Hypoglycemia and Hyperglycemia

Hypoglycemia

  • Occurs when glucose levels drop too low.
  • Brain struggles to function, leading to:
    • Confusion
    • Seizures
    • Coma
  • Brain glucose dysfunction triggers an emergency response, releasing adrenaline and epinephrine.
  • Symptoms include:
    • Sweating
    • Shakiness
    • Palpitations
  • Without intervention, brain function declines leading to:
    • Confusion
    • Seizure
    • Coma
  • Defined as blood sugar level under 7070 mg/dL.
  • Onset can be super rapid, happening in minutes.
  • Causes:
    • Excess insulin
    • Skipping meals (with insulin administration)
    • Excessive exercise
    • Alcohol use
    • Insulin overdose
  • Symptoms:
    • Shakiness
    • Sweating
    • Dizziness
    • Confusion
    • Hunger
    • Palpitations
    • Irritability

Hyperglycemia

  • Occurs when glucose levels climb too high.
  • Body becomes overwhelmed, causing:
    • Dehydration
    • Fatigue
  • Can lead to life-threatening complications like:
    • Diabetic ketoacidosis (DKA)
    • Hyperosmolar hyperglycemic state (HHS)
  • Excess glucose pulls water from the cells.
  • Brain perceives a hyperosmolar situation, causing excessive thirst.
  • Excessive thirst leads to increased urination.
  • Glucose elimination by kidneys also pulls water into the urine.
  • Without enough insulin, glucose remains trapped in the bloodstream, starving the cells, triggering hunger.
  • Over time, damages blood vessels, nerves, and organs, increasing the risk of life-threatening complications.
  • Usually defined as blood sugar level over 250250 mg/dL.
  • Onset:
    • Gradual, from hours to days, depending on whether it is DKA or HHS.
  • Causes:
    • Infections
    • Stress
    • Insulin deficiency
    • Corticosteroid use
    • Uncontrolled diabetes
  • In elderly patients, hyperglycemia can be an early sign of infection, even 24-48 hours before other symptoms appear.
  • Symptoms:
    • Blurred vision
    • Fatigue
    • Dry skin
    • Slow wound healing

Comparison of Hypoglycemia and Hyperglycemia

FeatureHypoglycemiaHyperglycemia
Blood Sugar LevelUnder 7070 mg/dLOver 250250 mg/dL
OnsetRapid (minutes)Gradual (hours to days)
CausesExcess insulin, skipping meals, exercise, alcohol, insulin overdoseInfections, stress, insulin deficiency, corticosteroids, uncontrolled diabetes
SymptomsShakiness, sweating, dizziness, confusion, hunger, palpitations, irritabilityBlurred vision, fatigue, dry skin, slow wound healing

Severe Complications

  • Hypoglycemia:
    • Loss of consciousness, seizures, coma, and death (quicker onset).
  • Hyperglycemia:
    • Type 1 Diabetes: DKA
    • Type 2 Diabetes: HHS

Management

  • Hypoglycemia:
    • If unconscious: Glucagon (if they cannot swallow)
    • Dextrose
  • Hyperglycemia:
    • Insulin administration.
    • IV fluids for dehydration.
    • Correcting underlying cause (e.g., treating infection, tapering corticosteroids).
    • Monitor for hypokalemia due to potassium shift from extracellular to intracellular space during insulin administration.