What Is Non-Diabetic Hypoglycemia?

Idiopathic functional hypoglycemia

Idiopathic functional hypoglycemia This disease is mainly seen in people with emotional instability and neuroticism, more common in middle-aged women. Psychological stimuli and anxiety are often induced, which may include anxiety, vasomotor instability, physical, and colonic irritability syndrome.

Idiopathic functional hypoglycemia disease name

Idiopathic functional hypoglycemia

Overview of Idiopathic Functional Hypoglycemia

Idiopathic functional hypoglycemia disease classification

Endocrinology

Idiopathic functional hypoglycemia symptoms and signs

Hypoglycemia occurs most frequently 2 to 4 hours after breakfast. The clinical manifestations are mainly adrenergic syndrome. Patients feel palpitations, palpitation, sweating, face

Clinical manifestation Pale, hungry, weak, tremor of hands and feet, high blood pressure, etc. There is generally no coma or convulsions, and occasional fainting, less after lunch and dinner. Each episode is about 15-20 minutes, which can relieve itself, the condition is non-progressive, the fasting blood glucose is normal, the blood glucose can be normal or as low as 2.8mmol / L (50mg / dl), but not lower. Plasma insulin levels, fasting blood glucose are normal, and blood glucose may be normal or as low as 2.8 mmol / L (50 mg / dl) at the onset, but not lower. Plasma insulin level and insulin release index were in the normal range. Oral glucose tolerance test, blood glucose can be reduced to too low 2 to 4 hours after taking glucose, and then restored to the level on an empty stomach. The patient can tolerate fasting for 72 hours. Family history of diabetes is often absent.

Causes of Idiopathic Functional Hypoglycemia

Its pathogenesis may be the unstable regulation of insulin secretion and / or glucose metabolism by neurohumoral fluid, or accelerated gastric emptying and excessive insulin secretion due to increased vagal tone. The etiology is not yet clear and may represent a group of heterogeneous diseases.

Pathophysiology of idiopathic functional hypoglycemia

Idiopathic functional hypoglycemia diagnostic test

Diagnosis can be made based on clinical manifestations and excluding the above.

I. Insulin-resistant diabetes in the early stages of reactive hypoglycemia, increased insulin secretion and / or delayed response after eating.

Diagnostic check After the peak of harvest, there is still too much insulin in the blood that leads to hypoglycemia, which usually occurs 3 to 5 hours after eating. Its characteristics are: 1. The delayed tolerance test after oral glucose showed a decreased tolerance or diabetes curve. Fasting blood glucose increased or was at the normal high limit. The initial blood glucose rose normally after eating glucose, but the peak value could be delayed to 2, 3 hours, and insulin secretion was significantly delayed In 2 to 4 hours, insulin secretion increases more than normal, hypoglycemia appears after the peak of blood glucose, 2. Some patients have a family history of diabetes; 3. Impaired glucose tolerance has a tendency to gradually develop into diabetes.

2. Reactive hypoglycemia after gastrointestinal surgery, caused by gastrectomy, gastrointestinal anastomosis, pyloroplasty with or without vagus nerve resection, etc., has a clear medical history. Food quickly moves to the small intestine after eating, which results in rapid food absorption and promotes premature insulin secretion. The oral glucose tolerance test showed that the peak of blood glucose appeared immediately after taking glucose, and the hypoglycemia appeared after 2-3 hours after taking glucose.

3. Insulin tumors Hypoglycemia of some insulinomas occurs after meals, which is easily confused with the disease and missed diagnosis. Oral glucose tolerance test in patients with insulinoma, hypoglycemia appeared 3 to 4 hours after taking glucose, and after hypoglycemia, blood glucose continued to drop, and insulin release index increased.

Treatment of idiopathic functional hypoglycemia

(1) Explain the nature of the disease to the patient, and give psychoanalysis and comfort explanation. Encourage patients to exercise.

Identify similar diseases

(2) Adjusting the diet The diet structure should appropriately increase the protein and fat content, reduce the amount of sugar, eat small meals, eat more dry food, and avoid hunger. In addition, adding fiber (non-absorbable carbohydrates such as gum) to foods can help.

(3) Try a small amount of anti-anxiety stabilizers such as diazepam and chlorine nitrogen. Anticholinergic drugs such as amphetamine and atropine. Can be used to delay food absorption and reduce insulin secretion.

Because the condition can be relieved naturally, after a period of reasonable treatment, the patient's condition should be re-evaluated to determine whether the treatment needs to be continued.

Idiopathic functional hypoglycemia avoids triggers

(1) Improper diet: Irregular diet and sudden decrease in the main food intake; meal time delay after insulin or oral sulfonylurea injection; excessive drinking and smoking.

(2) Improper exercise: The amount of exercise suddenly increases, or the exercise time is extended to the peak period of insulin action, and the bath is taken on an empty stomach. Excessive exercise during peak insulin should be avoided.

(3) Combined renal insufficiency: due to insulin metabolism disorders, reduced renal gluconeogenesis, low caloric intake and other reasons, hypoglycemia is prone to occur in advanced diabetic nephropathy. The amount of insulin should be appropriately reduced in this period to control blood glucose at a slightly higher level.

(4) Patients with fragile diabetes: due to the complete loss of islet function, the blood sugar is extremely unstable, and hypoglycemia and hyperglycemia are prone to occur alternately. You should try your best to live in a calm state. When using insulin, add biguanide drugs, or install an insulin pump.

Rational use of idiopathic functional hypoglycemia

The treatment of diabetes should be individualized, the length of the disease in different periods, the combined complications, and the differences in age and body shape.

medical treatement Choose to apply targeted hypoglycemic drugs. The indications for various hypoglycemic drugs should be strictly grasped.

(1) In the first-onset type 2 diabetes, generally the first is non-sulfonylurea drugs, which are to be used for 1 to 2 weeks. If the blood glucose control is not satisfactory, the sulfonylurea drugs are added. According to the response to the drug, if the blood glucose decline is large, choose short-acting and mitigating drugs, such as Glipizide (Mepida), Gliquidone (Sugarpine), etc .; If the blood glucose decreases less, select Medium, long-acting, stronger drugs, such as glibenclamide (hypoglycemic), gliclazide (damicon) and so on. Gradually adjust the dose based on blood glucose levels.

(2) Patients with renal insufficiency, especially patients with stage diabetic nephropathy, due to the presence of autonomic neuropathy, renal gluconeogenesis and hypoglycemia are prone to occur. Therefore, excessive doses and excessive effects should be avoided.

(3) For patients with type 1 diabetes who receive insulin treatment, hypoglycemia is prone to occur after several days of blood glucose control. This hypoglycemia often occurs shortly after blood glucose control. At this time, the amount of insulin should be reduced in time. When the blood glucose control is close to normal, Frequently ask patients if they feel hungry, or evaluate for signs of hypoglycemia.

(4) For patients with a long history, older age, autonomic neuropathy, and coronary heart disease, do not force their blood glucose to be completely normal.

(5) The course of disease is longer. Islet function is poor, basal secretion is insufficient, short-acting insulin is insufficient, blood sugar does not drop, and high-dose insulin is prone to hypoglycemia, especially short-acting insulin is used before three meals, often high fasting blood glucose, mistakenly believe that insulin is insufficient, repeated The increased amount causes hypoglycemia at night. At this time, medium and slow insulin zinc should be given at night or during meals. Biguanide hypoglycemic drugs can also be used to stabilize blood sugar.

(6) The best way to prevent severe hypoglycemia in patients with diabetes is to install an insulin pump.

Idiopathic functional hypoglycemia prognosis

^[1] Prevention of idiopathic functional hypoglycemia is the best treatment for idiopathic functional hypoglycemia. The focus of prevention is to popularize diabetes education, to enable patients and their families to master the basic knowledge of diabetes, to fully understand the symptoms of hypoglycemia, to learn self-help and self-made micro-method rapid blood glucose testing, to develop good living habits, to quit smoking and alcohol. For some reasons, you can adjust the dosage of insulin and other drugs in time when you cannot eat or the amount of exercise increases. When patients go out, they should bring food such as sweets and biscuits to help themselves. Specific methods can be done to remove the incentive and rational use of medicine.

1. Avoid predisposing factors

(1) Improper diet:

(2) Improper exercise

(3) with renal insufficiency

(4) Patients with fragile diabetes

2. Reasonable use of medicinal drugs is the main reason for idiopathic functional hypoglycemia. The treatment of diabetes should be individualized, the length of the disease in different periods, the combined complications, and the differences in age, body shape, etc., choose to apply targeted hypoglycemic drugs. The indications for various hypoglycemic drugs should be strictly grasped.

Idiopathic functional hypoglycemia prevention difference

1. Clinically, drug-induced idiopathic functional hypoglycemia is more common in patients with diabetes treated with insulin and sulfonylurea drugs, especially for patients with liver and renal insufficiency. In the course of treatment, insulin and sulfonylurea drugs The amount should be increased gradually to avoid excessive increase. Eat on time after insulin or oral hypoglycemic agents. Should also avoid excessive exercise intensity. Also monitor blood glucose closely, especially during intensive insulin therapy. Diabetics and their families should be familiar with this response, early prevention, early detection and early management. Pay attention to the Somogyi phenomenon to avoid errors in insulin dose adjustment.

2. The dosage of hypoglycemic agents for the elderly should be cautious. Long-acting sulfonylureas, especially glibenclamide, should be used with caution. The early symptoms of hypoglycemia are not obvious. Once the symptoms occur, the symptoms are very serious. Intravenous glucose should be infused immediately. Closely observe for at least 72 hours, and constantly monitor the blood glucose concentration. Adjust treatment in time.

3. When using sulfonylureas for treatment, they may interact with other drugs. Some drugs such as salicylic acid preparations, sulfa drugs, butytaxel, chloramphenicol, guanethidine, and reserpine can be used to reduce Reduce the mechanism of sulfonylurea binding to plasma proteins, reduce drug metabolism in the liver and renal excretion, and enhance the hypoglycemic effect of sulfonylurea drugs. Therefore, care should be taken when using enhanced sulfonylureas to prevent hypoglycemia.

4. For those suspected of B-cell tumors, starvation experiments and exercise experiments should be performed as soon as possible, the plasma insulin-C peptide concentration should be measured, and imaging examinations such as B ultrasound and CT should be performed. For early detection, early diagnosis and early surgical treatment. Can prevent the onset of hypoglycemia.

5. Explain the nature of the disease to patients with idiopathic functional hypoglycemia, and give psychoanalysis and comfort work. Encourage patients to exercise. The diet structure appropriately increases the protein and fat content, reduces the amount of sugar, eats small amounts, eats dry food, and avoids hunger. In addition, adding fiber (non-absorbent carbohydrates if gum) to foods can help. You can also try low-dose anxiolytics such as diazepam and the like.

6. Because ethanol can hinder liver gluconeogenesis and promote insulin secretion, it often occurs 8 to 12 hours after drinking too little and drinking too much, so avoid drinking a lot, especially those who eat less. Due to hypoglycemia triggered by ingestion of fructose, galactose or leucine, the preventive method is to limit or prevent the intake of these substances.

7. For patients with major gastric resection, gastric-jejunal anastomosis, pyloroplasty with or without vagus resection, food quickly enters the small intestine, resulting in rapid absorption of food, promoting premature insulin secretion and causing hypoglycemia . Therefore, avoid eating liquids and eating fast. Should be multiple, small amounts of high-protein, low-carb diet.

8. Addison's disease, hypohypophysis and hypothyroidism are particularly sensitive to insulin and oral hypoglycemic agents, which can cause hypoglycemia, so special attention should be paid.

Idiopathic functional hypoglycemia health tips

The disease is mainly seen in people with emotional instability and neuroticism, more common in middle-aged women.

Regulate your diet:

The diet structure should appropriately increase the protein and fat content, reduce the amount of sugar, eat small meals, eat dry food to avoid hunger. In addition, adding fiber (non-absorbable carbohydrates such as gums) to the food will help, and patients should exercise.

Idiopathic functional hypoglycemia