Hypoglycemia

Hypoglycemia

Hypoglycemia is characterized by a reduction in plasma glucose concentration to a level that may induce symptoms or signs such as altered mental status and/or sympathetic nervous system stimulation. This condition typically arises from abnormalities in the mechanisms involved in glucose homeostasis. The most common cause of hypoglycemia in patients with diabetes is injecting a shot of insulin and skipping a meal or overdosing insulin. ( O.Hamdy, R.Khardori., 2014)

Causes

1. Side effect of drugs used for the treatment of diabetes

2. Certain medications, such as quinine

3. Drinking too much alcohol

4. Some medical conditions, such as hepatitis or kidney disorders

5. A tumor that produces excess insulin

6. Endocrine disorders, such as adrenal gland deficiency

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Signs and Symptoms of Hypoglycemia

• Shakiness
• Nervousness or anxiety
• Sweating, chills and clamminess
• Irritability or impatience
• Confusion, including delirium
• Rapid/fast heartbeat
• Lightheadedness or dizziness
• Hunger and nausea
• Sleepiness
• Blurred/impaired vision
• Tingling or numbness in the lips or tongue
• Headaches
• Weakness or fatigue
• Anger, stubbornness, or sadness
• Lack of coordination
• Nightmares or crying out during sleep
• Seizures 

( http://www.diabetesinfo.org.au/webdata/images/hypoglycemia.gif )

Investigations.

          ·         Vital signs

          ·         Head, eyes, ears, nose, and throat

          ·         Cardiovascular

          ·         Glucose and electrolyte levels (including calcium, magnesium)

          ·         Oral glucose tolerance test and/or 72-hour fasting plasma glucose

          ·         Complete blood count

          ·         Blood cultures

          ·         Urinalysis

          ·         Serum insulin, cortisol levels, and thyroid hormone levels

          ·         C-peptide levels

          ·         Insulin radioimmunoassay

          ·         CT scanning

          ·         MRI

          ·         Octreotide scanning

Treatments

           ·         Glucose supplements (eg, dextrose)

           ·         Glucose-elevating agents (eg, glucagon)

           ·         Inhibitors of insulin secretion (eg, diazoxide, octreotide)

           ·         Antineoplastic agents (eg, streptozocin)

           ·         Fasting hypoglycemia: Dietary therapy (frequent meals/snacks preferred, especially at night, with complex carbohydrates); IV glucose infusion; IV octreotide

           ·         Reactive hypoglycemia: Dietary therapy (restriction of refined carbohydrates, avoidance of simple sugars, increased meal frequency, increased protein and fiber)

REFERENCES

• O.Hamdy, R.Khardori. (2014, december 22). Hypoglycemia . Retrieved May 7, 2015, from medscape: http://emedicine.medscape.com/article/122122-overview

• Association, A. D. (2014, September 16). Hypoglycemia (Low Blood Glucose). Retrieved May 7, 2015, from www.diabetes.org: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

• R.Nall. (2014, April 21). Low Blood Sugar (Hypoglycemia). Retrieved May 7, 2015, from www.healthline.com: http://www.healthline.com/health/hypoglycemia#Overview1