Hypoglycemia is the clinical syndrome that results from low blood sugar. The symptoms of hypoglycemia can vary from person to person, as can the severity. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range.
The body regulates its glucose level—the primary source of energy for the brain, muscles, and other essential cells – by the actions of different hormones. These hormones include insulin (which lowers the blood sugar level) and other chemicals which raise blood sugar (such as glucagon, growth hormone, and epinephrine).
- Both insulin and glucagon are manufactured in the pancreas, an organ near the stomach which assists the digestive tract. Special cells in the pancreas, called beta cells, make insulin. Alpha cells in the pancreas make glucagon.
- The role of insulin is to help in the absorption of glucose from the blood by causing it to be stored in the liver or be transported into other tissues of the body (for metabolism or storage).
- Glucagon increases the amount of glucose in the blood by breaking down stored glucose (starch, called glycogen) and releasing it from the liver into the bloodstream.
- Insulin and glucagon are usually correctly balanced if the liver and pancreas are functioning normally.
Traditionally considered a stress hormone, epinephrine (or adrenalin) is made in the adrenal gland and in certain cells in the central nervous system. Epinephrine also elevates blood glucose levels by making glucose available for the body during a time of stress. When this mechanism is not working properly, hypoglycemia can result. Other hormones also help in raising the level of blood glucose, like cortisol made by the adrenal gland and growth hormone made by the pituitary gland.
Most common causes
- Overmedication with insulin or antidiabetic pills (for example, sulfonylurea drugs)
- Use of medications such as beta blockers, pentamidine, and sulfamethoxazole and trimethoprim (Bactrim, Septra)
- Use of alcohol
- Missed meals
- Reactive hypoglycemia is the result of the delayed insulin release after a meal has been absorbed and occurs 4-6 hours after eating.
- Severe infection
- Cancer causing poor oral intake or cancer involving the liver
- Adrenal insufficiency
- Kidney failure
- Liver failure
- Congenital, genetic defects in the regulation of insulin release (congenital hyperinsulinism)
- Congenital conditions associated with increased insulin release (infant born to a diabetic mother, birth trauma, reduced oxygen delivery during birth, major birth stress, Beckwith-Wiedemann syndrome, and rarer genetic conditions
- Insulinoma or insulin-producing tumor
- Other tumors like hepatoma, mesothelioma, and fibrosarcoma, which may produce insulin-like factors
Signs and symptoms
Symptoms of hypoglycemia typically appear at levels below 60 mg/dL. Some people may feel symptoms above this level. Levels below 50 mg/dL affect brain function.
- Tachycardia and palpitations
- Blurred vision
- Seizures or loss of consciousness
- Cool, clammy skin
- Blood glucose level
- Electrolyte levels
- The patient will maintain airway patency and adequate circulation.
- The patient will display no change in neurologic status.
- The patient will demonstrate a blood glucose level between 60 and 150mg/dl.
- Ensure a patent airway.
- Administer liquids that contain glucose.
- If the patient is alert, give him juice with sugar added, followed by protein and complex carbohydrates to prevent hypoglycemia from recurring the next hour.
- If the patient has a decreased level of consciousness, establish a large-bore I.V.line and administer 50 ml of 50% dextrose as a bolus. If he doesn’t regain consciousness in 15 minutes, repeat the bolus of dextrose.
- If I.V. access can’t be established, administer glucose gel under the patient’s tongue or give glucose-rich liquids by nasogastric tube instead of providing the IM dextrose solution.
- If none of the above interventions is possible, administer glucagon or epinephrine I.M.
- Repeat the measurement of the blood glucose level in 1 hour.
- Monitor the patient’s heart rate, cardiac rhythm and blood pressure.
- Administer a normal saline bolus if hypotension occurs.
- Replace electrolytes based on laboratory test results.
- Help determine the cause of hypoglycemia by interviewing the patient and reviewing his history. Be sure to inquire about such common causes as poor food intake, medication changes, alcohol or other recreational drug use, hepatic or renal impairment that prevents gluconeogenesis, pancreatic tumor or an endocrine disorder, including impaired pituitary, thyroid, parathyroid, or adrenal glands.
- Be aware that postprandial hypoglycemia may occur with many conditions, especially after gastric by pass surgery.
- After determining which factors contributed to this incident of hypoglycemia help the patient understand how to prevent its recurrence.
- Teach the patient to recognize early signs and symptoms of hypoglycemia.
- Teach the patient how to use a glucometer at home if a chronic condition may cause hypoglycemia to recur.
- Emphasize the importance of having glucose tablets,hard candy, or other food containing simple sugars readily available.
Adult hypoglycemia treatment protocol developed by the Lovelace Medical Center Diabetes Episodes of Care (EOC) which you can read the entire treatment strategies here.
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