Hypoglycemia

more about Hypoglycemia

Also known as

Low blood sugar

Description

  • Glucose (a form of simple sugar) is the primary energy source for the body.  The brain almost exclusively uses glucose as its source of energy.
  • Normal fasting blood sugar is 70-110 mg/dL.  When the blood sugar falls below 50, symptoms usually occur.  If the blood sugar goes below 30, fainting, Seizures, Strokes, or even death may occur.
  • Diabetics take Insulin, which decreases blood sugar (under normal circumstances it prevents the blood sugar from becoming too high).

Symptoms

  • Nervousness
  • Sweating
  • Clammy feeling
  • Heart pounding
  • Weakness
  • Confusion
  • Disorientation
  • Headache
  • Blurred Vision

Cause

  • Idiopathic
  • Insulin usage
  • Oral diabetic medications
  • Postprandial (2-3 hours after eating)
  • Factitious
  • Alcohol Hypoglycemia
  • Pancreatic B cell tumor (Insulinoma)
  • Extrapancreatic tumor
  • Immunopathologic Hypoglycemia
  • Pentamidine

How the diagnosis is made

  • Blood sugar is less than 40 mg/dL after an overnight fast
  • ProInsulin concentration is elevated in Insulinoma
  • Suppressed plasma C peptide immunoreactive Insulin in factitious Insulin
  • Test of blood for oral hypoglycemic medications, if a factitious Consumption is suspected
  • Intravenous Glucagon (1mg), and evaluate Insulin blood level at baseline for 5 to 10 minutes (a rise above 200 uU/mL)
  • Kinetic MRI with multiple images to localize an Insulinoma

Treatment

    1. Frequent small meals of complex carbohydrates — six meals per day.
    2. Avoid concentrated sugar, such as found in sodas and juices, unless having symptoms of Hypoglycemia, because it will have a rebound effect, promoting Low Blood Sugar 1-2 hours later.  If someone is symptomatic, this is different and he needs concentrated sugar right away (such as sugar-containing soda or orange juice).

– Patient needs sugar right away — regular sodas, juices.  There are also glucose sprays available.  In the hospital, D50 is given intravenously in severe cases.

  • Oral hypoglycemic medications (oral diabetic medications):

– Patients who develop symptomatic Hypoglycemia while taking these medications usually need to be watched in a hospital for 24 hours.  The reason is that the medicine stays in the body for a long time, and the blood sugar tends to drop multiple times over the next 24 hours, until the medication is completely out of the system.

    1. Surgical removal is optimal.  Diazoxide by mouth helps decrease Insulin secretion (need to take hydrochlorothiazide as well because diazoxide causes water retention)
    2. Somatostatin may be helpful for individuals who are not surgical candidates.  Somatostatin inhibits Insulin release.
  • Factitious Hypoglycemia — this is a psychiatric disorder and needs appropriate psychiatric care.

If You Suspect this Condition

Anyone with symptoms of mental status change, such as confusion, Seizures, and disorientation, needs emergency medical care.  If you suspect this condition on a chronic, ongoing basis, you need to see your doctor.  Repeated episodes of Low Blood Sugar can cause permanent brain damage