Hypoglycemia (Low Blood Glucose Levels)

Hypoglycemia Definition

Hypoglycemia is the medical term for an abnormally low blood sugar (glucose) level below 70mg/dL. Although the blood glucose levels do fluctuate during the course of the day, it is usually maintained within a normal range. The most common reason behind hypoglycemia is due to the intake of drugs especially anti-diabetic drugs and other less common causes include insulin-secreting tumors and severe liver or kidney disease. To prevent permanent brain damage, hypoglycemic coma and death, the blood sugar level must be normalized with high sugary  foods like candy or intravenous glucose administration. The management of the underlying problem is essential to prevent repeat attacks of hypoglycemia.

Hypoglycemia Symptoms

Symptoms of hypoglycemia are sudden in onset and include :

  • Anxiety and nervousness.
  • Palpitation.
  • Profuse sweating.
  • Paleness.
  • Cold and clammy limbs.
  • Nausea and vomiting.
  • Headache.
  • Increased hunger.
  • Confusion, irritability and emotional outbursts.
  • Unexplained lethargy, amnesia and drowsiness.
  • Slurring of speech.
  • Abnormal gait
  • Blurring of vision and/or double vision.
  • Abnormal sensation-like needle prick in the limbs and paralysis.
  • Abnormal breathing.
  • Coma.
  • Epileptic fits (seizure).

Many of these symptoms are similar to a stroke or heart attack and these conditions have to be excluded. Untreated hypoglycemia may lead to permanent brain damage, coma and death. The above mentioned symptoms vary in occurrence depending upon the age of the patient. For example :

  • In infants,  hypoglycemia usually manifests as fits, increased sleepiness, sweating, abnormal jerky movements, respiratory distress and abnormal fall in body temperature.
  • In older children and adults, the symptoms of hypoglycemia resemble that of mania, intoxication ora  drunken state since restlessness, abnormal gait, sweating, disorientation and confusion are the main symptoms
  • In elderly patients symptoms of hypoglycemia simulate that of stroke, unexplained lethargy and body ache.
  • In long term diabetic patients due to damage to the autonomic nervous system (neuropathy), the symptoms of hypoglycemia may not occur (hypoglycemia unawareness). This is dangerous because it becomes difficult to suspect hypoglycemia because of lack of warning symptoms. Thus its timely management is also delayed, leading to chance of development of complications.

Hypoglycemia Causes

The principal energy source of the body is glucose. Most of the blood glucose comes from food through its absorption in the digestive tract and subsequent entry in to the blood stream and cells. Insulin secreted from the beta cells of the pancreas lowers the blood glucose level by influencing its absorption in the digestive tract, entry into different cells and storage in muscle and liver as glycogen.

Fall in blood glucose is normalized by release of glucagon from the pancreas resulting in the suppression of insulin action, mobilization of stored glucose from muscles and liver (glycogenolysis) and stimulating glucose synthesis in the body (neoglucogenesis). The most common causes of hypoglycemia are :

  • Intake of anti-diabetic drugs including insulin.
  • Chronic alcoholism.
  • Liver and kidney disease.
  • Overproduction of insulin by rare tumor of pancreas (insulinoma).

Hypoglycemia Risk Factors

Usually normal glucose regulation ensures that hypoglycemia does not occur. However, certain people are more likely to experience hypoglycemic attack. It is also dependent on the situation. Hypoglycemia may be associated with risks such as :

  • Excessive alcohol intake.
  • Elderly patients.
  • Sudden weight loss.
  • Missing meals and strenuous exercise mainly in patients with hypoglycemia.
  • Diabetics.

Hypoglycemia Treatment

The goals of hypoglycemia treatment includes :

  • Immediate normalization of blood glucose with intake of sugar through the mouth or in unconsciousness or severe vomiting intravenous glucose promptly normalizes blood glucose level.
  • Management of underlying conditions by :
    - changing the drug or dose adjustment of possible causative drug.
    - surgical removal of insulinoma.

Normally no other treatment measures are required. Patients do not need to be on chronic medication. Although these measures help reduce the severity of hypoglycemic attacks and reduce the frequency of attacks, it does not guarantee that such attacks may occur in the future.

Hypoglycemia Prevention

Patients who experience hypoglycemic attacks need to undergo further medical assessment in order to identifying underlying conditions. When these conditions are properly treated, hypoglycemic episodes may be prevented. Some simple measures to prevent hypoglycemia attacks includes :

  • Eating regularly and opting for low glycemic index (GI) foods for sustained glucose supply.
  • Having 5 to 6 small to medium-sized meals in a day rather than a few large meals.
  • Using medication as prescribed and not sharing medication.
  • Strenuous physical exercise should only be undertaken after eating an hour or two prior to activity.

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