What Is Hypoglycemia?

What Is Hypoglycemia?

What Is Hypoglycemia?

Hypoglycemia is a medical emergency, characterized by abnormally low blood sugar level in the blood/plasma. The symptoms of hypoglycemia may vary from one individual to another individual as well as in severity of symptoms, depending on the blood glucose level. But the principal symptoms are due to inadequate glucose supply to the brain (the only fuel brain can use is glucose), which leads to impairment of functioning of brain. The symptoms of hypoglycemia may range from mild dysphoria or disorientation to death (due to permanent brain damage due to lack of brain fuel glucose).

Although there is tremendous advances made in management/treatment of diabetes (type-1, type-2 as well as other types of diabetes), hypoglycemia is the major limiting factor for optimal glycemic control in diabetes treatment. Because, most antidiabetes medications highly effective in treating diabetes (hyperglycemia) carry a risk of hyperglycemia as well, which limits their use.

Definition/diagnosis of hypoglycemia:

Hypoglycemia diagnosis is not easy. To diagnose hypoglycemia, one has to satisfy Whipple’s triad, which include, (1) symptoms consistent with hypoglycemia, (2) a low plasma glucose concentration measured with a precise method (not by a glucose monitor, commonly used for self-monitoring of blood glucose), and (3) relief of those symptoms after the plasma glucose level is raised by administration of glucose. If all the three points mentioned in Whipple’s triad are satisfied, hypoglycemia can be diagnosed conclusively. Mere presence of low blood sugar level is not confirmation of hypoglycemia.

Only blood glucose level may not be able to define hypoglycemia satisfactorily. Usually blood glucose level in normal non diabetic individuals remain 70 mg to 140 mg per 100 ml of blood throughout 24 hours of the day. Various books have defined hypoglycemia as blood glucose level below 60 mg or 70 mg. But symptoms of hypoglycemia usually do not occur, unless blood glucose falls below 50-55 mg per 100 ml of blood. Different individuals experience symptoms of hypoglycemia at different blood glucose level. Hence, only blood glucose level may not be sufficient to define/diagnose hypoglycemia and Whipple’s triad is used for precise diagnosis. Blood glucose level may also vary depending on the method used for measuring and the age of the individual.

Who are at risk of hypoglycemia?

Non diabetic individuals usually do not suffer from hypoglycemia, even during long fasting. Individuals at risk of hypoglycemia usually include:

  1. Patients being for type-1 diabetes with insulin. As patients with type-1 diabetes do not produce insulin, they must be treated with insulin. Treatment with insulin always have some risk of hypoglycemia involved.
  2. Patients treated for type-2 and other types of diabetes (such as gestational diabetes that occur during pregnancy, maturity onset diabetes of young etc.), with or without insulin. The risk for type-2 diabetes and other type of diabetes patients for hypoglycemia is not as high as that of type-1 diabetes.
  3. Individuals with pre-diabetes are also at risk of hypoglycemia, although risk involved is less, due to insulin resistance.
  4. Individuals with insulin producing tumors of pancreas (known as insulinomas), a rare disease
  5. Individuals taking certain medications (including oral hypoglycemic medications used for treatment of diabetes, such as sulfonylureas).

 

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