Hypoglycemia.
Hypoglycemia means low blood sugar
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Commonest complication associated with diabetes management. |
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The development of hypoglycemia is an ever present possibility in all patients treated with insulin or oral medicines. |
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Occurrence of severe can lead to mortality, or serious morbidity such as permanent neurological sequelae, visual loss due to retinal bleeds, cardiovascular catastrophes, renal shutdown, etc. |
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Repeated episodes of even mild to moderate hypoglycemia can, also, lead to these severe morbid sequelae. |
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Hypoglycemic should be avoided, or at least recognized in the very early stages, so that prompt corrective action can avert any serious consequences. |
Symptoms of hypoglycemia include:
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Weakness, sweating, palpitation, tremor, nervousness, irritability, tingling, hunger, vomiting, head ache, visual disturbances, mental dullness, confusion, forgetfulness, seizures, coma. |
CLASSICAL SIGNS & SYMPTOMS OF HYPOGLYCEMIA | |
Sympathoadrenal |
Neuroglycopenic |
Weakness |
Headache |
Sweating |
Hypothermia (decreased body temperature) |
Tachycardia (increased pulse) |
Visual Disturbances |
Palpitations |
Mental dullness |
Tremor |
Confusion |
Nervousness |
Amnesia (forgetfulness) |
Irritability |
Seizures |
Tingling |
Coma |
Hunger |
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Vomiting |
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All patients need to manifest all these classical signs and symptoms of hypoglycemia. |
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Thus, diagnosis may have to based on clinical suspicion; |
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If available, capillary blood glucose measurement using finger prick test should aid diagnosis; in its absence, |
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Clinical improvement with glucose administration aids diagnosis. |
Non classical signs and symptoms.
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Many diabetics exhibit signs and symptoms which are truly hypoglycemia reactions although they may not fall into the "classical" manifestations. |
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Patients who become excessively quiet, or conversely, very boisterous, show a lack of interest in normal activities, throw uncalled for temper tantrums, become morose, ambitionless, complain of feeling faint, complain of peri-oral paraesthesias, etc. may all be manifesting hypoglycemia |
In simple terms,
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Any diabetic undergoing treatment who shows a behavior pattern which is not in keeping with his normal behavior, should have the presence of hypoglycemia ruled out. |
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If in doubt, treat as hypoglycemia until proven otherwise. |
Causes of signs and symptoms of hypoglycemia.
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caused by increased activity of the sympatho adrenergic system; may be triggered by a very rapid fall in blood glucose levels. |
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caused by action on the central nervous system; requires a level of blood glucose well in the hypoglycemic range |
Precipitating factors:
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Delayed or missed meals. |
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Unexpected calorie intake reduction. |
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Sudden undue vigorous activity. |
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Errors in dosage and/or timing of medicine. |
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Kidney and Liver dysfunction. |
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Interaction with other drugs. |
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Change in insulin species, i.e. beef to human insulins. |
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Change of injection site. |
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Deep intramuscular injection (instead of subcutaneous injection). |
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Hypothyroidism and/or adrenal insufficiency. |
Pseudo-hypoglycemia.?
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Some patients may manifest signs and symptoms of hypoglycemia, even if the blood glucose is not actually in the "hypoglycemic" range. |
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Usually seen with a very rapid drop in the blood glucose level. |
Nocturnal hypoglycemia.
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Means hypoglycemia during night while sleeping. |
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It is very important to rule out hypoglycemic reaction occurring during sleep. |
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These may not be severe enough to cause convulsions or coma. The patient may complain that the experiences night sweats, has recurring vivid dreams or nightmares, has early morning headaches which disappear after he takes his breakfast. |
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Such complaints must be investigated to rule out nocturnal hypoglycemia. |
Individual characteristics.
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Most patients show their own characteristic pattern of hypoglycemic manifestations, and this pattern often remains constant for the patient for a fairly long time. |
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Thus, it if very important for the patient, family and the doctor to be familiar with this pattern so that hypoglycemia can be correctly and rapidly diagnosed. |