Cause Of Hypoglycemia Diabetes

Hypoglycemia is reduced blood sugar level (more precisely serum glucose level) below normal lower limit. Plasma glucose concentrations are normally maintained within a relatively narrow range, roughly 70–110 mg/100 ml of blood (3.9–6.1 mmol/Liter) in the fasting state with slightly higher range after meal, despite wide variations in exogenous glucose delivery from meals and in endogenous glucose utilization.

In between meals, during fasting and during exercise the plasma glucose level is maintained by endogenous glucose production, hepatic glycogenolysis (breakdown of glycogen to glucose), and hepatic gluconeogenesis (formation of glucose from non carbohydrate sources like proteins and lipids). Plasma glucose level below 70 mg/100 ml of blood may not produce hypoglycemia symptoms, but at level below 55 mg/100 ml of blood invariably produce signs and symptoms of hypoglycemia which are promptly reversed if glucose level is raised.

Hypoglycemia Symptoms

Hypoglycemia cause two types of symptoms namely neuroglycopenic symptoms and neurogenic or autonomic symptoms of hypoglycemia. The neuroglycopenic hypoglycemia symptoms are due to glucose deprivation of central nervous system (CNS). The neuroglycopenic symptoms of hypoglycemia are confusion, fatigue, seizure, loss of consciousness, behavioral changes and, death in extreme cases if hypoglycemia is severe and prolonged. The neurogenic or autonomic hypoglycemia symptoms are adrenergic symptoms (such as palpitations or very fast heart rate, tremor, and anxiety), cholinergic symptoms (such as sweating, hunger, and paresthesias).

All the above symptoms are not specific to hypoglycemia and to prove the symptoms are due to hypoglycemia requires a corresponding low plasma glucose concentration and reversal of symptoms after the glucose level is raised, which is known as Whipple's triad. Whipple's triad are: (1) symptoms of that particular problem that are always in consistency with hypoglycemia, (2) a below normal plasma glucose level estimated with a best available method and (3) relief of the symptoms (mentioned in no. 1) after the plasma glucose level is raise.

Sign Of Hypoglycemia And Prevention

The signs of hypoglycemia are pallor of skin, increased heart rate, raised blood pressure etc. Sometimes there may be transient focal neurological deficit which generally reverse after the serum glucose is raised. Permanent neurological deficit, if ever occur is extremely rare.

To prevent hypoglycemia, especially recurrent hypoglycemia diabetes requires an understanding of the mechanism as well as a thorough knowledge of hypoglycemia symptoms and possibly signs of hypoglycemia. If it is due to some drug (drugs like quinine cause hypoglycemia) the offending drug should be withdrawn to prevent hypoglycemia. One of the commonest causes of hypoglycemia is use of oral hypoglycemic drugs (like sulfonylureas) for treatment of diabetes. If hypoglycemia is due to underlying disease the disease should be treated appropriately. Hypoglycemia due to tumor can be controlled by radiotherapy, chemotherapy or surgery.

If all the above measures fail to prevent hypoglycemia, than frequent feedings and avoidance of fasting may be required. Administration of uncooked cornstarch at bedtime or even an overnight intragastric infusion of glucose may be required in some patients to prevent hypoglycemia.