5 mcg 16 mcg tuna, canned 3 oz 1 mg 1 mcg 2 mcg |
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| What to do for Anemia in Chronic Kidney Disease ? | - Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food. - Anemia commonly occurs in people with chronic kidney disease (CKD)the permanent, partial loss of kidney function. Most people who have total loss of kidney function, or kidney failure, have anemia. - When kidneys are diseased or damaged, they do not make enough erythropoietin (EPO). As a result, the bone marrow makes fewer red blood cells, causing anemia. - Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food: - iron - vitamin B12 - folic acid - The first step in treating anemia is raising low iron levels. - If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. - Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions. - A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia. - A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. |
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| What is (are) Anemia in Chronic Kidney Disease ? | You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.
Booklets
- Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Kidney Transplantation - Kidney Failure: Eat Right to Feel Right on Hemodialysis
Fact Sheets
- Kidney Failure: What to Expect - Vascular Access for Hemodialysis - Treatment Methods for Kidney Failure: Hemodialysis - Hemodialysis Dose and Adequacy - Peritoneal Dialysis Dose and Adequacy - Amyloidosis and Kidney Disease - Anemia in Chronic Kidney Disease - Chronic Kidney Disease-Mineral and Bone Disorder - Financial Help for Treatment of Kidney Failure
Learning as much as you can about your treatment will help make you an important member of your health care team.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank: John C. Stivelman, M.D., Emory University School of Medicine; Kerri Cavanaugh, M.D., M.H.S., Vanderbilt University
This information is not copyrighted. The NIDDK encourages people to share this content freely.
July 2014 |
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| What is (are) Indigestion ? | Indigestion, also known as dyspepsia, is a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen.
Indigestion is common in adults and can occur once in a while or as often as every day. |
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| What causes Indigestion ? | Indigestion can be caused by a condition in the digestive tract such as gastroesophageal reflux disease (GERD), peptic ulcer disease, cancer, or abnormality of the pancreas or bile ducts. If the condition improves or resolves, the symptoms of indigestion usually improve.
Sometimes a person has indigestion for which a cause cannot be found. This type of indigestion, called functional dyspepsia, is thought to occur in the area where the stomach meets the small intestine. The indigestion may be related to abnormal motilitythe squeezing or relaxing actionof the stomach muscle as it receives, digests, and moves food into the small intestine. |
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| What are the symptoms of Indigestion ? | Most people with indigestion experience more than one of the following symptoms:
- Fullness during a meal. The person feels overly full soon after the meal starts and cannot finish the meal. - Bothersome fullness after a meal. The person feels overly full after a mealit may feel like the food is staying in the stomach too long. - Epigastric pain. The epigastric area is between the lower end of the chest bone and the navel. The person may experience epigastric pain ranging from mild to severe. - Epigastric burning. The person feels an unpleasant sensation of heat in the epigastric area.
Other, less frequent symptoms that may occur with indigestion are nausea and bloatingan unpleasant tightness in the stomach. Nausea and bloating could be due to causes other than indigestion.
Sometimes the term indigestion is used to describe the symptom of heartburn, but these are two different conditions. Heartburn is a painful, burning feeling in the chest that radiates toward the neck or back. Heartburn is caused by stomach acid rising into the esophagus and may be a symptom of GERD. A person can have symptoms of both indigestion and heartburn. |
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| How to diagnose Indigestion ? | To diagnose indigestion, the doctor asks about the person's current symptoms and medical history and performs a physical examination. The doctor may order x rays of the stomach and small intestine.
The doctor may perform blood, breath, or stool tests if the type of bacteria that causes peptic ulcer disease is suspected as the cause of indigestion.
The doctor may perform an upper endoscopy. After giving a sedative to help the person become drowsy, the doctor passes an endoscopea long, thin tube that has a light and small camera on the endthrough the mouth and gently guides it down the esophagus into the stomach. The doctor can look at the esophagus and stomach with the endoscope to check for any abnormalities. The doctor may perform biopsiesremoving small pieces of tissue for examination with a microscopeto look for possible damage from GERD or an infection.
Because indigestion can be a sign of a more serious condition, people should see a doctor right away if they experience
- frequent vomiting - blood in vomit - weight loss or loss of appetite - black tarry stools - difficult or painful swallowing - abdominal pain in a nonepigastric area - indigestion accompanied by shortness of breath, sweating, or pain that radiates to the jaw, neck, or arm - symptoms that persist for more than 2 weeks |
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| What are the treatments for Indigestion ? | Some people may experience relief from symptoms of indigestion by
- eating several small, low-fat meals throughout the day at a slow pace - refraining from smoking - abstaining from consuming coffee, carbonated beverages, and alcohol - stopping use of medications that may irritate the stomach liningsuch as aspirin or anti-inflammatory drugs - getting enough rest - finding ways to decrease emotional and physical stress, such as relaxation therapy or yoga
The doctor may recommend over-the-counter antacids or medications that reduce acid production or help the stomach move food more quickly into the small intestine. Many of these medications can be purchased without a prescription. Nonprescription medications should only be used at the dose and for the length of time recommended on the label unless advised differently by a doctor. Informing the doctor when starting a new medication is important.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve symptoms of indigestion. Many brands on the market use different combinations of three basic saltsmagnesium, calcium, and aluminumwith hydroxide or bicarbonate ions to neutralize the acid in the stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium, though they may cause constipation.
H2 receptor antagonists (H2RAs) include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid) and are available both by prescription and over-the-counter. H2RAs treat symptoms of indigestion by reducing stomach acid. They work longer than but not as quickly as antacids. Side effects of H2RAs may include headache, nausea, vomiting, constipation, diarrhea, and unusual bleeding or bruising.
Proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium) and are available by prescription. Prilosec is also available in over-the-counter strength. PPIs, which are stronger than H2RAs, also treat indigestion symptoms by reducing stomach acid. PPIs are most effective in treating symptoms of indigestion in people who also have GERD. Side effects of PPIs may include back pain, aching, cough, headache, dizziness, abdominal pain, gas, nausea, vomiting, constipation, and diarrhea.
Prokinetics such as metoclopramide (Reglan) may be helpful for people who have a problem with the stomach emptying too slowly. Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness, including fatigue, sleepiness, depression, anxiety, and involuntary muscle spasms or movements.
If testing shows the type of bacteria that causes peptic ulcer disease, the doctor may prescribe antibiotics to treat the condition. |
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| What to do for Indigestion ? | - Indigestion, also known as dyspepsia, is a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen. - Indigestion can be caused by a condition in the digestive tract such as gastroesophageal reflux disease (GERD), peptic ulcer disease, cancer, or abnormality of the pancreas or bile ducts. - Sometimes a person has indigestion for which a cause cannot be found. This type of indigestion is called functional dyspepsia. - Indigestion and heartburn are different conditions, but a person can have symptoms of both. - The doctor may order x rays; blood, breath, and stool tests; and an upper endoscopy with biopsies to diagnose indigestion. - Some people may experience relief from indigestion by making some lifestyle changes and decreasing stress. - The doctor may prescribe antacids, H2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), prokinetics, or antibiotics to treat the symptoms of indigestion. |
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| What is (are) Acromegaly ? | Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body. The pituitary, a small gland in the brain, makes GH. In acromegaly, the pituitary produces excessive amounts of GH. Usually the excess GH comes from benign, or noncancerous, tumors on the pituitary. These benign tumors are called adenomas.
Acromegaly is most often diagnosed in middle-aged adults, although symptoms can appear at any age. If not treated, acromegaly can result in serious illness and premature death. Acromegaly is treatable in most patients, but because of its slow and often "sneaky" onset, it often is not diagnosed early or correctly. The most serious health consequences of acromegaly are type 2 diabetes, high blood pressure, increased risk of cardiovascular disease, and arthritis. Patients with acromegaly are also at increased risk for colon polyps, which may develop into colon cancer if not removed.
When GH-producing tumors occur in childhood, the disease that results is called gigantism rather than acromegaly. A child's height is determined by the length of the so-called long bones in the legs. In response to GH, these bones grow in length at the growth platesareas near either end of the bone. Growth plates fuse after puberty, so the excessive GH production in adults does not result in increased height. However, prolonged exposure to excess GH before the growth plates fuse causes increased growth of the long bones and thus increased height. Pediatricians may become concerned about this possibility if a child's growth rate suddenly and markedly increases beyond what would be predicted by previous growth and how tall the child's parents are. |
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| What are the symptoms of Acromegaly ? | The name acromegaly comes from the Greek words for "extremities" and "enlargement," reflecting one of its most common symptomsthe abnormal growth of the hands and feet. Swelling of the hands and feet is often an early feature, with patients noticing a change in ring or shoe size, particularly shoe width. Gradually, bone changes alter the patient's facial features: The brow and lower jaw protrude, the nasal bone enlarges, and the teeth space out.
Overgrowth of bone and cartilage often leads to arthritis. When tissue thickens, it may trap nerves, causing carpal tunnel syndrome, which results in numbness and weakness of the hands. Body organs, including the heart, may enlarge.
Other symptoms of acromegaly include
- joint aches - thick, coarse, oily skin - skin tags - enlarged lips, nose, and tongue - deepening of the voice due to enlarged sinuses and vocal cords - sleep apnea-breaks in breathing during sleep due to obstruction of the airway - excessive sweating and skin odor - fatigue and weakness - headaches - impaired vision - abnormalities of the menstrual cycle and sometimes breast discharge in women - erectile dysfunction in men - decreased libido |
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| What causes Acromegaly ? | Acromegaly is caused by prolonged overproduction of GH by the pituitary gland. The pituitary produces several important hormones that control body functions such as growth and development, reproduction, and metabolism. But hormones never seem to act simply and directly. They usually "cascade" or flow in a series, affecting each other's production or release into the bloodstream.
GH is part of a cascade of hormones that, as the name implies, regulates the physical growth of the body. This cascade begins in a part of the brain called the hypothalamus. The hypothalamus makes hormones that regulate the pituitary. One of the hormones in the GH series, or "axis," is growth hormone-releasing hormone (GHRH), which stimulates the pituitary gland to produce GH.
Secretion of GH by the pituitary into the bloodstream stimulates the liver to produce another hormone called insulin-like growth factor I (IGF-I). IGF-I is what actually causes tissue growth in the body. High levels of IGF-I, in turn, signal the pituitary to reduce GH production.
The hypothalamus makes another hormone called somatostatin, which inhibits GH production and release. Normally, GHRH, somatostatin, GH, and IGF-I levels in the body are tightly regulated by each other and by sleep, exercise, stress, food intake, and blood sugar levels. If the pituitary continues to make GH independent of the normal regulatory mechanisms, the level of IGF-I continues to rise, leading to bone overgrowth and organ enlargement. High levels of IGF-I also cause changes in glucose (sugar) and lipid (fat) metabolism and can lead to diabetes, high blood pressure, and heart disease.
Pituitary Tumors
In more than 95 percent of people with acromegaly, a benign tumor of the pituitary gland, called an adenoma, produces excess GH. Pituitary tumors are labeled either micro- or macro-adenomas, depending on their size. Most GH-secreting tumors are macro-adenomas, meaning they are larger than 1 centimeter. Depending on their location, these larger tumors may compress surrounding brain structures. For example, a tumor growing upward may affect the optic chiasm-where the optic nerves crossleading to visual problems and vision loss. If the tumor grows to the side, it may enter an area of the brain called the cavernous sinus where there are many nerves, potentially damaging them.
Compression of the surrounding normal pituitary tissue can alter production of other hormones. These hormonal shifts can lead to changes in menstruation and breast discharge in women and erectile dysfunction in men. If the tumor affects the part of the pituitary that controls the thyroidanother hormone-producing glandthen thyroid hormones may decrease. Too little thyroid hormone can cause weight gain, fatigue, and hair and skin changes. If the tumor affects the part of the pituitary that controls the adrenal gland, the hormone cortisol may decrease. Too little cortisol can cause weight loss, dizziness, fatigue, low blood pressure, and nausea.
Some GH-secreting tumors may also secrete too much of other pituitary hormones. For example, they may produce prolactin, the hormone that stimulates the mammary glands to produce milk. Rarely, adenomas may produce thyroid-stimulating hormone. Doctors should assess all pituitary hormones in people with acromegaly.
Rates of GH production and the aggressiveness of the tumor vary greatly among people with adenomas. Some adenomas grow slowly and symptoms of GH excess are often not noticed for many years. Other adenomas grow more rapidly and invade surrounding brain areas or the venous sinuses, which are located near the pituitary gland. Younger patients tend to have more aggressive tumors. Regardless of size, these tumors are always benign.
Most pituitary tumors develop spontaneously and are not genetically inherited. They are the result of a genetic alteration in a single pituitary cell, which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but happens later in life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells. It permanently switches on the signal that tells the cell to divide and secrete GH. The events within the cell that cause disordered pituitary cell growth and GH oversecretion currently are the subject of intensive research.
Nonpituitary Tumors
Rarely, acromegaly is caused not by pituitary tumors but by tumors of the pancreas, lungs, and other parts of the brain. These tumors also lead to excess GH, either because they produce GH themselves or, more frequently, because they produce GHRH, the hormone that stimulates the pituitary to make GH. When these non-pituitary tumors are surgically removed, GH levels fall and the symptoms of acromegaly improve.
In patients with GHRH-producing, non-pituitary tumors, the pituitary still may be enlarged and may be mistaken for a tumor. Physicians should carefully analyze all "pituitary tumors" removed from patients with acromegaly so they do not overlook the rare possibility that a tumor elsewhere in the body is causing the disorder. |
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| How many people are affected by Acromegaly ? | Small pituitary adenomas are common, affecting about 17 percent of the population.1 However, research suggests most of these tumors do not cause symptoms and rarely produce excess GH.2 Scientists estimate that three to four out of every million people develop acromegaly each year and about 60 out of every million people suffer from the disease at any time.3 Because the clinical diagnosis of acromegaly is often missed, these numbers probably underestimate the frequency of the disease. |
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| How to diagnose Acromegaly ? | Blood tests
If acromegaly is suspected, a doctor must measure the GH level in a persons blood to determine if it is elevated. However, a single measurement of an elevated blood GH level is not enough to diagnose acromegaly: Because GH is secreted by the pituitary in impulses, or spurts, its concentration in the blood can vary widely from minute to minute. At a given moment, a person with acromegaly may have a normal GH level, whereas a GH level in a healthy person may even be five times higher.
More accurate information is obtained when GH is measured under conditions that normally suppress GH secretion. Health care professionals often use the oral glucose tolerance test to diagnose acromegaly because drinking 75 to 100 grams of glucose solution lowers blood GH levels to less than 1 nanogram per milliliter (ng/ml) in healthy people. In people with GH overproduction, this suppression does not occur. The oral glucose tolerance test is a highly reliable method for confirming a diagnosis of acromegaly.
Physicians also can measure IGF-I levels, which increase as GH levels go up, in people with suspected acromegaly. Because IGF-I levels are much more stable than GH levels over the course of the day, they are often a more practical and reliable screening measure. Elevated IGF-I levels almost always indicate acromegaly. However, a pregnant womans IGF-I levels are two to three times higher than normal. In addition, physicians must be aware that IGF-I levels decline with age and may also be abnormally low in people with poorly controlled diabetes or liver or kidney disease.
Imaging
After acromegaly has been diagnosed by measuring GH or IGF-I levels, a magnetic resonance imaging (MRI) scan of the pituitary is used to locate and detect the size of the tumor causing GH overproduction. MRI is the most sensitive imaging technique, but computerized tomography (CT) scans can be used if the patient should not have MRI. For example, people who have pacemakers or other types of implants containing metal should not have an MRI scan because MRI machines contain powerful magnets.
If a head scan fails to detect a pituitary tumor, the physician should look for non-pituitary "ectopic" tumors in the chest, abdomen, or pelvis as the cause of excess GH. The presence of such tumors usually can be diagnosed by measuring GHRH in the blood and by a CT scan of possible tumor sites.
Rarely, a pituitary tumor secreting GH may be too tiny to detect even with a sensitive MRI scan. |
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| What are the treatments for Acromegaly ? | Currently, treatment options include surgical removal of the tumor, medical therapy, and radiation therapy of the pituitary.
Goals of treatment are to
- reduce excess hormone production to normal levels - relieve the pressure that the growing pituitary tumor may be exerting on the surrounding brain areas - preserve normal pituitary function or treat hormone deficiencies - improve the symptoms of acromegaly
Surgery
Surgery is the first option recommended for most people with acromegaly, as it is often a rapid and effective treatment. The surgeon reaches the pituitary via an incision through the nose or inside the upper lip and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days.
Surgery is most successful in patients with blood GH levels below 45 ng/ml before the operation and with pituitary tumors no larger than 10 millimeters (mm) in diameter. Success depends in large part on the skill and experience of the surgeon, as well as the location of the tumor. Even with the most experienced neurosurgeon, the chance of a cure is small if the tumor has extended into critical brain structures or into the cavernous sinus where surgery could be risky.
The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and IGF-I levels. The overall rate of remission-control of the disease-after surgery ranges from 55 to 80 percent. (See For More Information to locate a board-certified neurosurgeon.)
A possible complication of surgery is damage to the surrounding normal pituitary tissue, which requires lifelong use of pituitary hormone replacement. The part of the pituitary that stores antidiuretic hormonea hormone important in water balancemay be temporarily or, rarely, permanently damaged and the patient may require medical therapy. Other potential problems include cerebrospinal fluid leaks and, rarely, meningitis. Cerebrospinal fluid bathes the brain and can leak from the nose if the incision area doesnt heal well. Meningitis is a bacterial or viral infection of the meninges, the outer covering of the brain.
Even when surgery is successful and hormone levels return to normal, people with acromegaly must be carefully monitored for years for possible recurrence of the disease. More commonly, hormone levels improve, but do not return to normal. Additional treatment, usually medications, may be required.
Medical Therapy
Medical therapy is most often used if surgery does not result in a cure and sometimes to shrink large tumors before surgery. Three medication groups are used to treat acromegaly.
Somatostatin analogs (SSAs) are the first medication group used to treat acromegaly. They shut off GH production and are effective in lowering GH and IGF-I levels in 50 to 70 percent of patients. SSAs also reduce tumor size in around 0 to 50 percent of patients but only to a modest degree. Several studies have shown that SSAs are safe and effective for long-term treatment and in treating patients with acromegaly caused by nonpituitary tumors. Long-acting SSAs are given by intramuscular injection once a month.
Digestive problems-such as loose stools, nausea, and gas-are a side effect in about half of people taking SSAs. However, the effects are usually temporary and rarely severe. About 10 to 20 percent of patients develop gallstones, but the gallstones do not usually cause symptoms. In rare cases, treatment can result in elevated blood glucose levels. More commonly, SSAs reduce the need for insulin and improve blood glucose control in some people with acromegaly who already have diabetes.
The second medication group is the GH receptor antagonists (GHRAs), which interfere with the action of GH. They normalize IGF-I levels in more than 90 percent of patients. They do not, however, lower GH levels. Given once a day through injection, GHRAs are usually well-tolerated by patients. The long-term effects of these drugs on tumor growth are still under study. Side effects can include headaches, fatigue, and abnormal liver function.
Dopamine agonists make up the third medication group. These drugs are not as effective as the other medications at lowering GH or IGF-I levels, and they normalize IGF-I levels in only a minority of patients. Dopamine agonists are sometimes effective in patients who have mild degrees of excess GH and have both acromegaly and hyperprolactinemiatoo much of the hormone prolactin. Dopamine agonists can be used in combination with SSAs. Side effects can include nausea, headache, and lightheadedness.
Agonist: A drug that binds to a receptor of a cell and triggers a response by the cell, mimicking the action of a naturally occurring substance. Antagonist: A chemical that acts within the body to reduce the physiological activity of another chemical substance or hormone.
Radiation Therapy
Radiation therapy is usually reserved for people who have some tumor remaining after surgery and do not respond to medications. Because radiation leads to a slow lowering of GH and IGF-I levels, these patients often also receive medication to lower hormone levels. The full effect of this therapy may not occur for many years.
The two types of radiation delivery are conventional and stereotactic. Conventional radiation delivery targets the tumor with external beams but can damage surrounding tissue. The treatment delivers small doses of radiation multiple times over 4 to 6 weeks, giving normal tissue time to heal between treatments.
Stereotactic delivery allows precise targeting of a high-dose beam of radiation at the tumor from varying angles. The patient must wear a rigid head frame to keep the head still. The types of stereotactic radiation delivery currently available are proton beam, linear accelerator (LINAC), and gamma knife. With stereotactic delivery, the tumor must be at least 5 mm from the optic chiasm to prevent radiation damage. This treatment can sometimes be done in a single session, reducing the risk of damage to surrounding tissue.
All forms of radiation therapy cause a gradual decline in production of other pituitary hormones over time, resulting in the need for hormone replacement in most patients. Radiation also can impair a patients fertility. Vision loss and brain injury are rare complications. Rarely, secondary tumors can develop many years later in areas that were in the path of the radiation beam. |
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| What are the treatments for Acromegaly ? | Currently, treatment options include surgical removal of the tumor, medical therapy, and radiation therapy of the pituitary.
Goals of treatment are to
- reduce excess hormone production to normal levels - relieve the pressure that the growing pituitary tumor may be exerting on the surrounding brain areas - preserve normal pituitary function or treat hormone deficiencies - improve the symptoms of acromegaly
Surgery
Surgery is the first option recommended for most people with acromegaly, as it is often a rapid and effective treatment. The surgeon reaches the pituitary via an incision through the nose or inside the upper lip and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days.
Surgery is most successful in patients with blood GH levels below 45 ng/ml before the operation and with pituitary tumors no larger than 10 millimeters (mm) in diameter. Success depends in large part on the skill and experience of the surgeon, as well as the location of the tumor. Even with the most experienced neurosurgeon, the chance of a cure is small if the tumor has extended into critical brain structures or into the cavernous sinus where surgery could be risky.
The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and IGF-I levels. The overall rate of remission-control of the disease-after surgery ranges from 55 to 80 percent. (See For More Information to locate a board-certified neurosurgeon.)
A possible complication of surgery is damage to the surrounding normal pituitary tissue, which requires lifelong use of pituitary hormone replacement. The part of the pituitary that stores antidiuretic hormonea hormone important in water balancemay be temporarily or, rarely, permanently damaged and the patient may require medical therapy. Other potential problems include cerebrospinal fluid leaks and, rarely, meningitis. Cerebrospinal fluid bathes the brain and can leak from the nose if the incision area doesnt heal well. Meningitis is a bacterial or viral infection of the meninges, the outer covering of the brain.
Even when surgery is successful and hormone levels return to normal, people with acromegaly must be carefully monitored for years for possible recurrence of the disease. More commonly, hormone levels improve, but do not return to normal. Additional treatment, usually medications, may be required.
Medical Therapy
Medical therapy is most often used if surgery does not result in a cure and sometimes to shrink large tumors before surgery. Three medication groups are used to treat acromegaly.
Somatostatin analogs (SSAs) are the first medication group used to treat acromegaly. They shut off GH production and are effective in lowering GH and IGF-I levels in 50 to 70 percent of patients. SSAs also reduce tumor size in around 0 to 50 percent of patients but only to a modest degree. Several studies have shown that SSAs are safe and effective for long-term treatment and in treating patients with acromegaly caused by nonpituitary tumors. Long-acting SSAs are given by intramuscular injection once a month.
Digestive problems-such as loose stools, nausea, and gas-are a side effect in about half of people taking SSAs. However, the effects are usually temporary and rarely severe. About 10 to 20 percent of patients develop gallstones, but the gallstones do not usually cause symptoms. In rare cases, treatment can result in elevated blood glucose levels. More commonly, SSAs reduce the need for insulin and improve blood glucose control in some people with acromegaly who already have diabetes.
The second medication group is the GH receptor antagonists (GHRAs), which interfere with the action of GH. They normalize IGF-I levels in more than 90 percent of patients. They do not, however, lower GH levels. Given once a day through injection, GHRAs are usually well-tolerated by patients. The long-term effects of these drugs on tumor growth are still under study. Side effects can include headaches, fatigue, and abnormal liver function.
Dopamine agonists make up the third medication group. These drugs are not as effective as the other medications at lowering GH or IGF-I levels, and they normalize IGF-I levels in only a minority of patients. Dopamine agonists are sometimes effective in patients who have mild degrees of excess GH and have both acromegaly and hyperprolactinemiatoo much of the hormone prolactin. Dopamine agonists can be used in combination with SSAs. Side effects can include nausea, headache, and lightheadedness.
Agonist: A drug that binds to a receptor of a cell and triggers a response by the cell, mimicking the action of a naturally occurring substance. Antagonist: A chemical that acts within the body to reduce the physiological activity of another chemical substance or hormone.
Radiation Therapy
Radiation therapy is usually reserved for people who have some tumor remaining after surgery and do not respond to medications. Because radiation leads to a slow lowering of GH and IGF-I levels, these patients often also receive medication to lower hormone levels. The full effect of this therapy may not occur for many years.
The two types of radiation delivery are conventional and stereotactic. Conventional radiation delivery targets the tumor with external beams but can damage surrounding tissue. The treatment delivers small doses of radiation multiple times over 4 to 6 weeks, giving normal tissue time to heal between treatments.
Stereotactic delivery allows precise targeting of a high-dose beam of radiation at the tumor from varying angles. The patient must wear a rigid head frame to keep the head still. The types of stereotactic radiation delivery currently available are proton beam, linear accelerator (LINAC), and gamma knife. With stereotactic delivery, the tumor must be at least 5 mm from the optic chiasm to prevent radiation damage. This treatment can sometimes be done in a single session, reducing the risk of damage to surrounding tissue.
All forms of radiation therapy cause a gradual decline in production of other pituitary hormones over time, resulting in the need for hormone replacement in most patients. Radiation also can impair a patients fertility. Vision loss and brain injury are rare complications. Rarely, secondary tumors can develop many years later in areas that were in the path of the radiation beam. |
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| What are the treatments for Acromegaly ? | No single treatment is effective for all patients. Treatment should be individualized, and often combined, depending on patient characteristics such as age and tumor size.
If the tumor has not yet invaded surrounding nonpituitary tissues, removal of the pituitary adenoma by an experienced neurosurgeon is usually the first choice. Even if a cure is not possible, surgery may be performed if the patient has symptoms of neurological problems such as loss of peripheral vision or cranial nerve problems. After surgery, hormone levels are measured to determine whether a cure has been achieved. This determination can take up to 8 weeks because IGF-I lasts a long time in the body's circulation. If cured, a patient must be monitored for a long time for increasing GH levels.
If surgery does not normalize hormone levels or a relapse occurs, an endocrinologist should recommend additional drug therapy. With each medication, long-term therapy is necessary because their withdrawal can lead to rising GH levels and tumor re-expansion.
Radiation therapy is generally reserved for patients whose tumors are not completely removed by surgery, who are not good candidates for surgery because of other health problems, or who do not respond adequately to surgery and medication. |
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| What to do for Acromegaly ? | - Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body. - In most people with acromegaly, a benign tumor of the pituitary gland produces excess GH. - Common features of acromegaly include abnormal growth of the hands and feet; bone growth in the face that leads to a protruding lower jaw and brow and an enlarged nasal bone; joint aches; thick, coarse, oily skin; and enlarged lips, nose, and tongue. - Acromegaly can cause sleep apnea, fatigue and weakness, headaches, impaired vision, menstrual abnormalities in women, and erectile dysfunction in men. - Acromegaly is diagnosed through a blood test. Magnetic resonance imaging (MRI) of the pituitary is then used to locate and detect the size of the tumor causing GH overproduction. - The first line of treatment is usually surgical removal of the tumor. Medication or radiation may be used instead of or in addition to surgery. |
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| What is (are) 4 Steps to Manage Your Diabetes for Life ? | What is diabetes?
There are three main types of diabetes:
- Type 1 diabetes Your body does not make insulin. This is a problem because you need insulin to take the sugar (glucose) from the foods you eat and turn it into energy for your body. You need to take insulin every day to live. - Type 2 diabetes Your body does not make or use insulin well. You may need to take pills or insulin to help control your diabetes. Type 2 is the most common type of diabetes. - Gestational (jest-TAY-shun-al) diabetes Some women get this kind of diabetes when they are pregnant. Most of the time, it goes away after the baby is born. But even if it goes away, these women and their children have a greater chance of getting diabetes later in life.
You are the most important member of your health care team.
You are the one who manages your diabetes day by day. Talk to your doctor about how you can best care for your diabetes to stay healthy. Some others who can help are:
- dentist - diabetes doctor - diabetes educator - dietitian - eye doctor - foot doctor - friends and family - mental health counselor - nurse - nurse practitioner - pharmacist - social worker
How to learn more about diabetes.
- Take classes to learn more about living with diabetes. To find a class, check with your health care team, hospital, or area health clinic. You can also search online. - Join a support group in-person or online to get peer support with managing your diabetes. - Read about diabetes online. Go to National Diabetes Education Program.
Take diabetes seriously.
You may have heard people say they have a touch of diabetes or that their sugar is a little high. These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it.
People with diabetes need to make healthy food choices, stay at a healthy weight, move more every day, and take their medicine even when they feel good. Its a lot to do. Its not easy, but its worth it!
Why take care of your diabetes?
Taking care of yourself and your diabetes can help you feel good today and in the future. When your blood sugar (glucose) is close to normal, you are likely to:
- have more energy - be less tired and thirsty - need to pass urine less often - heal better - have fewer skin or bladder infections
You will also have less chance of having health problems caused by diabetes such as:
- heart attack or stroke - eye problems that can lead to trouble seeing or going blind - pain, tingling, or numbness in your hands and feet, also called nerve damage - kidney problems that can cause your kidneys to stop working - teeth and gum problems
Actions you can take
- Ask your health care team what type of diabetes you have. - Learn where you can go for support. - Learn how caring for your diabetes helps you feel good today and in the future. |
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| What is (are) Solitary Kidney ? | When a person has only one kidney or one working kidney, this kidney is called a solitary kidney. The three main causes of a solitary kidney are
- birth defects. People with kidney agenesis are born with only one kidney. People born with kidney dysplasia have both kidneys; however, one kidney does not function. Many people with kidney agenesis or kidney dysplasia do not discover that they have a solitary kidney until they have an x ray, an ultrasound, or surgery for an unrelated condition. - surgical removal of a kidney. Some people must have a kidney removed to treat cancer or another disease or injury. When a kidney is removed surgically due to disease or for donation, both the kidney and ureter are removed. - kidney donation. A growing number of people are donating a kidney to be transplanted into a family member or friend whose kidneys have failed.
In general, people with a solitary kidney lead full, healthy lives. However, some people are more likely to develop kidney disease. |
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| What is (are) Solitary Kidney ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination. |
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| What to do for Solitary Kidney ? | People with a solitary kidney do not need to eat a special diet. However, people with reduced kidney function may need to make changes to their diet to slow the progression of kidney disease. More information about recommended dietary changes is provided in the NIDDK health topics, Nutrition for Early Chronic Kidney Disease in Adults and Nutrition for Advanced Chronic Kidney Disease in Adults, and on the National Kidney Disease Education Program website. People should talk with their health care provider about what diet is right for them.
Controlling Blood Pressure
People can control their blood pressure by not smoking, eating a healthy diet, and taking certain medications. Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressurelowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or ARB, a diuretica medication that helps the kidneys remove fluid from the bloodmay be prescribed. Beta-blockers, calcium channel blockers, and other blood pressure medications may also be needed.
Preventing Injury
For people with a solitary kidney, loss of the remaining working kidney results in the need for dialysis or kidney transplant. People should make sure their health care providers know they have a solitary kidney to prevent injury from medications or medical procedures. People who participate in certain sports may be more likely to injure the kidney; this risk is of particular concern with children, as they are more likely to play sports. The American Academy of Pediatrics recommends individual assessment for contact, collision, and limited-contact sports. Protective equipment may reduce the chance of injury to the remaining kidney enough to allow participation in most sports, provided that such equipment remains in place during activity. Health care providers, parents, and patients should consider the risks of any activity and decide whether the benefits outweigh those risks. |
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| What to do for Solitary Kidney ? | - When a person has only one kidney or one working kidney, this kidney is called a solitary kidney. The three main causes of a solitary kidney are birth defects, surgical removal of a kidney, and kidney donation. - In general, people with a solitary kidney lead full, healthy lives. However, some people are more likely to develop kidney disease. - People with a solitary kidney should be tested regularly for the following signs of kidney damage: - albuminuria - decreased glomerular filtration rate (GFR) - high blood pressure - People with a solitary kidney can protect their health by eating a nutritious diet, keeping their blood pressure at the appropriate level, and preventing injury to the working kidney. |
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| What is (are) What I need to know about Kidney Stones ? | A kidney* stone is a solid piece of material that forms in a kidney when there are high levels of certain substances in the urine. These substances are normally found in the urine and do not cause problems at lower levels.
A stone may stay in the kidney or travel down the urinary tract. Kidney stones vary in size. A small stone may pass on its own, causing little or no pain. A larger stone may get stuck along the urinary tract. A stone that gets stuck can block the flow of urine, causing severe pain or bleeding.
*See the Pronunciation Guide for tips on how to say the words in bold. |
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| What is (are) What I need to know about Kidney Stones ? | The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every day, the two kidneys process about 200 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra water. The urine flows from the kidneys to the bladder through tubes called ureters.
The bladder stores urine until releasing it through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder. |
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| What causes What I need to know about Kidney Stones ? | Kidney stones are caused by high levels of calcium, oxalate, and phosphorus in the urine. Some foods may cause kidney stones in certain people. You may be more likely to get a kidney stone if you have
- a condition that affects levels of substances in your urine that can cause stones to form - a family history of kidney stones - repeating, or recurrent, urinary tract infections - blockage of your urinary tract - digestive problems
You may also be more likely to get a kidney stone if you dont drink enough fluids or if you take certain medicines. |
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| What is (are) What I need to know about Kidney Stones ? | Doctors have found four main types of kidney stones:
- The most common types of stones contain calcium. Calcium is a normal part of a healthy diet. Calcium that is not used by the bones and muscles goes to the kidneys. In most people, the kidneys flush out the extra calcium with the rest of the urine. People who have calcium stones keep the calcium in their kidneys. The calcium that stays behind joins with other waste products to form a stone. People can have calcium oxalate and calcium phosphate stones. Calcium oxalate stones are more common. - A uric acid stone may form when the urine contains too much acid. People who eat a lot of meat, fish, and shellfish may get uric acid stones. - A struvite stone may form after you have a kidney infection. - Cystine stones result from a genetic disorder, meaning a problem passed from parent to child. The disorder causes cystine to leak through the kidneys and into the urine. |
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| What are the symptoms of What I need to know about Kidney Stones ? | You may have a kidney stone if you
- have pain while urinating - see blood in your urine - feel a sharp pain in your back or lower abdomenthe area between your chest and hips
The pain may last for a short or long time. You may have nausea and vomiting with the pain.
If you have a small stone that passes on its own easily, you may not have symptoms at all. |
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| How to diagnose What I need to know about Kidney Stones ? | To diagnose kidney stones, your doctor will do a physical exam and ask about your medical history. The doctor may ask if you have a family history of kidney stones and about your diet, digestive problems, and other health problems. The doctor may perform urine, blood, and imaging tests to complete the diagnosis.
- Urine tests can show whether you have an infection or your urine contains substances that form stones. - Blood tests can show problems that lead to kidney stones. - Imaging tests are used to find the location of kidney stones in your body. The tests may also be able to show problems that caused a kidney stone to form. |
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| What are the treatments for What I need to know about Kidney Stones ? | The treatment for kidney stones usually depends on their size and what they are made of. Kidney stones may be treated by your regular doctor or by a urologista doctor who specializes in the urinary tract. You may need treatment if you have symptoms or if a kidney stone is blocking your urinary tract. Small stones dont usually need treatment. Still, you may need pain medicine. You should also drink lots of fluids to help move the stone along. If you are vomiting often or dont drink enough fluids, you may need to go to the hospital and get fluids through a needle in your arm.
If you have a large kidney stone or your urinary tract is blocked, the urologist can remove the stone or break it into small pieces with the following treatments: |
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| How to prevent What I need to know about Kidney Stones ? | To prevent kidney stones, you need to know what caused your kidney stone. Your doctor may ask you to try to catch the kidney stone as it passes in your urine. The kidney stone can then be sent to a lab to find out what type of stone it is. If you have treatment in the hospital and the doctor removes the stone, it will also be sent to a lab for testing.
Your doctor may ask you to collect your urine for 24 hours after the stone has passed or been removed. Your doctor can then measure how much urine you produce in a day and mineral levels in the urine. You are more likely to form stones if you dont make enough urine each day or have a problem with mineral levels.
Once you know what type of kidney stone you had, you can make changes in your eating, diet, and nutrition and take medicines to prevent future kidney stones. |
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| What to do for What I need to know about Kidney Stones ? | You can help prevent kidney stones by making changes in how much you consume of the following:
- fluids - sodium - animal protein - calcium - oxalate
Drinking enough fluids each day is the best way to help prevent most types of kidney stones. You should drink 2 to 3 liters of fluid a day. If you had cystine stones, you may need to drink even more.
Though water is best, other fluids may also help prevent kidney stones, such as orange juice or lemonade. Talk with your health care provider if you cant drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.
You can make the following changes to your diet based on the type of kidney stone you had:
Calcium Oxalate Stones
- reduce sodium - reduce animal protein, such as meat, eggs, and fish - get enough calcium from food or take calcium supplements with food - avoid foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran
Calcium Phosphate Stones
- reduce sodium - reduce animal protein - get enough calcium from food or take calcium supplements with food
Uric Acid Stones
- limit animal protein
More information about how changes in diet affect kidney stone formation is provided in the NIDDK health topic, Diet for Kidney Stone Prevention.
Medicines
Your doctor may prescribe medicines based on the type of kidney stone you had and any health problems you have that make you more likely to form a stone. |
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| What to do for What I need to know about Kidney Stones ? | - A kidney stone is a solid piece of material that forms in a kidney when there are high levels of certain substances in the urine. These substances are normally found in the urine and do not cause problems at lower levels. - Kidney stones are caused by high levels of calcium, oxalate, and phosphorus in the urine. - You may have a kidney stone if you - have pain while urinating - see blood in your urine - feel a sharp pain in your back or lower abdomen - If you have a small stone that passes on its own easily, you may not have symptoms at all. - To diagnose kidney stones, your doctor will do a physical exam and ask about your medical history. The doctor may perform urine, blood, and imaging tests to complete the diagnosis. - The treatment for kidney stones usually depends on their size and what they are made of. You may need pain medicine. You should also drink lots of fluids. If you have a large kidney stone or your urinary tract is blocked, the urologist can remove the stone or break it into small pieces with shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. - To prevent kidney stones, you need to know what caused your kidney stone. - Once you know what type of kidney stone you had, you can make changes in your eating, diet, and nutrition and take medicines to prevent future kidney stones. |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What is (are) Hypoglycemia ? | Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.
After a meal, glucose is absorbed into the bloodstream and carried to the body's cells. Insulin, a hormone made by the pancreas, helps the cells use glucose for energy. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use glycogen for energy between meals. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy.
When blood glucose begins to fall, glucagonanother hormone made by the pancreassignals the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a normal level. In some people with diabetes, this glucagon response to hypoglycemia is impaired and other hormones such as epinephrine, also called adrenaline, may raise the blood glucose level. But with diabetes treated with insulin or pills that increase insulin production, glucose levels can't easily return to the normal range.
Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. If left untreated, hypoglycemia can get worse and cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death.
In adults and children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. Hypoglycemia can also result, however, from other medications or diseases, hormone or enzyme deficiencies, or tumors. |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What is (are) Hypoglycemia ? | Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.
After a meal, glucose is absorbed into the bloodstream and carried to the body's cells. Insulin, a hormone made by the pancreas, helps the cells use glucose for energy. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use glycogen for energy between meals. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy.
When blood glucose begins to fall, glucagonanother hormone made by the pancreassignals the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a normal level. In some people with diabetes, this glucagon response to hypoglycemia is impaired and other hormones such as epinephrine, also called adrenaline, may raise the blood glucose level. But with diabetes treated with insulin or pills that increase insulin production, glucose levels can't easily return to the normal range.
Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. If left untreated, hypoglycemia can get worse and cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death.
In adults and children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. Hypoglycemia can also result, however, from other medications or diseases, hormone or enzyme deficiencies, or tumors. |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What are the symptoms of Hypoglycemia ? | Hypoglycemia causes symptoms such as
- hunger - shakiness - nervousness - sweating - dizziness or light-headedness - sleepiness - confusion - difficulty speaking - anxiety - weakness
Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include
- crying out or having nightmares - finding pajamas or sheets damp from perspiration - feeling tired, irritable, or confused after waking up |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What are the symptoms of Hypoglycemia ? | Hypoglycemia causes symptoms such as
- hunger - shakiness - nervousness - sweating - dizziness or light-headedness - sleepiness - confusion - difficulty speaking - anxiety - weakness
Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include
- crying out or having nightmares - finding pajamas or sheets damp from perspiration - feeling tired, irritable, or confused after waking up |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What causes Hypoglycemia ? | Diabetes Medications
Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medicationspillsthat increase insulin production, such as
- chlorpropamide (Diabinese) - glimepiride (Amaryl) - glipizide (Glucotrol, Glucotrol XL) - glyburide (DiaBeta, Glynase, Micronase) - nateglinide (Starlix) - repaglinide (Prandin) - sitagliptin (Januvia) - tolazamide - tolbutamide
Certain combination pills can also cause hypoglycemia, including
- glipizide + metformin (Metaglip) - glyburide + metformin (Glucovance) - pioglitazone + glimepiride (Duetact) - rosiglitazone + glimepiride (Avandaryl) - sitagliptin + metformin (Janumet)
Other types of diabetes pills, when taken alone, do not cause hypoglycemia. Examples of these medications are
- acarbose (Precose) - metformin (Glucophage) - miglitol (Glyset) - pioglitazone (Actos) - rosiglitazone (Avandia)
However, taking these pills along with other diabetes medicationsinsulin, pills that increase insulin production, or bothincreases the risk of hypoglycemia.
In addition, use of the following injectable medications can cause hypoglycemia:
- Pramlintide (Symlin), which is used along with insulin - Exenatide (Byetta), which can cause hypoglycemia when used in combination with chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, and tolbutamide
More information about diabetes medications is provided in the NIDDK health topic, What I need to know about Diabetes Medicines, or by calling 18008608747.
Other Causes of Hypoglycemia
In people on insulin or pills that increase insulin production, low blood glucose can be due to
- meals or snacks that are too small, delayed, or skipped - increased physical activity - alcoholic beverages |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What causes Hypoglycemia ? | Diabetes Medications
Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medicationspillsthat increase insulin production, such as
- chlorpropamide (Diabinese) - glimepiride (Amaryl) - glipizide (Glucotrol, Glucotrol XL) - glyburide (DiaBeta, Glynase, Micronase) - nateglinide (Starlix) - repaglinide (Prandin) - sitagliptin (Januvia) - tolazamide - tolbutamide
Certain combination pills can also cause hypoglycemia, including
- glipizide + metformin (Metaglip) - glyburide + metformin (Glucovance) - pioglitazone + glimepiride (Duetact) - rosiglitazone + glimepiride (Avandaryl) - sitagliptin + metformin (Janumet)
Other types of diabetes pills, when taken alone, do not cause hypoglycemia. Examples of these medications are
- acarbose (Precose) - metformin (Glucophage) - miglitol (Glyset) - pioglitazone (Actos) - rosiglitazone (Avandia)
However, taking these pills along with other diabetes medicationsinsulin, pills that increase insulin production, or bothincreases the risk of hypoglycemia.
In addition, use of the following injectable medications can cause hypoglycemia:
- Pramlintide (Symlin), which is used along with insulin - Exenatide (Byetta), which can cause hypoglycemia when used in combination with chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, and tolbutamide
More information about diabetes medications is provided in the NIDDK health topic, What I need to know about Diabetes Medicines, or by calling 18008608747.
Other Causes of Hypoglycemia
In people on insulin or pills that increase insulin production, low blood glucose can be due to
- meals or snacks that are too small, delayed, or skipped - increased physical activity - alcoholic beverages |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| How to prevent Hypoglycemia ? | Diabetes treatment plans are designed to match the dose and timing of medication to a person's usual schedule of meals and activities. Mismatches could result in hypoglycemia. For example, taking a dose of insulinor other medication that increases insulin levelsbut then skipping a meal could result in hypoglycemia.
To help prevent hypoglycemia, people with diabetes should always consider the following:
- Their diabetes medications. A health care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take medications. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine. - Their meal plan. A registered dietitian can help design a meal plan that fits one's personal preferences and lifestyle. Following one's meal plan is important for managing diabetes. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks. - Their daily activity. To help prevent hypoglycemia caused by physical activity, health care providers may advise - checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL) - adjusting medication before physical activity - checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed - checking blood glucose periodically after physical activity - Their use of alcoholic beverages. Drinking alcoholic beverages, especially on an empty stomach, can cause hypoglycemia, even a day or two later. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Alcoholic beverages should always be consumed with a snack or meal at the same time. A health care provider can suggest how to safely include alcohol in a meal plan. - Their diabetes management plan. Intensive diabetes managementkeeping blood glucose as close to the normal range as possible to prevent long-term complicationscan increase the risk of hypoglycemia. Those whose goal is tight control should talk with a health care provider about ways to prevent hypoglycemia and how best to treat it if it occurs.
What to Ask the Doctor about Diabetes Medications
People who take diabetes medications should ask their doctor or health care provider
- whether their diabetes medications could cause hypoglycemia - when they should take their diabetes medications - how much medication they should take - whether they should keep taking their diabetes medications when they are sick - whether they should adjust their medications before physical activity - whether they should adjust their medications if they skip a meal |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What are the treatments for Hypoglycemia ? | Signs and symptoms of hypoglycemia vary from person to person. People with diabetes should get to know their signs and symptoms and describe them to their friends and family so they can help if needed. School staff should be told how to recognize a child's signs and symptoms of hypoglycemia and how to treat it.
People who experience hypoglycemia several times in a week should call their health care provider. They may need a change in their treatment plan: less medication or a different medication, a new schedule for insulin or medication, a different meal plan, or a new physical activity plan.
Prompt Treatment for Hypoglycemia
When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose:
- 3 or 4 glucose tablets - 1 serving of glucose gelthe amount equal to 15 grams of carbohydrate - 1/2 cup, or 4 ounces, of any fruit juice - 1/2 cup, or 4 ounces, of a regularnot dietsoft drink - 1 cup, or 8 ounces, of milk - 5 or 6 pieces of hard candy - 1 tablespoon of sugar or honey
Recommended amounts may be less for small children. The child's doctor can advise about the right amount to give a child.
The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it's still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above.
For People Who Take Acarbose (Precose) or Miglitol (Glyset)
People who take either of these diabetes medications should know that only pure glucose, also called dextroseavailable in tablet or gel formwill raise their blood glucose level during a low blood glucose episode. Other quick-fix foods and drinks won't raise the level quickly enough because acarbose and miglitol slow the digestion of other forms of carbohydrate.
Help from Others for Severe Hypoglycemia
Severe hypoglycemiavery low blood glucosecan cause a person to pass out and can even be life threatening. Severe hypoglycemia is more likely to occur in people with type 1 diabetes. People should ask a health care provider what to do about severe hypoglycemia. Another person can help someone who has passed out by giving an injection of glucagon. Glucagon will rapidly bring the blood glucose level back to normal and help the person regain consciousness. A health care provider can prescribe a glucagon emergency kit. Family, friends, or coworkersthe people who will be around the person at risk of hypoglycemiacan learn how to give a glucagon injection and when to call 911 or get medical help.
Physical Activity and Blood Glucose Levels
Physical activity has many benefits for people with diabetes, including lowering blood glucose levels. However, physical activity can make levels too low and can cause hypoglycemia up to 24 hours afterward. A health care provider can advise about checking the blood glucose level before exercise. For those who take insulin or one of the oral medications that increase insulin production, the health care provider may suggest having a snack if the glucose level is below 100 mg/dL or adjusting medication doses before physical activity to help avoid hypoglycemia. A snack can prevent hypoglycemia. The health care provider may suggest extra blood glucose checks, especially after strenuous exercise.
Hypoglycemia When Driving
Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. To prevent problems, people at risk for hypoglycemia should check their blood glucose level before driving. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again.
Hypoglycemia Unawareness
Some people with diabetes do not have early warning signs of low blood glucose, a condition called hypoglycemia unawareness. This condition occurs most often in people with type 1 diabetes, but it can also occur in people with type 2 diabetes. People with hypoglycemia unawareness may need to check their blood glucose level more often so they know when hypoglycemia is about to occur. They also may need a change in their medications, meal plan, or physical activity routine.
Hypoglycemia unawareness develops when frequent episodes of hypoglycemia lead to changes in how the body reacts to low blood glucose levels. The body stops releasing the hormone epinephrine and other stress hormones when blood glucose drops too low. The loss of the body's ability to release stress hormones after repeated episodes of hypoglycemia is called hypoglycemia-associated autonomic failure, or HAAF.
Epinephrine causes early warning symptoms of hypoglycemia such as shakiness, sweating, anxiety, and hunger. Without the release of epinephrine and the symptoms it causes, a person may not realize that hypoglycemia is occurring and may not take action to treat it. A vicious cycle can occur in which frequent hypoglycemia leads to hypoglycemia unawareness and HAAF, which in turn leads to even more severe and dangerous hypoglycemia. Studies have shown that preventing hypoglycemia for a period as short as several weeks can sometimes break this cycle and restore awareness of symptoms. Health care providers may therefore advise people who have had severe hypoglycemia to aim for higher-than-usual blood glucose targets for short-term periods.
Being Prepared for Hypoglycemia
People who use insulin or take an oral diabetes medication that can cause low blood glucose should always be prepared to prevent and treat low blood glucose by
- learning what can trigger low blood glucose levels - having their blood glucose meter available to test glucose levels; frequent testing may be critical for those with hypoglycemia unawareness, particularly before driving a car or engaging in any hazardous activity - always having several servings of quick-fix foods or drinks handy - wearing a medical identification bracelet or necklace - planning what to do if they develop severe hypoglycemia - telling their family, friends, and coworkers about the symptoms of hypoglycemia and how they can help if needed
Normal and Target Blood Glucose Ranges Normal Blood Glucose Levels in People Who Do Not Have Diabetes Upon wakingfasting 70 to 99 mg/dL After meals 70 to 140 mg/dL Target Blood Glucose Levels in People Who Have Diabetes Before meals 70 to 130 mg/dL 1 to 2 hours after the start of a meal below 180 mg/dL
For people with diabetes, a blood glucose level below 70 mg/dL is considered hypoglycemia. |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What are the treatments for Hypoglycemia ? | Signs and symptoms of hypoglycemia vary from person to person. People with diabetes should get to know their signs and symptoms and describe them to their friends and family so they can help if needed. School staff should be told how to recognize a child's signs and symptoms of hypoglycemia and how to treat it.
People who experience hypoglycemia several times in a week should call their health care provider. They may need a change in their treatment plan: less medication or a different medication, a new schedule for insulin or medication, a different meal plan, or a new physical activity plan.
Prompt Treatment for Hypoglycemia
When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose:
- 3 or 4 glucose tablets - 1 serving of glucose gelthe amount equal to 15 grams of carbohydrate - 1/2 cup, or 4 ounces, of any fruit juice - 1/2 cup, or 4 ounces, of a regularnot dietsoft drink - 1 cup, or 8 ounces, of milk - 5 or 6 pieces of hard candy - 1 tablespoon of sugar or honey
Recommended amounts may be less for small children. The child's doctor can advise about the right amount to give a child.
The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it's still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above.
For People Who Take Acarbose (Precose) or Miglitol (Glyset)
People who take either of these diabetes medications should know that only pure glucose, also called dextroseavailable in tablet or gel formwill raise their blood glucose level during a low blood glucose episode. Other quick-fix foods and drinks won't raise the level quickly enough because acarbose and miglitol slow the digestion of other forms of carbohydrate.
Help from Others for Severe Hypoglycemia
Severe hypoglycemiavery low blood glucosecan cause a person to pass out and can even be life threatening. Severe hypoglycemia is more likely to occur in people with type 1 diabetes. People should ask a health care provider what to do about severe hypoglycemia. Another person can help someone who has passed out by giving an injection of glucagon. Glucagon will rapidly bring the blood glucose level back to normal and help the person regain consciousness. A health care provider can prescribe a glucagon emergency kit. Family, friends, or coworkersthe people who will be around the person at risk of hypoglycemiacan learn how to give a glucagon injection and when to call 911 or get medical help.
Physical Activity and Blood Glucose Levels
Physical activity has many benefits for people with diabetes, including lowering blood glucose levels. However, physical activity can make levels too low and can cause hypoglycemia up to 24 hours afterward. A health care provider can advise about checking the blood glucose level before exercise. For those who take insulin or one of the oral medications that increase insulin production, the health care provider may suggest having a snack if the glucose level is below 100 mg/dL or adjusting medication doses before physical activity to help avoid hypoglycemia. A snack can prevent hypoglycemia. The health care provider may suggest extra blood glucose checks, especially after strenuous exercise.
Hypoglycemia When Driving
Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. To prevent problems, people at risk for hypoglycemia should check their blood glucose level before driving. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again.
Hypoglycemia Unawareness
Some people with diabetes do not have early warning signs of low blood glucose, a condition called hypoglycemia unawareness. This condition occurs most often in people with type 1 diabetes, but it can also occur in people with type 2 diabetes. People with hypoglycemia unawareness may need to check their blood glucose level more often so they know when hypoglycemia is about to occur. They also may need a change in their medications, meal plan, or physical activity routine.
Hypoglycemia unawareness develops when frequent episodes of hypoglycemia lead to changes in how the body reacts to low blood glucose levels. The body stops releasing the hormone epinephrine and other stress hormones when blood glucose drops too low. The loss of the body's ability to release stress hormones after repeated episodes of hypoglycemia is called hypoglycemia-associated autonomic failure, or HAAF.
Epinephrine causes early warning symptoms of hypoglycemia such as shakiness, sweating, anxiety, and hunger. Without the release of epinephrine and the symptoms it causes, a person may not realize that hypoglycemia is occurring and may not take action to treat it. A vicious cycle can occur in which frequent hypoglycemia leads to hypoglycemia unawareness and HAAF, which in turn leads to even more severe and dangerous hypoglycemia. Studies have shown that preventing hypoglycemia for a period as short as several weeks can sometimes break this cycle and restore awareness of symptoms. Health care providers may therefore advise people who have had severe hypoglycemia to aim for higher-than-usual blood glucose targets for short-term periods.
Being Prepared for Hypoglycemia
People who use insulin or take an oral diabetes medication that can cause low blood glucose should always be prepared to prevent and treat low blood glucose by
- learning what can trigger low blood glucose levels - having their blood glucose meter available to test glucose levels; frequent testing may be critical for those with hypoglycemia unawareness, particularly before driving a car or engaging in any hazardous activity - always having several servings of quick-fix foods or drinks handy - wearing a medical identification bracelet or necklace - planning what to do if they develop severe hypoglycemia - telling their family, friends, and coworkers about the symptoms of hypoglycemia and how they can help if needed
Normal and Target Blood Glucose Ranges Normal Blood Glucose Levels in People Who Do Not Have Diabetes Upon wakingfasting 70 to 99 mg/dL After meals 70 to 140 mg/dL Target Blood Glucose Levels in People Who Have Diabetes Before meals 70 to 130 mg/dL 1 to 2 hours after the start of a meal below 180 mg/dL
For people with diabetes, a blood glucose level below 70 mg/dL is considered hypoglycemia. |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What to do for Hypoglycemia ? | Two types of hypoglycemia can occur in people who do not have diabetes:
- Reactive hypoglycemia, also called postprandial hypoglycemia, occurs within 4 hours after meals. - Fasting hypoglycemia, also called postabsorptive hypoglycemia, is often related to an underlying disease.
Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia. Symptoms may include hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness.
To find the cause of a patient's hypoglycemia, the doctor will use laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body's use of energy.
Reactive Hypoglycemia
Diagnosis
To diagnose reactive hypoglycemia, the doctor may
- ask about signs and symptoms - test blood glucose while the patient is having symptoms by taking a blood sample from the arm and sending it to a laboratory for analysis* - check to see whether the symptoms ease after the patient's blood glucose returns to 70 mg/dL or above after eating or drinking
A blood glucose level below 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis. The oral glucose tolerance test is no longer used to diagnose reactive hypoglycemia because experts now know the test can actually trigger hypoglycemic symptoms.
Causes and Treatment
The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body's normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia.
A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastricor stomachsurgery can cause reactive hypoglycemia because of the rapid passage of food into the small intestine. Rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, also may cause reactive hypoglycemia.
To relieve reactive hypoglycemia, some health professionals recommend
- eating small meals and snacks about every 3 hours - being physically active - eating a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products - eating foods high in fiber - avoiding or limiting foods high in sugar, especially on an empty stomach
The doctor can refer patients to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet to treat reactive hypoglycemia.
Fasting Hypoglycemia
Diagnosis
Fasting hypoglycemia is diagnosed from a blood sample that shows a blood glucose level below 50 mg/dL after an overnight fast, between meals, or after physical activity.
Causes and Treatment
Causes of fasting hypoglycemia include certain medications, alcoholic beverages, critical illnesses, hormonal deficiencies, some kinds of tumors, and certain conditions occurring in infancy and childhood.
Medications. Medications, including some used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include
- salicylates, including aspirin, when taken in large doses - sulfa medications, which are used to treat bacterial infections - pentamidine, which treats a serious kind of pneumonia - quinine, which is used to treat malaria
If using any of these medications causes a person's blood glucose level to fall, the doctor may advise stopping the medication or changing the dose.
Alcoholic beverages. Drinking alcoholic beverages, especially binge drinking, can cause hypoglycemia. The body's breakdown of alcohol interferes with the liver's efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be serious and even fatal.
Critical illnesses. Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. Sepsis, which is an overwhelming infection, and starvation are other causes of hypoglycemia. In these cases, treating the illness or other underlying cause will correct the hypoglycemia.
Hormonal deficiencies. Hormonal deficiencies may cause hypoglycemia in very young children, but rarely in adults. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and treatment. Hormone replacement therapy may be advised.
Tumors. Insulinomas are insulin-producing tumors in the pancreas. Insulinomas can cause hypoglycemia by raising insulin levels too high in relation to the blood glucose level. These tumors are rare and do not normally spread to other parts of the body. Laboratory tests can pinpoint the exact cause. Treatment involves both short-term steps to correct the hypoglycemia and medical or surgical measures to remove the tumor.
Conditions occurring in infancy and childhood. Children rarely develop hypoglycemia. If they do, causes may include the following:
- Brief intolerance to fasting, often during an illness that disturbs regular eating patterns. Children usually outgrow this tendency by age 10. - Hyperinsulinism, which is the overproduction of insulin. This condition can result in temporary hypoglycemia in newborns, which is common in infants of mothers with diabetes. Persistent hyperinsulinism in infants or children is a complex disorder that requires prompt evaluation and treatment by a specialist. - Enzyme deficiencies that affect carbohydrate metabolism. These deficiencies can interfere with the body's ability to process natural sugars, such as fructose and galactose, glycogen, or other metabolites. - Hormonal deficiencies such as lack of pituitary or adrenal hormones.
*A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia. |
On this page: Low blood glucose, also called low blood sugar or hypoglycemia, occurs when the level of glucose in your blood drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 milligrams per deciliter (mg/dL).1 Your number might be different, so check with your doctor or health care team to find out what blood glucose level is low for you. Low blood glucose is common among people with type 1 diabetes and among people with type 2 diabetes who take insulin or some other diabetes medicines. In a large global study of people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over a 4-week period.2 Severely low blood glucose, defined as when your blood glucose level drops so low you can’t treat it yourself, is less common. Among U.S. adults with diabetes who take insulin or some diabetes medicines that help the pancreas release insulin into the blood, 2 in 100 may develop severely low blood glucose each year.3 You are more likely to develop low blood glucose if you4 Symptoms of low blood glucose tend to come on quickly and can vary from person to person. As Table 1 below shows, symptoms can range from mild to severe. Table 1. Symptoms of low blood glucose6 If your blood glucose level is low, you may feel If your blood glucose level is very low, your brain may stop working as it should. You may Severe hypoglycemia is dangerous and needs to be treated right away. Your blood glucose level can drop while you sleep and stay low for several hours, causing serious problems.7 Symptoms of low blood glucose while you sleep can include Although you may not wake up or notice any symptoms, low blood glucose can interfere with your sleep, which may affect your quality of life, mood, and ability to work. Having low blood glucose during sleep can also make you less likely to notice and respond to symptoms of low blood glucose during the day. Mild-to-moderate low blood glucose can be easily treated. But severely low blood glucose can cause serious complications, including passing out, coma, or death. Repeated episodes of low blood glucose can lead to Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level. Two types of diabetes pills can cause low blood glucose The following may also lower your blood glucose level If you take insulin or other medicines that lower blood glucose, the following actions may help you prevent low blood glucose levels. If you begin to feel one or more symptoms of low blood glucose, check your blood glucose level. If your blood glucose level is below your target or less than 70 mg/dL, follow these steps Some diabetes medicines slow down the digestion of carbohydrates to keep blood glucose levels from rising too high after you eat. If you develop low blood glucose while taking these medicines, you will need to take glucose tablets or glucose gel right away. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Glucagon—a hormone that raises blood glucose levels—is the best way to treat severely low blood glucose. Available as an injection or a nasal spray, glucagon will quickly raise your blood glucose level. Your doctor can prescribe you a glucagon kit for use in case of an emergency. If your blood glucose level drops very low, you won’t be able to treat it by yourself. Be prepared to address severely low blood glucose by The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future. Researchers are studying many aspects of low blood glucose levels in diabetes, such as Find out if clinical studies are right for you. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can view a filtered list of clinical studies on low blood glucose that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study. [1] American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73–S84. doi: 10.2337/dc21-S006 [2] Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27,585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes, Obesity, & Metabolism. 2016;18(9):907–915. doi: 10.1111/dom.12689 [3] Karter AJ, Lipska KJ, O'Connor PJ, et al. High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) network. Journal of Diabetes and Its Complications. 2017;31(5):869–873. doi: 10.1016/j.jdiacomp.2017.02.009 [4] Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Current Diabetes Reports. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0 [5] American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S168–S179. doi: 10.2337/dc21-S012 [6] Masharani U. Diabetes mellitus & hypoglycemia. In: Papadakis MA, McPhee SJ, eds. Current Medical Diagnosis & Treatment. McGraw Hill; 2018:1222–1268. [7] Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Research and Clinical Practice. 2017;133:30–39. doi: 10.1016/j.diabres.2017.08.012 [8] Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Canadian Journal of Diabetes. 2018;42(suppl 1):S104–S108. doi: 10.1016/j.jcjd.2017.10.010
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
The NIDDK would like to thank:Martha Funnell, M.S., R.N., C.D.E., University of Michigan Medical School
| What to do for Hypoglycemia ? | Diabetes-related Hypoglycemia
- When people with diabetes think their blood glucose level is low, they should check it and treat the problem right away. - To treat hypoglycemia, people should have a serving of a quick-fix food, wait 15 minutes, and check their blood glucose again. They should repeat the treatment until their blood glucose is 70 mg/dL or above. - People at risk for hypoglycemia should keep quick-fix foods in the car, at workanywhere they spend time. - People at risk for hypoglycemia should be careful when driving. They should check their blood glucose frequently and snack as needed to keep their level 70 mg/dL or above.
Hypoglycemia Unrelated to Diabetes
- In reactive hypoglycemia, symptoms occur within 4 hours of eating. People with reactive hypoglycemia are usually advised to follow a healthy eating plan recommended by a registered dietitian. - Fasting hypoglycemia can be caused by certain medications, critical illnesses, hereditary enzyme or hormonal deficiencies, and some kinds of tumors. Treatment targets the underlying problem. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What is (are) Kidney Stones in Adults ? | A kidney stone is a solid piece of material that forms in a kidney when substances that are normally found in the urine become highly concentrated. A stone may stay in the kidney or travel down the urinary tract. Kidney stones vary in size. A small stone may pass on its own, causing little or no pain. A larger stone may get stuck along the urinary tract and can block the flow of urine, causing severe pain or bleeding.
Kidney stones are one of the most common disorders of the urinary tract. Each year in the United States, people make more than a million visits to health care providers and more than 300,000 people go to emergency rooms for kidney stone problems.1
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Terms that describe the location of the stone in the urinary tract are sometimes used. For example, a ureteral stoneor ureterolithiasisis a kidney stone found in the ureter. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What is (are) Kidney Stones in Adults ? | The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every day, the two kidneys process about 200 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra water. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| Who is at risk for Kidney Stones in Adults? ? | Anyone can get a kidney stone, but some people are more likely to get one. Men are affected more often than women, and kidney stones are more common in non-Hispanic white people than in non-Hispanic black people and Mexican Americans. Overweight and obese people are more likely to get a kidney stone than people of normal weight. In the United States, 8.8 percent of the population, or one in 11 people, have had a kidney stone.2 |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What causes Kidney Stones in Adults ? | Kidney stones can form when substances in the urinesuch as calcium, oxalate, and phosphorusbecome highly concentrated. Certain foods may promote stone formation in people who are susceptible, but scientists do not believe that eating any specific food causes stones to form in people who are not susceptible. People who do not drink enough fluids may also be at higher risk, as their urine is more concentrated.
People who are at increased risk of kidney stones are those with
- hypercalciuria, a condition that runs in families in which urine contains unusually large amounts of calcium; this is the most common condition found in those who form calcium stones - a family history of kidney stones - cystic kidney diseases, which are disorders that cause fluid-filled sacs to form on the kidneys - hyperparathyroidism, a condition in which the parathyroid glands, which are four pea-sized glands located in the neck, release too much hormone, causing extra calcium in the blood - renal tubular acidosis, a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a persons blood to remain too acidic - cystinuria, a condition in which urine contains high levels of the amino acid cystine - hyperoxaluria, a condition in which urine contains unusually large amounts of oxalate - hyperuricosuria, a disorder of uric acid metabolism - gout, a disorder that causes painful swelling of the joints - blockage of the urinary tract - chronic inflammation of the bowel - a history of gastrointestinal (GI) tract surgery
Others at increased risk of kidney stones are people taking certain medications including
- diureticsmedications that help the kidneys remove fluid from the body - calcium-based antacids - the protease inhibitor indinavir (Crixivan), a medication used to treat HIV infection - the anti-seizure medication topiramate (Topamax) |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What is (are) Kidney Stones in Adults ? | Four major types of kidney stones can form:
- Calcium stones are the most common type of kidney stone and occur in two major forms: calcium oxalate and calcium phosphate. Calcium oxalate stones are more common. Calcium oxalate stone formation may be caused by high calcium and high oxalate excretion. Calcium phosphate stones are caused by the combination of high urine calcium and alkaline urine, meaning the urine has a high pH. - Uric acid stones form when the urine is persistently acidic. A diet rich in purinessubstances found in animal protein such as meats, fish, and shellfishmay increase uric acid in urine. If uric acid becomes concentrated in the urine, it can settle and form a stone by itself or along with calcium. - Struvite stones result from kidney infections. Eliminating infected stones from the urinary tract and staying infection-free can prevent more struvite stones. - Cystine stones result from a genetic disorder that causes cystine to leak through the kidneys and into the urine, forming crystals that tend to accumulate into stones. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What are the symptoms of Kidney Stones in Adults ? | People with kidney stones may have pain while urinating, see blood in the urine, or feel a sharp pain in the back or lower abdomen. The pain may last for a short or long time. People may experience nausea and vomiting with the pain. However, people who have small stones that pass easily through the urinary tract may not have symptoms at all. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| How to diagnose Kidney Stones in Adults ? | To diagnose kidney stones, the health care provider will perform a physical exam and take a medical history. The medical history may include questions about family history of kidney stones, diet, GI problems, and other diseases and disorders. The health care provider may perform urine, blood, and imaging tests, such as an x ray or computerized tomography (CT) scan to complete the diagnosis.
- Urinalysis. Urinalysis is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. Urinalysis can show whether the person has an infection or the urine contains substances that form stones. - Blood test. A blood test involves drawing blood at a health care providers office or commercial facility and sending the sample to a lab for analysis. The blood test can show biochemical problems that can lead to kidney stones. - Abdominal x ray. An abdominal x ray is a picture created using radiation and recorded on film or on a computer. The amount of radiation used is small. An x ray is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging. Anesthesia is not needed. The person will lie on a table or stand during the x ray. The x-ray machine is positioned over the abdominal area. The person will hold his or her breath as the picture is taken so that the picture will not be blurry. The person may be asked to change position for additional pictures. The x rays can show the location of stones in the kidney or urinary tract. - CT scans. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. CT scans can show stone locations and conditions that may have caused the stone to form. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What are the treatments for Kidney Stones in Adults ? | Treatment for kidney stones usually depends on their size and what they are made of, as well as whether they are causing pain or obstructing the urinary tract. Kidney stones may be treated by a general practitioner or by a urologista doctor who specializes in the urinary tract. Small stones usually pass through the urinary tract without treatment. Still, the person may need pain medication and should drink lots of fluids to help move the stone along. Pain control may consist of oral or intravenous (IV) medication, depending on the duration and severity of the pain. IV fluids may be needed if the person becomes dehydrated from vomiting or an inability to drink. A person with a larger stone, or one that blocks urine flow and causes great pain, may need more urgent treatment, such as
- Shock wave lithotripsy. A machine called a lithotripter is used to crush the kidney stone. The procedure is performed by a urologist on an outpatient basis and anesthesia is used. In shock wave lithotripsy, the person lies on a table or, less commonly, in a tub of water above the lithotripter. The lithotripter generates shock waves that pass through the persons body to break the kidney stone into smaller pieces to pass more readily through the urinary tract. - Ureteroscopy. A ureteroscopea long, tubelike instrument with an eyepieceis used to find and retrieve the stone with a small basket or to break the stone up with laser energy. The procedure is performed by a urologist in a hospital with anesthesia. The urologist inserts the ureteroscope into the persons urethra and slides the scope through the bladder and into the ureter. The urologist removes the stone or, if the stone is large, uses a flexible fiber attached to a laser generator to break the stone into smaller pieces that can pass out of the body in the urine. The person usually goes home the same day.
- Percutaneous nephrolithotomy. In this procedure, a wire-thin viewing instrument called a nephroscope is used to locate and remove the stone. The procedure is performed by a urologist in a hospital with anesthesia. During the procedure, a tube is inserted directly into the kidney through a small incision in the persons back. For large stones, an ultrasonic probe that acts as a lithotripter may be needed to deliver shock waves that break the stone into small pieces that can be removed more easily. The person may have to stay in the hospital for several days after the procedure and may have a small tube called a nephrostomy tube inserted through the skin into the kidney. The nephrostomy tube drains urine and any residual stone fragments from the kidney into a urine collection bag. The tube is usually left in the kidney for 2 or 3 days while the person remains in the hospital. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| How to prevent Kidney Stones in Adults ? | The first step in preventing kidney stones is to understand what is causing the stones to form. The health care provider may ask the person to try to catch the kidney stone as it passes, so it can be sent to a lab for analysis. Stones that are retrieved surgically can also be sent to a lab for analysis.
The health care provider may ask the person to collect urine for 24 hours after a stone has passed or been removed to measure daily urine volume and mineral levels. Producing too little urine or having a mineral abnormality can make a person more likely to form stones. Kidney stones may be prevented through changes in eating, diet, and nutrition and medications.
Eating, Diet, and Nutrition
People can help prevent kidney stones by making changes in their fluid intake. Depending on the type of kidney stone a person has, changes in the amounts of sodium, animal protein, calcium, and oxalate consumed can also help.
Drinking enough fluids each day is the best way to help prevent most types of kidney stones. Health care providers recommend that a person drink 2 to 3 liters of fluid a day. People with cystine stones may need to drink even more. Though water is best, other fluids may also help prevent kidney stones, such as orange juice or lemonade. Talk with your health care provider if you cant drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.
Recommendations based on the specific type of kidney stone include the following:
Calcium Oxalate Stones
- reducing sodium - reducing animal protein, such as meat, eggs, and fish - getting enough calcium from food or taking calcium supplements with food - avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran
Calcium Phosphate Stones
- reducing sodium - reducing animal protein - getting enough calcium from food or taking calcium supplements with food
Uric Acid Stones
- limiting animal protein
More information about how changes in diet affect kidney stone formation is provided in the NIDDK health topic, Diet for Kidney Stone Prevention.
Medications
The health care provider may prescribe certain medications to help prevent kidney stones based on the type of stone formed or conditions that make a person more prone to form stones:
- hyperuricosuriaallopurinol (Zyloprim), which decreases uric acid in the blood and urine - hypercalciuriadiuretics, such as hydrochlorothiazide - hyperoxaluriapotassium citrate to raise the citrate and pH of urine - uric acid stonesallopurinol and potassium citrate - cystine stonesmercaptopropionyl glycine, which decreases cystine in the urine, and potassium citrate - struvite stonesantibiotics, which are bacteria-fighting medications, when needed to treat infections, or acetohydroxamic acid with long-term antibiotic medications to prevent infection
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands. In most cases, only one of the glands is enlarged. Removing the glands cures hyperparathyroidism and prevents kidney stones. |
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional. You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all. Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form. Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines. If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. This content is also available in:
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
| What to do for Kidney Stones in Adults ? | - A kidney stone is a solid piece of material that forms in a kidney when substances that are normally found in the urine become highly concentrated. - Kidney stones are one of the most common disorders of the urinary tract. - Certain foods may promote stone formation in people who are susceptible, but scientists do not believe that eating any specific food causes stones to form in people who are not susceptible. - People with kidney stones may have pain while urinating, see blood in the urine, or feel a sharp pain in the back or lower abdomen. However, people who have small stones that pass easily through the urinary tract may not have symptoms at all. - To diagnose kidney stones, the health care provider will perform a physical exam and take a medical history. The health care provider may perform urine, blood, and imaging tests to complete the diagnosis. - Treatment for kidney stones usually depends on their size and what they are made of, as well as whether they are causing pain or obstructing the urinary tract. Treatments may include shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. - Kidney stones may be prevented through changes in eating, diet, and nutrition and medications. |
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| What is (are) Pyelonephritis: Kidney Infection ? | Pyelonephritis is a type of urinary tract infection (UTI) that affects one or both kidneys. |
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| What is (are) Pyelonephritis: Kidney Infection ? | The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every day, the two kidneys process about 200 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra water. Children produce less urine than adults. The amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called the ureters. The bladder stores urine until releasing it through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder. |
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| What causes Pyelonephritis: Kidney Infection ? | Pyelonephritis is caused by a bacterium or virus infecting the kidneys. Though many bacteria and viruses can cause pyelonephritis, the bacterium Escherichia coli is often the cause. Bacteria and viruses can move to the kidneys from the bladder or can be carried through the bloodstream from other parts of the body. A UTI in the bladder that does not move to the kidneys is called cystitis. |
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| Who is at risk for Pyelonephritis: Kidney Infection? ? | People most at risk for pyelonephritis are those who have a bladder infection and those with a structural, or anatomic, problem in the urinary tract. Urine normally flows only in one directionfrom the kidneys to the bladder. However, the flow of urine may be blocked in people with a structural defect of the urinary tract, a kidney stone, or an enlarged prostatethe walnut-shaped gland in men that surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen. Urine can also back up, or reflux, into one or both kidneys. This problem, which is called vesicoureteral reflux (VUR), happens when the valve mechanism that normally prevents backward flow of urine is not working properly. VUR is most commonly diagnosed during childhood. Pregnant women and people with diabetes or a weakened immune system are also at increased risk of pyelonephritis. |
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| What are the symptoms of Pyelonephritis: Kidney Infection ? | Symptoms of pyelonephritis can vary depending on a persons age and may include the following:
- fever - vomiting - back, side, and groin pain - chills - nausea - frequent, painful urination
Children younger than 2 years old may only have a high fever without symptoms related to the urinary tract. Older people may not have any symptoms related to the urinary tract either; instead, they may exhibit confusion, disordered speech, or hallucinations. |
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| What are the complications of Pyelonephritis: Kidney Infection ? | Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics.
In rare cases, pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. These problems usually occur in people with a structural problem in the urinary tract, kidney disease from other causes, or repeated episodes of pyelonephritis.
Infection in the kidneys may spread to the bloodstreama serious condition called sepsisthough this is also uncommon. |
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| How to diagnose Pyelonephritis: Kidney Infection ? | The tests used to diagnose pyelonephritis depend on the patients age, gender, and response to treatment and include the following:
- Urinalysis. Urinalysis is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. The presence of white blood cells and bacteria in the urine indicate infection. - Urine culture. A urine culture is performed by placing part of a urine sample in a tube or dish with a substance that encourages any bacteria present to grow. The urine sample is collected in a special container in a health care providers office or commercial facility and sent to a lab for culture. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified. The health care provider can then determine the best treatment. - Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging; anesthesia is not needed. The images can show obstructions in the urinary tract. Ultrasound is often used for people who do not respond to treatment within 72 hours. - Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. CT scans can show obstructions in the urinary tract. The test is often used for people who do not respond to treatment within 72 hours. - Voiding cystourethrogram (VCUG). A VCUG is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The procedure is performed in an outpatient center or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some people. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the person urinates. This test can show abnormalities of the inside of the urethra and bladder and is usually used to detect VUR in children. - Digital rectal examination (DRE). A DRE is a physical exam of the prostate that is performed in the health care providers office. Anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies in front of the rectum. Men with suspected pyelonephritis may have a DRE to determine whether a swollen prostate may be obstructing the neck of the bladder. - Dimercaptosuccinic acid (DMSA) scintigraphy. DMSA scintigraphy is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive material. Because the dose of radioactive material is small, the risk of causing damage to cells is low. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Radioactive material is injected into a vein in the persons arm and travels through the body to the kidneys. Special cameras and computers are used to create images of the radioactive material as it passes through the kidneys. The radioactive material makes the parts of the kidney that are infected or scarred stand out on the image. DMSA scintigraphy is used to show the severity of kidney infection or kidney damage, such as scarring. |
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| What are the treatments for Pyelonephritis: Kidney Infection ? | Pyelonephritis is treated with antibiotics, which may need to be taken for several weeks. While a urine sample is sent to a lab for culture, the health care provider may begin treatment with an antibiotic that fights the most common types of bacteria. Once culture results are known and the bacteria is clearly identified, the health care provider may switch the antibiotic to one that more effectively targets the bacteria. Antibiotics may be given through a vein, orally, or both. Urinary tract obstructions are often treated with surgery.
Severely ill patients may be hospitalized and limited to bed rest until they can take the fluids and medications they need on their own. Fluids and medications may be given intravenously during this time.
In adults, repeat urine cultures should be performed after treatment has ended to make sure the infection does not recur. If a repeat test shows infection, another 14-day course of antibiotics is prescribed; if infection recurs again, antibiotics are prescribed for 6 weeks. |
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| What to do for Pyelonephritis: Kidney Infection ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing pyelonephritis. |
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| What to do for Pyelonephritis: Kidney Infection ? | - Pyelonephritis is a type of urinary tract infection that affects one or both kidneys. - Pyelonephritis is caused by a bacterium or virus infecting the kidneys. Though many bacteria and viruses can cause pyelonephritis, the bacterium Escherichia coli is often the cause. Bacteria and viruses can move to the kidneys from the bladder or can be carried through the bloodstream from other parts of the body. - Symptoms of pyelonephritis can vary depending on a persons age and may include the following: - fever - vomiting - back, side, and groin pain - chills - nausea - frequent, painful urination - Children younger than 2 years old may only have a high fever without symptoms related to the urinary tract. Older people may not have any symptoms related to the urinary tract either; instead, they may exhibit confusion, disordered speech, or hallucinations. - Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics. |
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| What is (are) Viral Hepatitis: A through E and Beyond ? | Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.
All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.
Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus. |
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| What are the symptoms of Viral Hepatitis: A through E and Beyond ? | Symptoms include
- jaundice, which causes a yellowing of the skin and eyes - fatigue - abdominal pain - loss of appetite - nausea - vomiting - diarrhea - low grade fever - headache
However, some people do not have symptoms. |
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| What to do for Viral Hepatitis: A through E and Beyond ? | - Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses. - Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth. - Vaccines offer protection from hepatitis A and hepatitis B. - No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection. - Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis. |
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| What causes Viral Hepatitis: A through E and Beyond ? | Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus. These cases are called non-AE hepatitis. Scientists continue to study the causes of non-AE hepatitis. |
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| What is (are) What I need to know about Gestational Diabetes ? | Gestational* diabetes is a type of diabetes that develops only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Your body uses glucose for energy. Too much glucose in your blood is not good for you or your baby.
Gestational diabetes is usually diagnosed during late pregnancy. If you are diagnosed with diabetes earlier in your pregnancy, you may have had diabetes before you became pregnant.
Treating gestational diabetes can help both you and your baby stay healthy. You can protect your baby and yourself by taking action right away to control your blood glucose levels.
If you have gestational diabetes, a health care team will likely be part of your care. In addition to your obstetrician-gynecologist, or OB/GYNthe doctor who will deliver your babyyour team might include a doctor who treats diabetes, a diabetes educator, and a dietitian to help you plan meals.
For Women with Type 1 or Type 2 Diabetes If you already have type 1 or type 2 diabetes and are thinking about having a baby, talk with your doctor before you get pregnant. Untreated or poorly controlled diabetes can cause serious problems for your baby. More information is provided in the NIDDK health topic, What I need to know about Preparing for Pregnancy if I Have Diabetes or call 18008608747 and request a copy.
*See the Pronunciation Guide for tips on how to say the words in bold type. |
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