Hypoglycemia is a pathological condition associated with abnormally low blood glucose levels. People with diabetes mellitus, severe liver and pancreas diseases, digestive tract problems, endocrine gland dysfunctions (adrenal cortex, pituitary gland, etc.), and some infectious diseases (encephalitis, meningitis) can experience hypoglycemia attacks. At risk are also people who are too active in using low-carb diets, which today are very popular with losing weight.
We will get acquainted with those signs of hypoglycemia, which in no case can be ignored.
With a mild form of hypoglycemia, hunger usually occurs suddenly. This is the response of the corresponding brain center to a low concentration of glucose in the blood. Sudden hunger often appears in diabetics against the background of physical exertion, eating disorders or improper use of sugar-lowering drugs. Starvation may be accompanied by nausea.
In healthy people who follow a low-carb diet, unexpected hunger also appears due to the rejection of foods rich in fiber (vegetables, fruits, cereals). They, getting into the stomach, create a long-lasting feeling of satiety. With a complete rejection of carbohydrates, a person can be hungry all the time, even immediately after eating.
A significant decrease in blood glucose usually results in a drop in blood pressure. As a result, a headache occurs, often accompanied by dizziness. Short-term speech disturbances and visual effects (for example, bifurcation of the image or color spots in front of the eyes) sometimes appear.
Disorders of the central nervous system
The human body uses glucose as a universal source of energy. With its deficiency in the blood, nerve cells are especially affected, therefore, signs of a deterioration in brain function occur almost immediately.
Hypoglycemia is accompanied by the following manifestations:
- drowsiness, lethargy,
- difficulties with orientation in space,
- motor coordination disorders,
- inability to concentrate
- memory impairment
- hand tremor
- epileptic seizures.
Lack of help with the appearance and increase of these symptoms leads to a hypoglycemic coma, which can be fatal.
The deficit of “universal fuel” has a bad effect on the state of all organs and systems of the human body. During an attack of hypoglycemia, the patient may experience chills, complain of a cold in the fingers and toes. Cold sweat may occur (the back of the neck and the entire scalp are sweating). If an attack of hypoglycemia occurs at night, the whole body sweats profusely: a person wakes up in completely wet underwear.
Stabilizing weight while dieting
People trying to get rid of excess weight with low-carb diets often notice that at a certain stage, their weight stops decreasing, despite a strictly limited diet. This may be a sign of hypoglycemia. The fact is that with insufficient intake of carbohydrates, the liver begins to process glycogen stores into glucose, and the intensity of the breakdown of stored fats decreases.
Glucose is involved in the production of the “hormone of happiness” - serotonin. With its lack, a person ceases to enjoy life, becomes tense and gloomy. In addition, glucose deficiency inhibits the activity of the brain. An attack of hypoglycemia can cause the patient anxiety, fear or excessive agitation. In severe cases, inappropriate behavior or outbreaks of unmotivated aggression are not ruled out.
People with diabetes usually know how to control their blood glucose and know what needs to be done to normalize it. For a person who is poorly informed and faced with hypoglycemia for the first time, this situation is very dangerous.
A severe attack, accompanied by confusion, impaired speech and coordination of movements, vomiting, etc., requires medical intervention, an ambulance must be urgently called for such a patient.
An attack of mild hypoglycemia can be stopped on its own by delivering 12–15 g of easily digestible (so-called fast) carbohydrates to the body. This portion contains:
- a glass of warm tea with two tablespoons of sugar,
- two pieces of refined sugar,
- two teaspoons of honey (it’s better to slowly dissolve in the mouth),
- 150 ml packaged fruit drink or juice,
- one chocolate candy or two slices of milk chocolate,
- one banana
- five to six pieces of dried apricots.
Within half an hour after taking one of these funds, the patient's condition should improve. Unfortunately, stopping the attack does not mean that the problem is resolved. Symptoms of hypoglycemia cannot be ignored: a deficiency of glucose in the blood can lead to the development of very serious pathologies. If the attacks recur, you must urgently consult a doctor, at the same time refusing to follow a low-carb diet.
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Education: First Moscow State Medical University named after I.M. Sechenov, specialty "General Medicine".
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That is, symptoms of hypoglycemia can occur in a healthy person with the following conditions and provoking factors:
- Starvation, malnutrition, diets (deficient in minerals, fiber, vitamins). This is the most common cause of the development of symptoms of hypoglycemia in a relatively healthy person. If you refrain from a normal diet for a long time, and then eat carbohydrate products, blood sugar rises quickly, but also quickly and is consumed to a level lower than normal.
- Inadequate drinking regimen. The lack of water in the body leads to a compensatory consumption of blood sugar to maintain normal functioning.
- Stress Emotional stress activates the endocrine system, which leads to a rapid consumption of blood sugar in a short period of time.
- Abuse of refined carbohydrates in the diet. The pancreas against the background of a constant excess of sweets gets used to produce large amounts of insulin. With a constant excess of insulin, blood glucose levels tend to decrease.
- Strong physical activity. The body increases the consumption of stored glycogen and the consumption of blood sugar during intense training or hard physical work, leading to a physiological drop in blood glucose.
- Menstruation period. A drop in sugar level can occur against the background of a sharp drop in the production of estrogen and progesterone, which in normal concentrations increase (estrogen) and normalize (progesterone) blood sugar.
- Physiological hypoglycemia of newborns of the first day of life. Immediately after birth, the baby’s energy needs are covered by maternal glucose, a small amount of which is stored in the umbilical vein. But the rapid depletion of glycogen stores leads to a drop in glucose levels for 1-2 hours of life. Gradually, when establishing nutrition in healthy children, this indicator is restored. However, congenital pathology may also occur.
- The introduction of a large volume of saline (NaCl) intravenously, leading to an artificial decrease in blood sugar.
Causes of Hypoglycemia in Diabetics
Skipping food intake by a diabetic. Needing energy, the body begins to expend glucose from the depot - glycogen or, more simply, starch, whose supply in people with diabetes is small and does not compensate for the need for glucose (see diabetes mellitus symptoms).
Pathological Causes in People Without Diabetes
The reasons listed below can also be realized in a diabetic, only hypoglycemia will always be brighter and faster than in people without diabetes.
- Dehydration. When dehydrated in the peripheral blood, a deficiency of vitamins, minerals and blood sugar is observed, since they leave the body with sweat and urine and are not compensated from the outside (see symptoms and causes of dehydration).
- Exhaustion. When depleted, the glycogen reserve drops to a critical level, respectively, glucose does not enter from the outside and can no longer be compensated by the internal reserves of the body.
- Liver diseases (cirrhosis, necrosis, liver failure), in which the process of glucose formation is disturbed (see symptoms of liver diseases).
- Hormone deficiency: cortisol (may occur when corticosteroid drugs are canceled, chronic adrenal cortex insufficiency), growth hormone, adrenaline and glucagon, stimulating the mobilization of glucose in the liver, hypopituitarism (insufficiency of the pituitary gland)
- Impaired carbohydrate absorption - gastrointestinal diseases (colitis, enteritis, dumping syndrome).
- Meningitis, encephalitis, sarcoidosis
- Alcoholism, overdose of alcohol. Ethanol metabolism occurs in the liver using the enzyme alcohol dehydrogenase. The cofactor that starts this process is NAD - a special substance that is involved in the synthesis of glucose. The more alcohol enters the body, the greater the expense of NAD, while inhibiting the process of gluconeogenesis and leading to a drop in glucose in the blood.
- Critical insufficiency of vital organs: heart, liver, and kidneys (see symptoms of kidney diseases) - leading to dysfunction of the body as a whole and dysregulation of blood sugar.
- Sepsis. Increased glucose uptake by tissues with a large number of macrophages, in parallel, insulin production increases and glucose synthesis in the liver is significantly reduced.
- Pancreatic insulinoma (benign or malignant neoplasms of beta islets), against the background of which there is excessive glucose utilization.
- Congenital malformations: autoimmune hypoglycemia, 5-cell hypersecretion, 7-ectopic insulin secretion, in which there is insufficient glucose production.
The mechanism of formation of blood glucose
After eating carbohydrate food, the body receives glucose, which is distributed by blood throughout all cells. As soon as glucose begins to enter the bloodstream (absorbed from the digestive tract), the pancreas begins to secrete the hormone insulin, which helps cells use the incoming sugar as an energy source. In healthy people, the amount of glucose received and the response fraction of insulin are always equal to each other.
In patients with insulin-dependent diabetes, the pancreas is not able to produce the required amount of insulin, and they must be administered from the outside, and in the right dose.
According to the severity of the course, the state of lack of blood glucose is divided into 3 degrees:
- Easy (2.7-3.3 mmol / l, see blood glucose norm) - the person is conscious, can independently stop the lack of glucose. If glucose does not enter the bloodstream for a further 20-30 minutes, a severe degree and even coma may develop.
- Severe (2-2.6 mmol / L) - a person is conscious, but can not help himself without outside help.
- Hypoglycemic coma (symptomatic hypoglycemia that occurs in patients with diabetes mellitus with a sharp drop in blood glucose from high to normal levels and does not require correction. At the same time, symptoms typical of the condition are observed. To avoid sudden jumps in sugar levels, patients with diabetes should always follow a diet (see diet for diabetes).
- Space disorientation, amnesia
- Decreased concentration and performance
- Lack of coordination of movements
- Hemiplegia - unilateral paralysis
- Diplopia - visual double vision
- Aphasia - speech disorders
- Primitive automatisms, inappropriate behavior
- Focal neurological disorders
- Circulatory and respiratory distress (central origin)
- Epileptiform seizures
- Drowsiness, then impaired consciousness leading to fainting and coma
- Increased aggressiveness, unmotivated agitation
- Fear and anxiety
- Increased sweating
- Hand tremor
- Muscle hypertonicity, overstrain of individual muscle fiber groups
- Mydriasis - dilated pupils
- Pallor of mucous membranes and skin
- General weakness and malaise
People with diabetes have long been able to recognize this condition by 2-3 signs. The rest should remember a certain sequence of symptoms that occur one after another, and quite quickly. Unfortunately, not everyone has classic symptoms, so the best assistant in this situation is a device for measuring blood sugar!
Signs of hypoglycemia by the frequency of occurrence:
- Sudden general weakness
- Nausea, vomiting,
- Hand shake
- Unmotivated aggression and nervousness,
- Double vision, colored circles,
- Confusion of speech and understanding of what is happening,
It doesn’t sound scary, but just such a scenario unfolds if help is not provided on time!
Hypoglycemia in children
The causes of this condition in children are:
- diseases of the nervous and endocrine systems, including diabetes,
- unbalanced nutrition
- physical overload.
In addition to the above, there are 2 fundamental reasons for the development of childhood hypoglycemia:
- An increase in the content of ketone bodies in the blood. У таких детей наблюдается своеобразный ацетоновый запах изо рта, постоянные головокружения, рвота, обморочные состояния, обусловленные токсическим действием ацетона.
- Непереносимость лейцина врожденного характера — аминокислоты, входящей в состав белка, требующая соблюдения особой диеты. Основные симптомы: вялость, потливость, бледность кожи, сонливость.
Частые гипогликемические приступы негативно влияют на интеллектуальное и физическое развитие детей. Relief of hypoglycemia in children is carried out as well as in adults. With leucine intolerance, products such as eggs, fish, nuts, milk and others containing leucine are excluded.
Help with hypoglycemia - pre-hospital and inpatient
For quick help, the body produces tablets containing d-glucose (dextrose) or glucagon. The instructions for these drugs must be known to all diabetics and people living with them. Patients prone to hypoglycemia should always carry such drugs with them!
In a state of sugar deficiency, both the lack of compensation and an excess of glucose are dangerous. An overdose of glucose inevitably leads to subsequent hyperglycemia, no less dangerous for the diabetic.
Assistance should begin by measuring your blood sugar with a household meter to confirm your blood glucose deficiency. Blood sugar should be measured as assistance is provided. If this is not possible, you should immediately begin to stop the condition.
You can independently stop your condition by oral administration of 12-15 grams of simple, easily digestible carbohydrate from the list below:
- d-glucose (in tablets). The most preferred method with a predictable scenario of events, i.e. a smooth increase in blood glucose. 1 gram of glucose increases blood sugar by 0.22 mmol / L. Knowing the initial numbers of blood sugar, it is easy to calculate the required dose of tablets,
- 150 g of sweet fruit juice or a sweet drink,
- warm tea with 2 teaspoons of sugar,
- 1 banana
- 5-6 slices of dried apricots,
- a couple of milk chocolate slices or 1 candy,
- 2 teaspoons of honey or sugar (dissolve),
- 2 slices of refined sugar.
Attention. Eat or drink something one of the proposed options! The specified quantity must not be exceeded.
If after 15-20 minutes the blood sugar has not increased, and the condition remains unsatisfactory, you should again take 15-20 grams of simple carbohydrate. A person's condition improves within an hour after taking light carbohydrates, i.e. do not wait for instant relief after taking a glucose tablet.
- Quickly give a person 12-15-20 grams of easily digestible carbohydrate. After 20 minutes, a person should eat another 15-20 grams of complex carbohydrates (bread, cracker cookies, bread rolls, cereal).
- If a person is greatly inhibited, can swallow, but is no longer able to chew, glucose should be given in the form of a solution, having dissolved the required number of tablets in a small amount of water. Or just offer sweet water.
- Abroad, glucose is sold in a gel state, which can be used to lubricate the oral cavity, where sugar quickly begins to be absorbed into the blood.
If a person is in an unconscious state or his consciousness is confused, oral administration of liquids and other products is excluded! Call an ambulance.
First aid consists of an intramuscular injection of 1 ml of glucagon - express kits with 1 syringe and drug are sold in pharmacies. In a hospital, the treatment of hypoglycemia is carried out by the intravenous administration of 40% glucose. If the condition does not stop, resort to subcutaneous administration of adrenaline and other resuscitation measures.
The consequences of hypoglycemia
Frequent seizures of the condition can provoke angiopathy of the vessels of the legs and eyes, increase the risk of developing diseases of the heart, blood vessels, and brain. The death of a person who falls into a hypoglycemic coma occurs due to the death of brain cells that feed on glucose. This is an extreme case, but quite real, if you do not help a person in time.
Physiology of the phenomenon
At first a boring and dry definition. Hypoglycemia is an endocrine-metabolic syndrome that occurs when plasma glucose levels decrease by at least 0.5 mmol / L from the lower normal range and are accompanied by symptoms of a central nervous system malfunction. Let me remind you - the norm is 3.5–5.5 mmol / l.
The fact is that the brain is a highly energy-consuming organ (especially its gray matter), one might say - a spender. Yes, yes, in comparison with other organs, it consumes an immeasurable amount of energy and at the same time lives in isolation (cranial box).
This means that any fasting, whether oxygen or glucose, within a few minutes can lead to the death of the organ. And the fact that the brain lives in the cranium, unable to grow even with cell edema, exacerbates the problem.
Here I must explain that any tissue damage leads to edema: bite your finger and it will swell, but after a couple of days (or even hours) the swelling will disappear and the finger will regain its former appearance and functionality, but the swollen brains, increasing in size, they will rest against the walls of the dungeon (skull) and begin to flow away to where there is free space. The vessels will shrink, food will stop, damage to nerve cells will intensify, brains will swell even more and proceed to the large occipital foramen. The first to suffer are the neurons of the medulla oblongata, in which the oldest centers of respiration and control of the cardiovascular system are located, and this will finish the body completely.
And I ask you not to think that brains swell only from a blow against the wall - they swell from any damaging factor, including a lack of oxygen, glucose and other substrates that lead to cell damage.
Causes of hypoglycemia
Undoubtedly, patients with diabetes mellitus are most susceptible to this condition, for example, due to an overdose of insulin, errors in the method of its administration (administration of insulin without prior agitation in a vial, administration of the drug to places where rapid absorption of the drug may occur). After all, some manage (apparently thinking that for some reason they didn’t insert), along with subcutaneous administration, to expand insulin into the vein as well.
By the way, it is quite possible to develop a hypoglycemic state after the very first insulin injection. After all, it is not always possible to predict the body's response to the usual dose of the drug.
Causes of hypoglycemia that are not related to diabetes mellitus are also distinguished: tumors producing insulin, adrenal insufficiency, renal and liver failure. Alcohol, β-blockers, sulfonamides are also able to lower glucose levels ...
I will not list all the reasons, enough and frequent. But I think you understand that this condition is not so rare. Even completely healthy people can experience it on themselves. Sometimes patients are brought to us in an alcoholic coma with low sugar, especially often during the cold period, when the muscles in the last attempt to save the body begin to contract, warming the body, but consuming more glucose.
Most recently, a patient in a superficial coma, with prohibitively low blood glucose (1.5 mmol / l), entered my shift. How long she lay at home in this state is not known; her relatives at that time consumed alcohol substitutes. The introduction of large doses of glucose led to a positive result, the woman woke up, but the brain swollen from the damage turned on with behavioral disorders, she growled, screamed, was torn. Subsequently, her mental processes recovered. However, frequent hypoglycemia, sooner or later, will lead to irreversible damage to brain neurons, which clinically manifests itself as a decrease in intelligence.
Someone will ask: what about the liver and glycogen stores in it? Good question. I will say more - not only the liver is able to maintain the vital activity of the nerve cell for some time, there are other systems and biochemical reactions (glycogenolysis, gluconeogenesis, proteolysis, lipolysis). However, these reserves are not infinite and, in addition, quite expensive for the body, and the brain wants to eat here and now. And he, as an organ of higher origin, does not want to wait a couple of hours until "hen is caught, nibbled and cooked." The brain, like a hysterical woman, immediately loses consciousness and gives out convulsions, and not theatrical, but the real ones. He feels bad, and he quickly dies ...
How is this manifested
I want you to know how outwardly a person with hypoglycemia looks, especially since sometimes such people themselves do not notice their condition, pushing themselves to the limit.
So, in a state of hypoglycemia, a person becomes indifferent to the environment, lethargic, drowsy. He has a feeling of hunger, a headache, dizziness, fog in his eyes, "flies are floating", the images are "double."
If time does not help, the patient loses consciousness, while the jaw clenches and cramps begin throughout the body. Muscle contractions also require energy, which further exacerbates the situation.
The heart beats accelerated, blood pressure rises. Those who experience hypoglycemia in a dream have nightmares.
In a patient with diabetes, the above symptoms should unconditionally suggest hypoglycemia.
How to prevent this condition?
The vast majority of patients with diabetes mellitus do not need my advice, but I will nevertheless set out general recommendations.
- Patients prone to the development of a hypoglycemic state should eat 6 times a day. It is recommended to have a bite before bedtime to prevent hypoglycemia at night.
- When the first signs of hypoglycemia appear, it is enough to drink a glass of milk and determine the level of glycemia using a glucometer (fortunately, there are no problems with this now).
- If the blood sugar level is less than 3.3 mmol / L, consume 10 g of glucose, for example in the form of 100 ml of orange juice and several crackers. In general, each patient should have a piece of sugar or candy and a document certifying that its owner has diabetes.
- In case of severe hypoglycemia, patients should have glucagon, a physiological insulin antagonist, and relatives should be able to administer it at a dose of 1 mg subcutaneously (I just don’t know if anyone saw this drug with their own eyes).
It is clear that if the patient is in a coma, then he should not push sweets into his mouth, it is still not enough to arrange aspiration with a foreign body. Call an ambulance. If there is a skill and opportunity - while waiting for the arrival of an ambulance, inject the affected glucose into the vein. Even if he doesn’t have hypo-hyperglycemia, you won’t harm him at all - in a hospital with high sugars they can easily figure it out. But if you miss the time with hypoglycemia, then irreversible changes are quite possible.
Be healthy! And do not forget that at all times it is cheaper to prevent diseases than to cure them.