41. Hypoglycemia

Hypoglycemia?

Serum glucose below 3,5 mmol/L

Most frequently occurs in diabetic patients who have administered too much insulin

- Most characteristic in DM1

Other disorders that can cause hypoglycemia?

- Chronic alcoholics -> they are starving & NAD+ production depletes body of pyruvate

- ß-blockers (block the adrenergic activation)

- Insulinomas

What will hypoglycemia activate?

Adrenergic hormones like epinephrine and norepinephrine

- Activates glycogenolysis and to some extent -> gluconeogenesis

Symptoms of hypoglycemia?

Divided into two groups:

- Due to increased adrenergic activity

- Due to decreased glucose supply to brain

Adrenergic symptoms?

Appear around 3.0 mmol/L

- Sweating

- Tachycardia

- Palpitations

- Aggressiveness

- Hunger

Neuroglycopaenia symptoms?

Appear around 2,8 mmol/L

- Headache

- Weakness

- Dizziness

- Confusion

- Convulsions

- Coma

Death?

May occur in severe cases

Types of hypoglycemia?

- Postprandial hypoglycemia

- Fasting hypoglycemia

- Diabetic hypoglycemia

Postprandial hypoglycemia?

After food intake

-> Late dumping syndrome - due to massive immune response

-> Inborn errors of metabolism - fructose intolerance

Fasting hypoglycemia?

Increased glucose usage

- Exercise

- Insulinoma

- Overdose of insulin

Decreased glucose production

- End-stage of starvation

- Premature babies

- Acute liver failure

- Adrenal, glucagon deficiency

- Alcohol intoxication

Hypoglycemia in diabetes?

Common episodes in DM1

- Can be hard to strictly monitor correct food intake and insulin administration

What factors can cause hypoglycemia in DM1?

- Too much insulin intake

- Consuming too little glucose/(food)

- Exercising

- Alcohol ingestion -> decreasing endogenous glucose production

What can increase risk of fatal outcome of hypoglycemia?

Diabetic neuropathy

- There are lack of symptoms -> not aware of them

Hypoglycemia DM2?

Does not occur so often

- Only in severe insulin overdose

Hypoglycemic coma?

If glucose levels drop suddenly and rapidly

Brain does not receive enough glucose => energy deficiency

- Edema

- No membrane transport

Treatment hypoglycemia?

Give glucose

- Treat underlying cause