• Hypoglycemia: symptoms and treatment, causes, symptoms

    What it is? Hypoglycemia is a condition where the blood glucose level is less than 3.0 mmol / liter, which is accompanied by the development of specific symptoms.

    Pathology belongs to the category of urgent, since the brain is very difficult to work in conditions of a reduced concentration of glucose.

    Although there is no hard correlation between the level of glucose and developing symptoms, blood concentrations below 2.5 mmol / l are dangerous because of the development of hypoglycemic coma, when the future life of a person depends on the speed of proper care.

    Hypoglycemia can develop in healthy and sick people. This condition occurs not only on an empty stomach;in some cases, a person may lack glucose after a very short time after eating.

    Causes of hypoglycemia

    Hypoglycemia is divided into one that occurs after 5 or more hours after eating( it is called "fasting hypoglycaemia") and its alimentary appearance, which develops 1,5-3 hours after the end of food intake. The reasons for these two states are different.
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    At the heart of fasting hypoglycaemia is the disparity between the production of glucose by the liver and its use by peripheral tissues. That is, it occurs if either the liver does not cope with the synthesis of this carbohydrate, or when the tissues use it very much. The liver can "not know" that the tissues need a large amount of glucose due to:

    1. 1) The production of insulin in such a volume that prevents the action of glucagon hormone on the liver, which causes in it the cleavage of glycogen to glucose;
    2. 2) Inadequate release of amino acids from the muscles from which glucose should be formed;
    3. 3) Disturbance of the delivery of fatty acids to the liver or their oxidation in the liver, which affects the rate of glucose formation from amino acids.
    The synthesis of glucose in the liver slows down due to the following reasons:

    • pituitary dysfunction;
    • adrenal insufficiency;
    • decreased production of adrenaline, norepinephrine;
    • lack of glucagon;
    • less than normal, the number of enzymes that participate in the synthesis of glucose;
    • reduced amount of glucose with:
    • late pregnancy;
    • starvation;
    • decrease in muscle mass;
    • ketosis hypoglycemia, which develops in children;
    • liver disease:
    • congestion in the liver;
    • hepatitis;
    • renal and hepatic insufficiency;
    • cirrhosis;
    • reception of alcohol, salts of salicylic acid in the composition of other drugs, some drugs to lower blood pressure.
    Glucose is rapidly used by tissues due to such reasons:

    • tumor producing insulin;
    • introduction of synthetic insulin or sugar-reducing drugs;
    • shock, which develops in the massive disintegration of microbes in the body( endotoxic);
    • administration of quinine for the treatment of three-day malaria.
    With a normal amount of insulin, increased glucose utilization may result from:

    • liver tumors;
    • adrenal cancer;
    • cancers of the gastrointestinal tract.
    Hypoglycemia that occurs after eating develops as a result of:

    1. 1) Rapid devastation of the stomach and intestines due to such surgical interventions as gastric removal, artificial connection of the stomach with jejunum, pyloricheskogo stomach, vagotomy, performed with peptic ulcer.
    2. 2) The intake of galactose by a child with galactosemia.
    3. 3) Use of products with fructose by children with impaired tolerance to this carbohydrate.
    4. 4) The intake of amino acid leucine in people with susceptibility to it.
    5. 5) Early phase of diabetes mellitus.
    In healthy people, hypoglycemia develops with increased muscular work, when glucose is consumed, and easily digestible carbohydrates do not enter the body.

    Symptoms of hypoglycemia

    The first signs of hypoglycemia occur when the concentration of glucose in the blood is 3 mmol / l. Symptoms of this condition are pronounced:

    • arousal, anxiety, anxiety, fear;
    • general weakness;
    • tremor;
    • cold sticky sweat;
    • feeling hungry;
    • tachycardia;
    • dizziness;
    • pallor of the skin;
    • increased blood pressure;
    • coordination disorder;
    • nausea, vomiting;
    • double vision.
    With mild hypoglycemia, a person feels anxiety, he has a feeling of hunger, he begins to shiver;numb fingers, lips. He can also feel a stronger heartbeat.

    When hypoglycemia of moderate severity a person becomes irritable, anxious, it is difficult for him to concentrate on anything. Vision deteriorates, the head starts to hurt and turn.

    Severe hypoglycemia( usually observed with figures of 2.2 mmol / L and lower) is accompanied by inadequate behavior, gradually turning into drowsiness. If you do not help at this stage, the violation of consciousness deepens up to the sopor and coma, cramps are observed.

    There may be focal neurological symptoms of hypoglycemia and primitive automatisms( grasping, sucking reflex, grimaces).

    See also, the norm of sugar in the blood.

    Diagnosis of hypoglycemia

    To find out that a person currently has glycemia, you can use a blood test for glucose in the plasma( you can use a glucometer).But it is necessary( if it was not a single episode of hypoglycemia that developed against the backdrop of heavy physical work) also to find out the cause of this condition.

    When fasting hypoglycemia, you need to determine:

    • the level of insulin in the blood;
    • concentration of the hormone cortisol in the blood plasma;
    • level of C-peptide;
    • lactate in venous blood;
    • concentration in the plasma of glucagon, epinephrine;
    • carnitine in the blood;
    • proteinogram( protein and protein fractions in venous blood);
    • hepatic assays;
    • ultrasound or CT scan( as indicated) of the abdominal organs;
    • tests are performed with starvation, when a person is hospitalized and not fed, every 6 hours determining the levels of glucose, cortisol( a stress hormone) and insulin in the plasma;
    • samples with glucagon, butamide, leucine.
    When hypoglycemia develops after eating, the survey is different. The following are determined:

    • glucose tolerance test for 5 hours;
    • level of C-peptide;
    • level of insulin;
    • antibodies to insulin.

    Treatment of hypoglycemia

    If there is a violation of consciousness, a person with hypoglycemia should be given emergency help - to inject 20-100 ml of 40% glucose solution into the vein and then transfer to the dropwise administration of its less concentrated solution( 10-20%).

    These activities are carried out until the patient has come to a clear consciousness and can not eat food containing easily digestible carbohydrates( this is the only way to replenish glycogen in the liver).If hypoglycemia developed against an overdose of hypoglycemic drugs, glucose infusion does not stop, moving with the restoration of consciousness to a slower introduction of it under the control of blood sugar.

    Treatment of a disease causing hypoglycemia:

    1. 1) Resection of insulinoma;
    2. 2) If the suspicion of insulin is confirmed, but the tumor is not found, the drug is treated with "Diazoxide" or a combination of "Streptozocin" and "5-fluorouracil";
    3. 3) Removal of tumors of the adrenal glands, pituitary gland, their radiation or chemotherapy;
    4. 4) Treatment of pathologies of the liver, gastrointestinal tract;
    5. 5) Diet for patients with galactosemia, intolerance to fructose or leucine.

    Prevention of hypoglycemia

    It is possible to prevent the development of hypoglycemia in the event that its cause is known, which must be eliminated. Also, a person should always have easy digestible carbohydrates, which he must take when he develops signs of hypoglycemia. It can be:

    • sugar;
    • candy;
    • crackers;
    • honey;
    • corn syrup;
    • fruit juice;
    • milk;
    • cheese.

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