Diet

Hypoglycaemia

Medical: Hypoglycemia

English: hypoglycemia

definition

Under one Hypoglycaemia (Hypoglycemia) one understands a lowered value of the blood sugar level (Glucose) which values under 40 mg / dl or 2.2 mmol / l having. Hypoglycemia is also considered to be a blood sugar level that has fallen to below 45 mg / dl with additional hypoglycemic symptoms as well as relief from the symptoms of sugar administration (Whipple triad). Hypoglycemic symptoms are included neurological, psychiatric such as vegetative Complaints that occur with hypoglycaemia.

Epidemiology

At Diabetics enter a Hypoglycaemia about once or twice a week.

Pathophysiology

On the one hand, the sugar intake with food is responsible for regulating the blood sugar level (exogenous intake), on the other hand, various hormones such as insulin and glucagon as well as the sugar consumption of the body by its cells. In addition, the body can also produce glucose itself, which is done with the help of the liver (Glycogen stores) occurs from glycogen or as a new formation.

Read more on the topic: Abandonment of insulin

If sugar is now absorbed with food from the gastrointestinal tract, the hormone insulin becomes reactive through the pancreas (pancreas) released, which enables glucose uptake in certain body cells. There the glucose is used to generate energy. If the blood sugar level is too low, the hormone glucagon is released from the pancreas (pancreas) released and caused, among other things, with the help of the glycogen stores of the liver or through the formation of new glucose (Gluconeogenesis) an increase in blood sugar levels.

In summary, the blood sugar level drops when the body cells use glucose for energy blood record, tape. The sugar level is increased either through food intake or through the release of glucose from the liver. This mechanism is disturbed if you have hypoglycaemia. In response, the body pours adrenaline, a Catecholamine, which causes the autonomic symptoms (see below). For this reason, the autonomic symptoms are also known as adrenergic. The central nervous complaints are the result of the glucose deficiency in the brain, whereby the only energy source of the nerve structures is eliminated and from which disturbances of their function result. Another name for these complaints is neuroglycopenic symptoms (Neuroglycopenia = Glucose poverty in nerve structures).

diagnosis

A hypoglycemia is diagnosed on the basis of the symptoms as well as by measuring the sugar level in the blood. Is there no diabetes mellitus (Diabetes) previously known, further examinations will investigate the cause of the hypoglycaemia. This primarily includes the measurement of blood glucose, insulin in the blood and the C-peptide, a protein that is produced in the body when insulin is formed. One C-peptide molecule is created for each insulin molecule.
Read about this: Test strips for blood sugar

If both insulin and C-peptide have increased levels in the blood, it can be concluded that the hypoglycemia was caused by too much insulin produced in the body or by orally ingested sulfonylureas (antidiabetic drug). To differentiate between these two causes, one determines the sulfonylurea level and the amount of proinsulin in the blood. If the former is increased, it is possible to take medication beforehand; if the latter increases, the body itself overproduces insulin (for example as a result of an insulinoma).

If, on the other hand, the C-peptide has a low value, it is very likely an exogenous ("from the outside“) Insulin supply, which caused the hypoglycaemia.

The diagnosis of hypoglycaemia can be supplemented by imaging procedures such as computed tomography or magnetic resonance tomography (for tumors) and determination of further laboratory values (liver values, kidney values) or hormone levels (for adrenal or anterior pituitary insufficiency).

How do I recognize diabetes?

The first signs of diabetes can be frequent urination, increased thirst, as well as persistent tiredness and fatigue. Diabetes can also occur in babies, toddlers and children, which is also manifested by strong thirst and frequent urination. Your breath can also smell like nail polish remover.

Pregnant women can also be affected by diabetes, but the typical signs of diabetes do not occur, such as frequent urination.
More on the topic here: Frequent urination

Differential diagnosis

If an affected person has the symptoms described, hypoglycaemia is not the only possible cause. Are also conceivable Epilepsies (Seizures), a stroke (Apoplexy) or psychiatric illnesses (psychoses). These can be differentiated in the course of further diagnostic examinations.

prophylaxis

In diabetics, hypoglycaemia can be prevented by attending training on the disease and the early signs of an impending Hypoglycaemia participates. Since there are individual differences in the perception of these early symptoms, this must first be learned in the training.
One way of learning is behavioral medicine training (according to Cox), which includes introspection, interpretation of the hypoglycaemia symptoms and taking countermeasures (for example glucose eat or Cola / juice drink) includes.

forecast

Slight hypoglycaemia in and of itself does not pose a major risk. One risk, however, is that the body will become too low Blood sugar level accustomed and the perception of hypoglycaemia no longer works.
If, however, recurring severe hypoglycaemia is not treated, this can damage the Brain entail (for example dementia). In the worst case, death occurs, usually as a result of impaired consciousness, which can lead to traffic accidents or falls.
Otherwise, the prognosis depends on the underlying disease.

Summary

„Hypoglycaemia“ (Hypoglycemia) denotes either a low blood sugar level with values below 40mg / dl or a value below 45mg / dl with hypoglycemic symptoms (neurological, psychiatric, vegetative) and ending the complaints by adding sugar (Glucose).
Regarding the root cause one divides hypoglycemia into three forms:

reactive hypoglycemia
Fasting hypoglycemia and
exogenous hypoglycemia.

It is true that symptoms vary from person to person Hypoglycaemia in general, however, these can be divided into two forms:

autonomous (vegetative) such as
central nervous Symptoms.

Autonomous complaints are caused by cravings, restlessness, sweat, Tremors and palpitations. Central nervous symptoms concern this brain and initially express themselves as a headache, bad mood, confusion or decreased ability to concentrate. In addition, there can be automatisms such as grimacing, seizures and, in the case of very severe hypoglycaemia, hypoglycemic shock.

Hypoglycaemia is first diagnosed based on the blood sugar level. The determination of further Laboratory parameters as well as imaging procedures complement the diagnostic procedure.
Therapy consists in removing the triggering cause. Hypoglycemia is treated symptomatically by administering glucose, which is administered orally (also in the form of sugary drinks) or intravenously, depending on the severity of the hypoglycaemia. Alternatively, the hormone glucagon can be injected to increase blood sugar.
The prognosis and prevention depend on the underlying disease.