Hypoglycemia is a drop in blood glucose below a level of approximately 60 mg/dl or 3.3 mmol/l. In the medical sense, hypoglycemia is not a disease in its own right, but rather a condition caused by other circumstances or diseases.
What is hypoglycemia?
Hypoglycemia is when blood sugar levels fall below certain levels. In this case, important organs such as the brain are not supplied with sufficient glucose (sugar), which can lead to neurological deficits. Hypoglycemia is usually recognized by its symptoms, but symptoms do not always have to be present. Depending on the severity of the hypoglycemia, symptoms are divided into three groups. First symptoms – also called autonomic or adrenergic signs – manifest as ravenous hunger, nausea, vomiting, sweating and palpitations. As it progresses, neurological deficits are added, such as confusion, coordination and visual disturbances. These symptoms are signs that glucose deficiency has already affected the central nervous system. This group of symptoms is called neuroglycopenic signs. If the hypoglycemia is not treated as it progresses, it can lead to paralysis, hypoglycemic shock, and seizures. The third group of symptoms is called nonspecific signs. These are accompanying symptoms that are not characteristic of hypoglycemia. However, nausea, dizziness, and headache may be early indications of hypoglycemia.
Causes
There are many causes of hypoglycemia. Often, underlying diseases such as diabetes mellitus are present. In this case, an excessively high dose of insulin can be the trigger of hypoglycemia, so that this is referred to as diabetic-induced hypoglycemia. Another form is the so-called reactive hypoglycemia. This often affects overweight and obese people. Due to a high intake of carbohydrates, too much insulin is released into the blood for a short time, causing the sugar level to drop rapidly. Other causes are heavy physical exertion at work and in sports, as this depletes the body’s energy reserves, so that hypoglycemia can occur if this is not compensated for. Alcohol abuse results in the body having an excess demand for sugar, as the organs need the energy to break down the alcohol. As a result of alcohol abuse, the liver is usually severely damaged, so that it is no longer able, or only to a limited extent, to store glucose or to form new glucose. Hormones also have an influence on blood glucose levels, as they are necessary helpers to produce glucose from amino acids. In various diseases such as cancer, kidney disease and pancreatitis, various hormones such as cortisol can no longer be produced, which can result in hypoglycemia. Medications, gluten and fructose intolerance, and food allergies can also be causes of hypoglycemia.
Symptoms, complaints, and signs
Hypoglycemia is manifested by symptoms such as cravings, tremors, and difficulty concentrating. In many patients, hypoglycemia causes severe fatigue and lassitude, often associated with impaired consciousness. These symptoms are accompanied by increased irritability and inner restlessness. In individual cases, hypoglycemia causes skin irritations. Those affected then suffer temporarily from severe itching and redness, which can occur all over the body. However, hypoglycemia can also cause serious complications. If the hypoglycemia is not quickly compensated, the affected person may lose consciousness or even fall into a coma. In less severe cases, hypoglycemia causes the affected person to feel very unwell. In most cases, this is accompanied by a feeling of sickness that slowly recedes after the blood glucose level has stabilized. Hypoglycemia usually occurs suddenly or over the course of a few hours and persists for several hours. If the blood glucose level is balanced early on, the symptoms and discomfort can be reduced, but the concentration problems and dizziness often persist for some time. In diabetes patients, hypoglycemia can have life-threatening consequences. If the patient is not given insulin immediately, he may lose consciousness and fall into a diabetic coma.
Diagnosis and course
Hypoglycemia is diagnosed by the general practitioner. Symptoms such as trembling, sweating, ravenous appetite, concentration disorders are the first clues. After the initial examination, a so-called blood glucose test is performed right at the beginning. With a small prick in the fingertip, a small amount of blood is taken with a test strip, which can be evaluated immediately on site with the help of a blood glucose meter. During the evaluation, it is important to note whether the patient is diabetic or not. In non-diabetics, hypoglycemia is said to be below 60 mg/dl. In diabetics, however, a value of less than 80 mg/dl can already be considered hypoglycemia, since they are usually accustomed to higher blood glucose levels. Mild hypoglycemia, such as can occur after exercise, is relatively harmless. However, more frequent occurrences can lead to habituation, resulting in life-threatening complications in the form of hypertension and CHD (coronary heart disease). Because hypoglycemia is sometimes asymptomatic, mild hypoglycemia can be overlooked and immediately develop into severe hypoglycemia. The course of severe hypoglycemia with hypoglycemic shock can be life-threatening. Since this condition is often accompanied by paralysis and unconsciousness, immediate emergency medical attention is required. Studies in type 2 diabetics have found that repeated severe hypoglycemia increases the risk of developing dementia later in life.
Complications
Hypoglycemia causes severe limitations in the patient’s life. It is not uncommon for affected individuals to faint and lose consciousness, which can occur especially during strenuous physical activity or sports. There is a disturbance of concentration and coordination. The affected person suffers from ravenous hunger and often trembles. Furthermore, inner restlessness occurs and the patient suffers from sweating or panic attacks. If unconsciousness occurs, the patient may injure himself in a possible fall or suffocate afterwards. As a rule, help from another person is always necessary. If hypoglycemia persists over a long period of time, damage to organs or paralysis may also occur. In many cases, these are not reversible and therefore cannot be treated subsequently. Likewise, hypoglycemia results in an increased risk of dementia. In most cases, hypoglycemia is treated acutely by adding glucose. No further complications occur. However, the symptoms and sequelae depend on the duration of hypoglycemia.
When should you go to the doctor?
If symptoms such as ravenous hunger, weakness, and tremors are noticed, hypoglycemia may be underlying. A physician should be consulted if symptoms persist for several days or recur within a few weeks. If other symptoms develop, such as irritability, inner restlessness or poor concentration, medical advice is also required. Low blood glucose levels indicate diabetes or another serious disease that needs to be diagnosed and treated, if not already done. That is why a doctor should be consulted at the first sign of hypoglycemia. If paralysis, panic attacks or coordination problems occur, it is best to call an emergency doctor or the affected person must be taken immediately to the nearest clinic. People suffering from diabetes mellitus, cancer, pancreatitis or hormonal disorders should talk to the doctor in charge if they show signs of hypoglycemia. Overweight people and alcoholics are also among the risk groups who should clarify said symptoms immediately. With children who show signs of low blood sugar is best to go to the pediatrician.
Treatment and therapy
In the treatment of hypoglycemia, a distinction can be made between acute therapy and long-term therapy. The form of therapy depends on the blood glucose levels. Immediate therapy may be as follows:
If the blood glucose value is less than 80 mg/dl, one meal is usually sufficient to rebalance the glucose balance. If the value is below 60 mg/dl, one or two pieces of dextrose (1 BE) will help, so that the symptoms of hypoglycemia will recede. After about 30 minutes, blood glucose should be measured.In the event of severe hypoglycemia with values below 50 mg/dl, emergency medical care is urgently required, as only a dose of glucose administered intravenously can help to restore blood glucose balance. Furthermore, close blood glucose monitoring over a longer period of time is necessary. Long-term therapy involves intensive education of the patient at the beginning. If hypoglycemia is present in a diabetic, family members should also learn how to use glucagon prefilled syringes so that they can be injected into the thigh or buttocks of the affected person in an emergency.
Prevention
Preventive measures for hypoglycemia include education and training of the sufferer and their family members. Those who frequently suffer from hypoglycemia should regularly check their blood glucose levels. There are inexpensive devices for home use that can be carried around because they are so handy. It is important that those affected eat a regular and healthy diet, especially when physical exertion is imminent. Alcohol should be avoided. Patients should always carry glucose with them for immediate therapy. Furthermore, it is useful to keep a hypoglycemia diary, noting when and during which activities hypoglycemia occurs.
Follow-up
Hypoglycemia (low blood sugar) requires follow-up care even after timely and successful treatment. On the one hand, this applies to the regeneration of the weakened organism and, on the other hand, to the prevention of renewed hypoglycemia. Initially, patients affected by hypoglycemia allow themselves physical rest and also avoid psychological excitement. Both have an effect on the blood glucose level, which should, however, be kept at a stable level after successfully treated hypoglycemia, as long as the person needs to recover from the illness. Part of the aftercare is therefore the initial abstention from exercise, which must be maintained over a longer period of time. In addition, with an eye to the future, measures must be planned to counteract hypoglycemia during exercise. These include, above all, taking regular breaks from eating and, if necessary, measuring blood glucose levels. The same applies to the patient’s working life, especially if this involves more or less physically demanding activities. Aftercare of hypoglycemia due to illness also includes developing an adequate eating plan. This includes not only the type and amount of meals, but also the times at which they are eaten. A professional nutritionist can offer useful support. In addition, those affected should arrange regular check-ups with their doctor in order to keep a permanent eye on the long-term sugar levels in the blood and to be able to make rapid changes if necessary.
What you can do yourself
Hypoglycemia can be due to a number of different causes. What self-help measures the patient can take depends on what is triggering the disorder. Hypoglycemia can result from diabetes mellitus, for example. Particularly in diabetics who are poorly controlled with medication, hypoglycemia can occur again and again. Those affected can counteract this by having their blood glucose levels tested regularly and also using the prescribed medication as prescribed. Overweight people who are prone to eating attacks often suffer from reactive hypoglycemia. If too many carbohydrates are consumed during an eating attack, the body reacts by releasing excessive amounts of insulin, which can cause blood glucose levels to drop dramatically. If this happens more often, those affected must change their diet. This may require the help of a therapist in the case of addictive behavior. This also applies to people whose sugar levels are regularly too low due to continued alcohol abuse. When high amounts of alcohol are consumed, the body uses more sugar to break down the toxin. In addition, a liver that has been pre-damaged by alcohol can only store a small amount of glucose, which exacerbates the problem. In addition, intense physical exertion, for example during sports, can lead to more sugar being consumed than supplied. This can be prevented by regular breaks and small snacks.
