symptoms: anxiety, hunger, a tingling sensation in the hands,
palpitations, profuse perspiration, shakiness, or weakness.
These symptoms may not occur in people taking beta-blocker
drugs and in those with long-standing diabetes.
of nighttime hypoglycemia: nightmares, restlessness, or profuse
symptoms, due to inadequate supply of glucose to the brain: agitation,
amnesia, confusion, dizziness, disorientation, feeling cold,
headache, impaired vision, lack of coordination, numbness, or
symptoms: seizures, temporary paralysis of one side of the body,
or loss of consciousness.
When To Call Your Doctor
an ambulance immediately if someone loses consciousness.
a doctor if you develop symptoms of hypoglycemia.
What Is It?
Hypoglycemia is an abnormally low blood sugar level,
arising from an imbalance in the rates of glucose release from
the liver and its use by other body tissues. Glucose (a simple
sugar) is absolutely essential as an energy source for the cells
of the central nervous system. Insulin regulates blood glucose
levels by slowing the release of glucose by the liver and stimulating
its entry into other cells. Low blood glucose levels trigger
the release of adrenaline, which produces the symptoms of a hypoglycemic
episode, characterized by a sudden attack of anxiety, shakiness,
dizziness, hunger, and excessive perspiration. Such episodes
are generally not dangerous, because the symptoms incite people
to ingest a sugar-containing food or drink, and the adrenaline
(and other hormones) released tend to help restore blood sugar
levels to normal.
However, prolonged, severe hypoglycemia may be
very dangerous, as it gradually and insidiously starves the brain
of glucose, which may lead to disorientation and confusion, eventually
progressing to seizures, partial paralysis, or loss of consciousness.
If left untreated, hypoglycemia may ultimately result in permanent
brain damage and, in rare cases, even death. There are two types
of hypoglycemic episodes: those that occur two to five hours
after eating, known as postprandial hypoglycemia, and those that
occur after an extended period without food (usually overnight),
known as fasting hypoglycemia.
Postprandial hypoglycemia may be unpleasant, but
is usually not serious; it can be corrected easily by eating
or drinking and by the action of hormones. Fasting hypoglycemiawhich
most commonly occurs among people with diabetes when too much
insulin is administeredis potentially very dangerous, because
of the risk of brain damage. In addition, people with long-standing
diabetes often do not have typical symptoms of hypoglycemia.
In many cases, however, hypoglycemia can be prevented by carefully
following specific diet and lifestyle guidelines (see Diabetes
Mellitus for more information).
What Causes It?
In most cases
of postprandial hypoglycemia, the cause is unknown. It may occur,
however, as one of the early manifestations of diabetes mellitus
or following stomach surgery.
The most common
cause of fasting hypoglycemia is the administration of too much
insulin to a person with diabetes. Risk is increased when these
patients exercise or miss meals.
of fasting hypoglycemia include excessive alcohol ingestion,
insulin-producing tumors of the pancreas (insulinoma), tumors
in other organs, adrenal or pituitary insufficiency, rampant
leukemia, congestive heart failure, chronic kidney failure, severe
liver failure, and some childhood metabolic disorders, such as
fructose intolerance and galactosemia.
hypoglycemia may be triggered by excessive amounts of certain
medications, including oral hypoglycemic agents, aspirin (especially
among children), and beta-blockers.
diabetes should carefully follow their regimen of diet, medication,
exercise, and blood glucose monitoring and should always carry
some fast-acting carbohydrate (glucose tablets, hard candies,
gumdrops, or fruit juice) to consume at the first sign of symptoms.
Also, people with diabetes who use insulin should never drive
or travel in a car, plane, or train without having some sort
of carbohydrate food (such as peanut butter crackers) available
for a snack.
Those who experience
postprandial hypoglycemic episodes should eat five or six small
meals a day that are low in simple carbohydrates and high in
protein, fat, and fiber.
In those who
do not have diabetes, diagnosis requires demonstration of low
blood glucose levels accompanied by the usual symptoms. Depending
on the type of hypoglycemia, blood glucose is measured either
during a glucose tolerance test or after an overnight fast. Further
tests and a detailed patient history are then necessary to determine
the underlying cause of hypoglycemia.
diabetes can verify and document episodes of hypoglycemia with
home blood glucose monitoring.
How To Treat It
If you sense
a hypoglycemic episode coming on, stop all activity. If you are
driving a car, for example, pull over.
portion of any fast-acting carbohydrate: four ounces of fruit
juice or sugared drink; some candy, such as six or seven jelly
beans, or three large marshmallows; or one-half of a tube of
Glutose (80 gram container). If you do not feel better quickly,
consume one more portion. However, do not eat chocolate because
the fat in it slows absorption of sugar into the bloodstream.
family and friends to give you a small drink of fruit juice or
to smear syrup inside your mouth if you become disoriented or
uncooperative (symptoms of worsening hypoglycemia).
Show your family
and friends how to administer an injection of glucagon, a hormone
that helps raise your blood sugar level, in the event you lose
consciousness from hypoglycemia. After the injection they should
call an ambulance and, in the meantime, not attempt to give food
or fluids and most certainly not administer insulin.
may adjust or change your medication if you are receiving too
much insulin or if you are taking one of the other drugs that
sometimes triggers hypoglycemia in those who are susceptible.
required to treat a pancreatic tumor (insulinoma) that causes
hypoglycemia. This sometimes involves removing most of the pancreas.
In cases where surgery is not an option, chemotherapy may be
used to destroy cancerous cells.
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