What Is Diabetic Hypoglycemia?

Refers to a syndrome caused by low blood glucose levels caused by multiple causes. Generally, hypoglycemia is defined as plasma blood glucose concentration <2.8mmol / L, or whole blood glucose <2.5mmol / L. The diagnostic criteria for hypoglycemia in children is 1.11 mmol / L lower than the adult value.

Basic Information

nickname: Hypoglycemia
Visiting department: Endocrinology
Common symptoms: Hunger, weakness, sweating, tachycardia, increased systolic blood pressure, reduced diastolic blood pressure, tremor, transient blackness, disturbance of consciousness, coma

Contagious: no

Causes of hypoglycemia

Hypoglycemia on an empty stomach

Hypoglycemia appears before breakfast.

(1) Endocrine Too much insulin or insulin-like substance. Insulinoma (including benign, malignant, and proliferative), extrapancreatic tumors such as giant fibroids or fibrosarcomas; Hydrocortisone (cortisol) deficiency, hypoadrenal cortex function, hypopituitar function, growth hormone deficiency, Hypothyroidism.

(2) Hepatic Severe diffuse liver disease; Severe heart failure with liver congestion; Hepatic enzyme abnormalities, such as hepatic glycogen accumulation, galactosemia, and glycogen synthase deficiency.

(3) Excessive consumption and insufficient intake Fasting hypoglycemia during pregnancy; Chronic diarrhea, chronic hunger, excessive drinking, renal diabetes, and advanced renal failure; Severe malnutrition.

2. postprandial hypoglycemia

Symptoms occur 2 to 5 hours after eating and are also called reactive hypoglycemia.

(1) Functional hypoglycemia of unknown cause.

(2) Early type 2 diabetes.

(3) Hypoglycemia after gastrointestinal surgery, such as most resection of the stomach and anastomosis of the stomach and jejunum.

(4) Hypoglycemia caused by leucine, excessive insulin secretion due to excessive sensitivity to leucine.

3. Drug-induced hypoglycemia

Blood glucose is the main source of energy for brain cells. During hypoglycemia, brain tissue mainly depends on glycogen breakdown of the brain itself and liver reserve to maintain metabolism, while glycogen stored in the brain tissue itself is limited, only 800mg / dl, especially the cerebral cortex contains only 73mg / dl. So the effect of hypoglycemia on the body is mainly the nervous system, especially the brain and / or sympathetic nerves. Severe and prolonged episodes of hypoglycemia can cause extensive neurological disease. Early hypoglycemia is the point of cerebral congestion and multiple bleeding; in the later period, Na ⁺ and K ⁺ enter the cells and cause brain cell edema and hemorrhagic punctate necrosis, which are most obvious in the cerebral cortex, basal nucleus, hippocampus, etc. Disappeared and brain tissue softened. In the early stage, the cerebral cortex was inhibited, and then the subcortical center including the basal nucleus, the hypothalamus, and the autonomic nerve center were successively involved, and finally affected the midbrain and the medulla. Brain cells become more sensitive to hypoxia and glucose.

Clinical manifestations of hypoglycemia

1. Patients with acute hypoglycemia and short duration present sympathetic nervous excitement groups, such as irritability, hunger, weakness, sweating, tachycardia, elevated systolic blood pressure, reduced diastolic blood pressure, tremor, transient blackness, and disturbance of consciousness And even coma.

2. Patients with subacute and slow blood glucose decline have encephalopathy symptoms in various forms, but each episode of the same patient often presents the same type of symptoms. Most patients present with symptoms of the cerebral cortex and / or cerebellum, such as headache, dizziness, anxiety, irritability, lethargy, distracted attention, disorientation, tremor, major or minor seizures, personality changes (crying, noisy, noisy, Scolding), bizarre behavior, ataxia, etc., finally coma. Long-term severe hypoglycemia can cause permanent brain damage.

Hypoglycemia test

Inspection

Measure fasting and onset blood glucose, blood insulin, C peptide levels, calculate insulin release index (fasting blood insulin / fasting blood glucose), and if necessary, do starvation test (whether fasting for 12 to 72 hours induces hypoglycemia) and insulin release inhibition test Compare serum C-peptide levels before and after injection).

2. Abdominal ultrasound examination

Do as necessary.

3.X-ray inspection

In patients with suspected insulinoma, abdominal CT, especially pancreatic CT, portal vein and splenic vein catheters can be used to measure insulin, and selective pancreatic angiography.

Hypoglycemia diagnosis

In addition to a detailed medical history and determination of blood glucose, three Whipple standards must be met: the onset is mostly under fasting or exertion; clinical symptoms can be quickly relieved after glucose injection or oral sugar water; blood glucose in adults and children at the onset Below 3.0mmol / L. For hypoglycemia caused by adrenal and pituitary diseases, urine 17-ketosteroids, 17-hydroxysteroids, growth hormone, ACTH measurement, L-leucine test, glucagon test, etc., as well as plain skull or CT, MRI Etc. to assist in diagnosis.

Hypoglycemia Treatment

Emergency treatment

Gently administer sugar foods or beverages. Those who cannot take orally or have severe symptoms immediately inject 50% glucose 50 100ml, followed by 5 10% glucose infusion. Those who have no obvious response to glucose supplementation may be: long-term hypoglycemia; hypoglycemia accompanied by fever; hypoglycemia with decreased endocrine function. Need to add a larger amount of glucose, and add hydrocortisone 100-200mg mixed with glucose drip. Glucagon can also be injected intramuscularly or intravenously. If you are unconscious, do not feed to avoid suffocation of the respiratory tract.

2. Etiology treatment

Functional and reactive hypoglycemia should be given to a low-sugar, high-fat, high-protein diet, eat less and eat more, and give a small amount of sedatives and drugs to inhibit the vagus nerve. Hypoglycemia caused by tumors and other reasons must be treated accordingly.

Hypoglycemia prevention

Many hypoglycemia can be prevented by appropriate treatment. Cortisone can be used in patients with hypohypophysis and adrenal cortex; hypothyroidism can be supplemented with dry thyroid tablets to promote metabolism, glucose absorption, and blood sugar levels; hypoglycemic liver disease can be treated with A high-protein diet with meals before bedtime.