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Hypoglycemia
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- 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).
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- Nervousness
- Sweating
- Clammy feeling
- Heart pounding
- Weakness
- Confusion
- Disorientation
- Headache
- Blurred Vision
- Coma
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- 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
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- 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
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- Frequent small meals of complex
carbohydrates -- six meals per day.
- 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.
- Surgical removal is optimal. Diazoxide by mouth helps decrease Insulin secretion
(need to take hydrochlorothiazide as well because
diazoxide causes water retention)
- 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.
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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.
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