Symptoms
Hypoglycemia is an abnormally low blood glucose level. The organism first tries to counteract by activating the sympathetic nervous system, because this increases the level. Central symptoms occur because the brain is no longer supplied with sufficient glucose (neuroglycopenia). The brain can hardly store glucose and is dependent on a continuous supply. Possible symptoms include:
- Feeling of hunger, ravenous appetite
- Sweating, pale skin
- Palpitations, racing heart, high blood pressure.
- Headache, dizziness
- Nausea, vomiting
- Fatigue, weakness, drowsiness
- Tremor, restlessness, irritability, anxiety.
- Concentration disorders
- Confusion, behavioral changes, visual disturbances, speech disorders.
- Bradycardia, shallow breathing.
- Convulsions
- Drowsiness, unconsciousness
- Coma
Hypoglycemia can lead to accidents and, in the worst case, can be fatal. Before driving, diabetics should measure blood glucose. Repeated hypoglycemia can negatively affect well-being, quality of life, social activities, and work, and can be a barrier to successful therapy. A possible complication of hypoglycemia is weight gain because patients overeat out of fear. Hypoglycemia can also occur during the night. Possible complaints include nightmares and sweating, as well as fatigue and irritability upon waking. It should be noted that beta-blockers can mask these symptoms because they are sympatholytic.
Causes
Hypoglycemia often occurs as a side effect of antidiabetic drugs, typically after taking sulfonylureas and after injecting insulins. Insulin-dependent patients are more commonly affected. Risk factors include:
- A high dose of the antidiabetic drugs
- Combination therapies
- Lack of information to patients
- No regular blood glucose control
- Drug interactions
- Alcohol consumption
- Exuberant meals, fasting (fasting, Ramadan).
- Physical activity, sports
- Poor general condition, diseases, liver and kidney failure.
Diagnosis
The diagnosis can be made on the basis of clinical symptoms, medication history and with an examination of blood glucose. Under which blood glucose value is spoken of a hypoglycemia, is different and individual. A capillary blood glucose value of 3.9 mmol/L is common. The diagnosis is confirmed when the patient’s condition improves after glucose administration. Other possible causes of hypoglycemia include alcohol abuse, liver disease, fasting, insulinoma, or heredity. This article refers to hypoglycemia in the context of diabetes therapy.
Nonpharmacologic treatment
If symptoms of hypoglycemia occur, individuals should first immediately take 10 to 20 g of glucose1 to be ingested, e.g., in the form of fruit juices, sodas (no light products), as glucose for chewing, as a glucose gel, or as a sweet. If this is not sufficient after 15 minutes, the dose should be given again. Diabetics should therefore always carry an appropriate product. In case of severe hypoglycemia, 30 g of glucose is recommended. After blood glucose has normalized, an additional snack or meal should be consumed.
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Drug treatment
Glucose can also be administered intravenously as a drug. This is necessary only when oral therapy is not desired by patients or is not possible because of unconsciousness. In the case of insulin therapy, the antihypoglycemic drug glucagon is also approved. It is injected subcutaneously or intramuscularly and increases blood glucose levels. Glucagon is an antagonist of insulin. The injection must be administered by a third person, such as a partner or friend. The environment must be instructed accordingly. In 2020, an easy-to-use glucagon nasal spray was also approved in many countries.