In diabetics, hypoglycemia occurs about once or twice a week. Responsible for the regulation of the blood sugar level are on the one hand the sugar intake with food (exogenous supply), on the other hand different hormones like insulin and glucagon as well as the sugar consumption of the body by its cells. In addition, the body can also produce glucose itself, which is done with the help of the liver (glycogen storage) from glycogen or as new formation.
If sugar is now taken up with food from the gastrointestinal tract, the hormone insulin is reactively released by the pancreas, which enables glucose to be absorbed into certain body cells. There the glucose is used to produce energy. If the blood sugar level is too low, the hormone glucagon is released from the pancreas and causes an increase in the blood sugar level with the help of the liver‘s glycogen stores or through the formation of new glucose (gluconeogenesis).
In summary, it can be said that the blood sugar level drops when the body cells absorb glucose for energy production from the blood. The sugar level is increased either by food intake or by glucose delivery from the liver. With a Unterzuckerung this mechanism is disturbed.
In response, the body releases adrenaline, a catecholamine, which causes the autonomic symptoms (see below). For this reason, the autonomic symptoms are also called adrenergic. The central nervous symptoms are the result of a glucose deficiency in the brain, which means that the only source of energy for the nerve structures is lost, resulting in disorders in their function.
Another name for these complaints is neuroglycopenic symptoms (neuroglycopenia = glucose deficiency in nerve structures). Hypoglycaemia is diagnosed on the basis of the symptoms as well as by means of sugar determination in the blood. If no diabetes mellitus is known in the affected person, the cause of hypoglycaemia is investigated further.
These include first and foremost the measurement of blood glucose, insulin in the blood and C-peptide, a protein that is produced during insulin production in the body. One C-peptide molecule is produced per insulin molecule. If both insulin and C-peptide show elevated blood levels, it can be concluded that hypoglycaemia is caused by too much insulin produced in the body or by orally absorbed sulfonylureas (antidiabetic).
To differentiate between these two causes, the level of sulfonylurea and the amount of proinsulin in the blood is determined. If the former is increased, a previous intake of medication is possible; if the latter is increased, an overproduction of insulin by the body itself (for example as a result of an insulinoma). If, on the other hand, the C-peptide has a low value, there is very likely an exogenous (“external”) insulin supply which has caused hypoglycaemia.
The diagnosis of hypoglycaemia can be supplemented by imaging procedures such as computer tomography or magnetic resonance imaging (for tumors) and determination of other laboratory values (liver values, kidney values) or hormone levels (for adrenal or anterior pituitary insufficiency). The first signs of diabetes can be frequent urination, increased thirst, as well as persistent fatigue and exhaustion. Diabetes can also occur in babies, toddlers and children, which is also manifested by severe thirst and frequent urination.
Their breath may also smell of nail polish remover. Pregnant women can also be affected by diabetes, but they do not experience the typical signs of diabetes such as frequent urination. More on this topic: Frequent urinationIf the symptoms described above are present in an affected person, hypoglycemia is not the only possible cause.
Epilepsies (seizures), a stroke (apoplexy) or psychiatric illnesses (psychoses) are also conceivable. These can be differentiated in the course of further diagnostic investigations. In diabetics, hypoglycaemia can be prevented by taking part in a training course on the disease and on the early signs of imminent hypoglycaemia. Since there are individual differences in the perception of these early symptoms, this must first be learned in training.One way to learn is behavioural training (according to Cox), which includes self-observation, interpretation of hypoglycaemia symptoms and taking countermeasures (e.g. eating glucose or drinking cola/juice).