Sign-in
(your email):
(case sensitive):



 
 

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hypoglycemia


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
251.0 - Hypoglycemic Coma; Iatrogenic Hyperinsulinism; Non-diabetic Insulin Coma
251.1 - Hypoglycemia, Other Specified; Hyperinsulinism NOS, Ectopic, Functional; Hyperplasia of Pancreatic Islet Beta Cells NOS
251.2 - Hypoglycemia, Unspecified; Hypoglycemia NOS; Reactive; Spontaneous

Related Terms

  • Low Blood Glucose
  • Low Blood Sugar

Overview

Hypoglycemia is a condition in which blood sugar (glucose) levels (glycemia) are abnormally low. It is a serious condition because the body uses glucose for fuel, and when levels are too low, many organ systems, particularly the brain and nervous system, malfunction.

Hypoglycemia can result when an individual with diabetes mellitus (type 2 diabetes) accidentally takes too much of the medicine (insulin, sulfonylureas) used to reduce blood glucose levels. Individuals with diabetes (diabetics) may also lose the ability to secrete major counter-regulatory hormones such as glucagon and epinephrine, which help control insulin levels. Many other drugs that are not related to treatment of diabetes can also cause hypoglycemia.

Meals high in refined carbohydrates, excessive alcohol consumption, and certain types of gastrointestinal surgery can produce an episode of hypoglycemia. Starvation and strenuous exercise can lead to hypoglycemia in rare instances, but this usually happens in individuals with some other underlying disease (e.g., pituitary or adrenal gland disease, liver disease). Those with hypopituitarism may become hypoglycemic due to deficiencies in growth hormone and cortisol production.

Excessive production of insulin (usually caused by a tumor of the cells in the pancreas that normally secrete insulin [beta cells], named insulinoma), kidney failure, heart failure, malnutrition, cancer, shock, severe infection, and extensive liver disease can all produce hypoglycemia.

Normal plasma glucose levels are about 70 to 110 mg/dL (3.9 to 6.1 mmol/L) in the fasting state. Although normal blood sugar levels vary depending on whether the individual has been fasting, blood glucose levels below 45 mg/dL (2.5 mmol/L) in women or below 55 mg/dL (3.0 mmol/L) in men may indicate hypoglycemia. However, exceptionally, certain individuals, particularly those that are young and female, can tolerate blood sugar levels as low as 20 mg/dL (1.11 mmol/L) without experiencing symptoms; thus, it is possible that the relative speed and drop in blood sugar is more important in triggering hypoglycemic symptoms than the absolute blood sugar level itself.

Incidence and Prevalence: Because hypoglycemia is not a disease itself but rather a sign of some other illness or condition, incidence and prevalence are difficult to establish. One report suggests that approximately 90% of all individuals who receive insulin have experienced hypoglycemic episodes (Briscoe).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk of hypoglycemia is similar in men and women. Diabetics attempting to achieve better glycemic control suffer many episodes of mild to moderate hypoglycemia (Briscoe). Older adults with comorbidities (hepatic, renal or cardiac disorders), those using multiple medications, and those who are frequently hospitalized are at greater risk for hypoglycemia due to the medication that they take. Hypoglycemia may also occur due to a pancreatic tumor secreting excess insulin (insulinoma).

Source: Medical Disability Advisor



Diagnosis

History: The individual may have a history of passing out or complain of hunger, headache, weakness, a pounding in the chest (cardiac palpitations), sweating, feelings of anxiousness, and difficulty concentrating. Family members may notice confusion or personality changes in the individual. Monitoring the timing of these symptoms in relation to food consumption is important.

Physical exam: On examination, the heart rate may be above 100 beats per minute (tachycardia), and the blood pressure may be high (hypertension). The skin will be pale and feel cool and clammy. The individual may be unconscious or have involuntary muscle jerking (convulsions).

Tests: A blood test reveals abnormally low levels of glucose. This result is definitive for this condition. The physician may order a test to measure blood glucose level after eating (nonfasting or postprandial) or after 12 hours of fasting. A 72 hour fasting protocol may be necessary to definitively rule out fasting hypoglycemia. Insulin levels should also be measured in all cases during an episode, if possible. Insulin levels are not helpful if the simultaneous glucose level is not low.

Examination of blood insulin:glucose ratios, proinsulin levels, and visualization studies such as angiography may help diagnose the presence of an insulinoma.

Source: Medical Disability Advisor



Treatment

Hypoglycemia is treated by having the individual (if conscious) consume sugar in any form (e.g., candy, fruit juice, glucose tablets, milk). This is often followed by more sustaining carbohydrates, such as crackers with peanut butter. If the individual is unconscious, intravenous glucose solution is given. These methods successfully restore glucose levels within minutes.

Long-term treatment includes education on the symptoms for early detection and intervention. If the individual is diagnosed as a diabetic, education and a thorough understanding of the disease and its treatment are perhaps the best therapy. Dietary changes may include small, frequent meals instead of three large meals per day. Those at risk for severe episodes of hypoglycemia may benefit from having a hormone called glucagon handy at all times. This medication is given by injection and returns glucose levels to normal within minutes.

Oral diazoxide may be helpful to lower insulin secretion if a pancreatic tumor is present, but in the extremely rare cases of a tumor, surgical removal is indicated.

Source: Medical Disability Advisor



Prognosis

With early intervention, the outcome is good. Patient education and dietary changes are very effective in preventing or limiting episodes of hypoglycemia. In cases in which glucagon is administered, hypoglycemia will generally resolve within minutes.

When surgical removal of pancreatic tumors is necessary, the outcome will depend on the ability of the surgeon to locate and remove all tumors, the presence of surgical complications, and the individual's response to the surgery.

The long-term outcome is based on the underlying cause and the individual's response to treatment.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Endocrinologist
  • Family Physician

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications may include seizures, coma, or death if hypoglycemia is left untreated. Complications are based on degree and timing of medical intervention and the severity of the underlying cause.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors influencing the length of disability may include controlling the underlying disease, the individual's awareness of hypoglycemic symptoms, and the individual's ability to self-intervene. Progression of other underlying causes/diseases (i.e., tumor of pancreas) also influences the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Accommodations include flexibility in the work schedule to allow for prevention or response to symptoms of hypoglycemia. Other restrictions may include working at consistent levels of physical exertion, limiting work in high places, and limiting operation of vehicles or high-speed equipment. Individuals should not work in isolated areas or without a coworker. Due to the risk of losing consciousness, sedentary positions might be preferable.

Risk: Jobs with heavy strenuous exercise may precipitate hypoglycemic events in susceptible individuals.

Capacity: No impact on capacity would be expected.

Tolerance: Education is the mainstay of encouraging treatment and compliance. Individuals may require easy access to blood sugar testing, as well as caloric drinks.

Source: Medical Disability Advisor



Maximum Medical Improvement

7 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual complain of hunger, headache, weakness, a pounding in the chest (cardiac palpitations), sweating, feelings of anxiousness, or difficulty concentrating?
  • Was individual confused? Did individual have convulsions? Lose consciousness?
  • Was heart rate or blood pressure elevated?
  • Was individual's skin cool, pale, and clammy?
  • Is individual diabetic? Taking insulin? If so, is dose correct?
  • Has hypoglycemia been confirmed?
  • Have conditions with similar symptoms been ruled out?
  • Has underlying cause of hypoglycemia been identified? If cause is undetermined, is inpatient observation and testing beneficial?

Regarding treatment:

  • If at risk for hypoglycemic episodes, does individual recognize early symptoms?
  • Does individual carry a form of glucose or glucagon with him/her at all times?
  • Is individual eating small, frequent meals instead of three large meals a day? Does regular diet include longer-lasting carbohydrates such as bread or crackers? Would individual benefit from consultation with a nutritionist?
  • Is surgical removal of insulin-secreting tumors an option? Is surgeon a specialist experienced in this type of tumor?
  • If symptoms persist despite surgical treatment, is it possible that not all the insulin-secreting tumors were removed?

Regarding prognosis:

  • Has primary cause of hypoglycemia been identified?
  • Has treatment of underlying condition been effective in reducing hypoglycemic episodes?
  • If symptoms persist despite treatment, does diagnosis need to be revisited?
  • Would individual benefit from evaluation by an endocrinologist?
  • Is individual diligent in preventing hypoglycemic episodes? If episodes do occur, does individual recognize early symptoms and seek appropriate intervention?
  • Does individual wear a medical ID tag to alert emergency medical personnel about hypoglycemic condition?

Source: Medical Disability Advisor



References

Cited

Briscoe, V. J. , and S. N. Davis. "Hypoglycemia in Type 1 and Type 2 Diabetes: Physiology, Pathophysiology, and Management." Clinical Diabetes 24 (2006): 115-121.

Hamdy, Osama. "Hypoglycemia." eMedicine. Eds. Romesh Khardori, et al. 21 Apr. 2014. Medscape. 21 Jun. 2014 <http://emedicine.com/med/topic1123.htm>.

Source: Medical Disability Advisor