Hypoglycemia: Most common complication of Diabetes

Hypoglycemia is defined arbitrarily as blood glucose less than 3.5 mmol/l or 70mg/dl with clinical features of neuroglycopenia and autonomic over activity. Glucose is an obligate metabolic fuel for the brain  under physiological conditions. It requires a virtually continuous supply of glucose from the circulation. Because the brain cannot synthesize glucose, or utilize physiologic concentrations of circulating non-glucose fuels effectively.hypoglycemia: healthnadvices.com

Causes of Hypoglycemia:

Autonomic features are also called warning symptoms

  • Sweating
  • Tremor
  • Palpitation
  • Hunger and
  • Anxiety

Neuroglycopenic features occurs due to disturbance of CNS from low blood glucose

  • Confusion
  • Drowsiness
  • Speech difficultyhypoglycemia|healthnadvices
  • Inability to concentrate
  • In coordination
  • Irritability and
  • anger

Non-specific

  • Nausea
  • Tiredness and
  • Headache

Drugs

  • Insulin or insulin secretagogue
  • Alcohol

Critical Illnesses

  • Hepatic, renal, or cardiac failure
  • And Sepsis

Hormonal Deficiency

  • Cortisol
  • Glucagon and epinephrine (in insulin-deficient diabetes mellitus)

Others

  • Unexpected or unusual exercise
  • Missed, delayed or inadequate meal
  • Insulinoma (insulin producing tumor )
  • Post-gastric bypass hypoglycemia
  • Autoimmune
  • Antibody to insulin and/or Antibody to insulin receptor
  • Finally, Accidental, Surreptitious, or Malicious

Diabetes is Actually the mother of all Diseases. Severe hypoglycemia in diabetic patients may leads to life threatening conditions. It is true that Hypoglycemia is Dangerous than Hyperglycemia.

CNS

  • Impaired cognitive function
  • Coma
  • Convulsions
  • Intellectual decline
  • Transient ischemic attack
  • stroke  Brain damage (rare)
  • Focal neurological lesions (rare)

Heart

  • Cardiac arrhythmia
  • Myocardial ischemia

Eye

  • Vitreous hemorrhage
  • Worsening of diabetic retinopathy

Other

  • Accidents (including road traffic accidents) with injury
  • Hypothermia

Emergency treatment in case of mild hypoglycemia

  • 10-15 gm glucose or equivalent foods usually raise blood sugar up to normal range.
  • This food/drink is repeated until patient is stable.
  • Stop all sort of anti diabetic medications.
  • If the features persists even after several attempts, hospitalization is to be considered.

In case Of Severe hypoglycemia:

  • Intramuscular injection of glucagon 1mg can be given.
  • Intravenous injection of 50-100ml of 25% glucose can be given. Thereby, hospitalization is only option.
  • If hypoglycemia occurs due to long acting anti diabetic agents, then 10% dextrose IV should be started to prevent recurrent hypoglycemia.

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