Hypoglycemia

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What is Hypoglycemia?

Hypoglycemia, also known as Low Blood Glucose, is a condition where the blood sugar levels in the body are below the normal range. Blood sugar is also called glucose. Hypoglycemia is common in people with diabetes. It can also occur in non-diabetic individuals.

Alternate name

  • Low Blood Sugar

Is Hypoglycemia a Medical emergency?

Hypoglycemia can be a dangerous condition, therefore it requires immediate treatment.

Causes

Hypoglycemia can occur in people with or without diabetes. It most commonly occurs as a side effect of the medications that are used to treat diabetes. It can occur due to a high dose of diabetic medication, especially insulin, or due to a change in diet or exercise.

The food an individual consumes is turned into glucose, which is used as energy. Insulin is a hormone produced by a gland called the pancreas in the body that helps glucose to get into the cells of the body to provide energy to muscles and tissues. This function of insulin does not take place in diabetes. Thus, instead of getting absorbed in the body, glucose piles up in the bloodstream leading to high blood sugar levels. To control this high level of sugar in the blood, insulin is taken in form of medication. Taking too much insulin medication can result in the absorption of more blood sugar than required, thus decreasing the blood sugar levels in the blood, resulting in Hypoglycemia.

Hypoglycemia can also occur if a person does not eat on time, skips meals, or eats less than normal after taking diabetes medication. It also occurs if a diabetic person exercises more than normal.

Hypoglycemia can also occur in individuals who do not take any insulin medication. However, it is less common in individuals without diabetes. Possible causes of Hypoglycemia in non-diabetic individuals include the following:

  • Excessive alcohol consumption
  • Taking certain medications, such as quinine
  • Presence of underlying medical illness such as hepatitis, cirrhosis, or kidney problems
  • A tumor in the pancreases that overproduces insulin
  • Presence of hormone deficiencies, such as adrenal gland deficiency

Risk factors

A diabetic person is at an increased risk of developing Hypoglycemia:

  • Taking an increased dose of diabetic medication
  • Consuming alcohol and recreational drugs
  • Doing moderate to intense exercises
  • Not eating meals on time or skipping meals

Symptoms & signs

When blood sugar levels in the blood fall below the normal range, the following signs and symptoms are observed.

  • An irregular or fast heartbeat
  • Blurry vision
  • Sweating
  • Fatigue
  • Mood changes
  • Pale skin
  • Headache
  • Feeling hungry
  • Shaking
  • Irritability
  • Tingling of the lips, tongue, or cheeks
  • Loss of consciousness
  • Confusion
  • Seizures and coma

Investigations/ Diagnosis

Physical examination is performed to review signs and symptoms the person is experiencing. Apart from this, a blood test is done to measure blood sugar levels. If a person is taking insulin daily, blood glucose levels are to be checked daily. Blood glucose meters are available in the market and it is advisable to keep a glucose meter handy. The blood glucose test kit consists of a lancet that is used to prick the finger. A small sample of blood is taken and placed on the strip that is inserted into the glucose meter. This gives the level of blood sugar in the blood. If the level is noted to below the normal range, Hypoglycemia is confirmed.

The following three things are considered for determining and confirming that a person has Hypoglycemia:

  • Blood sugar levels being lower than the normal range
  • Signs and symptoms at the time of low blood sugar
  • Disappearing of the signs and symptoms after blood sugar level is raised

Thus, if the symptoms are improved after increasing the blood sugar levels, the diagnosis is confirmed as Hypoglycemia.

Treatment options

Medical treatment

When blood sugar levels are too low, carbohydrates are to be taken. High-carbohydrate snacks include fruit juices, dry fruits, cookies, fruits, granola bars, etc. 15-20 grams of carbohydrate snack is sufficient to raise the blood sugar levels to normal. If a diagnosis of Hypoglycemia is confirmed, the following steps are to be followed:

  • Eat sugary foods such as fruit juices
  • Eat a snack or a small meal to restore glycogen levels
  • Take a glucagon injection or intravenous glucose if required
  • Recheck blood sugar levels after consuming the above foods or drinks
  • If in case the person is unconscious and not in a position to consume food, emergency medical care is required

If Hypoglycemia is recurrent, the underlying cause of the condition is identified and treatment is given to treat that condition. If certain medications are identified to cause Hypoglycemia, those medications are discontinued. The presence of a tumor in the pancreas also increases insulin production in the body which can lead to Hypoglycemia. Therefore, if a pancreas tumor is identified, it is surgically removed.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

If a person has diabetes, diabetic management and plan should be following accordingly to avoid Hypoglycemia. Whenever a diabetic person is taking new medications, changing diet plans, or adding a new exercise to routine, it is advisable to consult a physician before making these changes. A device called a continuous glucose monitor (CGM) is also used to check blood sugar levels frequently.

There are several ways to prevent episodes of low blood sugar.

  • If diabetic, make a habit of checking blood sugar levels regularly
  • Keep carbohydrate-rich snacks on hand such as cookies, dry fruits, etc.
  • Before exercise, blood sugar levels are required to be checked. If low, eat a small or a snack rich in carbohydrates.
  • Avoid doing intense exercise. Always prefer to do moderate exercise. Heavy exercises can consume more energy.
  • Always follow the diet plan as directed by the physician
  • Always advisable to check blood sugar levels before driving or operating heavy machinery to avoid falls
  • Avoid drinking alcohol. Consuming alcohol can lead to an episode of Hypoglycemia

Complications

Complications that are associated with Hypoglycemia include the following:

  • Dizziness and weakness
  • Loss of consciousness
  • Seizures
  • Coma
  • Falls and injuries
  • Motor vehicle accidents
  • Dementia
  • Death

Prognosis

The prognosis of Hypoglycemia depends upon the cause, the severity, and its duration. If neglected, Hypoglycemia can potentially lead to coma or even death. Hypoglycemia can easily be prevented by eating at regular intervals without skipping meals and maintaining a consistent exercise level.

When to contact the doctor? / How to identify the complications?

If signs and symptoms of Hypoglycemia are observed immediate medical consultation is recommended. If a diabetic individual is experiencing frequent episodes of Hypoglycemia, they should contact the doctor. A non-diabetic individual who experiences a Hypoglycemia episode should contact the doctor to determine the underlying cause of the disease.

Indications for hospitalization

If the blood sugar levels fall too low, emergency medical care is required. Hospitalization may be recommended if intravenous glucose should be given.

Suggested clinical specialists/ Departments to consult for this condition

  • Endocrinology

Additional Information

Repeated episodes of Hypoglycemia can lead to Hypoglycemia unawareness. The body does not produce any signs and symptoms of Hypoglycemia neither the brain can no longer recognize the warning signs of Hypoglycemia. This situation is called Hypoglycemia unawareness. This can lead to a life-threatening condition.

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