Hypoglycemia

Hypoglycemia is most often encountered in diabetic patients who fail to balance caloric intake with the amount of insulin or hypoglycemic agent taken. Less commonly, hypoglycemia occurs in fasting alcoholics (owing to the inhibition of gluttonousness by alcohol), patients with hepatic dysfunction, and in otherwise healthy elderly adults after a prolonged fast. Hypoglycemia also occurs in infants with poor caloric intake (inadequate glycogen stores) and children who ingest alcohol (owing to inhibition of gluconeogenesis and poor glycogen stores).

Many other medications stimulate insulin secretion or inhibit gluconeogenesis (e.g., pentamidine, propranolol, quinine, and salicylates, among others) and can cause hypoglycemia in overdose. Rarely, an insulinoma is the cause of hypoglycemia.

Causes

The possible specific causes of hypoglycemia in people without diabetes is lengthy. Causes include the following:

• Meals or snacks that are too small, delayed.
• Increased activity or exercise
• Excessive drinking of alcohol. Alcohol consumption can block the process of glucose production, depleting your body's stores of glycogen.
• Taking someone else's oral diabetes medication accidentally is a common cause of hypoglycemia.
• Medications used to control diabetes, other medications may cause hypoglycemia, especially in children and in people with kidney failure. One of the commonly used medications that may have this effect is quinine, which is used to treat leg cramps and malaria.

Symptoms

Signs and symptoms can be categorized into hyperadrenergic(owing to release of counter-regulatory hormones, such as epinephrine, secreted in response to a falling serum glucose) and neuroglucopenic (cerebral dysfunction due to insufficient glucose). Hyperadrenergic manifestations may be absent in longstanding diabetes due to diabetic autonomic neuropathy.

• Neuroglucopenic: progress from subtly diminished ability to concentrate to impaired judgment and memory, confusion, drowsiness, and disorientation
• Hyperadrenergic: sweating, tremor, sensation of warmth, generalized weakness, hunger, palpitations, and dizziness

Signs

• AMS: confusion ++++, bizarre behavior suggestive of a psychiatric disturbance ++, stupor ++, coma ++
• Seizures ++
• Focal neurologic deficit +; for example, a sudden hemiparesis suggestive of a stroke

Treatment

If you feel your blood glucose is too low. You use a blood glucose meter to check your level. If it is below, have one of these "quick fix" foods right away to raise your blood glucose. If symptoms of hyperglycemia occur:

• Half cup of any fruit juice
• 4 ounces of a regular soft drink
• 2 or 3 glucose tablets
• 1 cup of milk
• 5 or 6 pieces of hard candy
• One and some extra teaspoons of sugar or honey
• Take your usual insulin dose. Do Not Skip it.
• Keep eating your meals.
• Test your blood for glucose and your urine for ketones every two hours.