Introduction
Hypoglycaemia means deficiency or low level of glucose in the bloodstream.
Hypoglycemia can occur with malnutrition and starvation when you don't get enough food, and the glycogen stores your body needs to create glucose are used up. An eating disorder called anorexia nervosa is one example of a condition that can cause hypoglycemia and result in long-term starvation. Diabetes treatment and other conditions can cause hypoglycaemia. For example
Insulin overproduction.
Signs and symptoms hypoglycemia:
This can lead to blurred vision, difficulty concentrating, confused thinking, slurred speech, numbness, and drowsiness. If blood glucose stays low for too long, starving the brain of glucose, it may lead to seizures, brain damage, coma, and very rarely death.
Some of the most common symptoms of hypoglycemia are shakiness, dizziness, hunger, irritability, and fatigue, as well as pale skin, a rapid heartbeat, headache, sweating, and lack of concentration, increased blood pressure.
Diabetic hypoglycemia occurs when patient with diabetes doesn't have enough sugar (glucose) in his or her blood. Glucose is the main source of fuel for the body and brain, so you can't function well if you don't have enough.
Dangerously low blood sugar:
Blood sugar below 55 mg/dL is considered severely or dangerously low.
Diabetic coma , functional brain failure and death:
Coma can occur at glucose levels in the range of 41–49 mg/dl as well as at lower glucose levels. All of these responses are typically corrected after the plasma glucose concentration is raised.
•Diabetic coma:
The difference between diabetic coma and hypoglycemic coma:
You're most likely to get hypoglycemia if you skip a meal after injecting insulin or if you take too much insulin. Diabetic coma happens when you don't take steps to fix blood sugar that's too high or too low.
A diabetic coma is a life-threatening disorder that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma.
*High blood sugar level can also cause diabetic coma:
A diabetic coma could happen when your blood sugar gets too high that is 600 milligrams per deciliter (mg/dL) or more causing you to become very dehydrated. It usually affects people with type II diabetes that isn't well-controlled.
A person can recover from a diabetic coma:
A diabetic coma can affect a person with diabetes when they have high or low blood sugar levels or other substances in the body. With prompt treatment, a rapid recovery is possible. However, without early treatment, it can be fatal or result in brain damage.
•Diabetic seizures:
Diabetic hypoglycemia causes seizures.
A diabetic seizure occurs when the sugar levels in the blood are extremely low (below 30 mg/dL). The brain needs glucose to function properly. When there is a drop in blood sugar, the actions of the neurons in the brain decrease and the person experiences a seizure.
Substantial changes in blood sugar either low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia) can affect the excitability of nerve cells (neurons), allowing seizures to occur more easily.
You can have a seizure from low blood sugar.Severe low blood sugar is a medical emergency. It can cause seizures and brain damage. Severe low blood sugar that causes you to become unconscious is called "hypoglycemic or insulin shock".
Hypoglycaemia, common in diabetic patients treated with insulin, can induce various neurological disturbances. Of these, seizures are the most common acute symptoms, mainly of the generalised tonic-clonic type, with focal events only exceptionally being reported and documented.Epilepsy or seizures are often observed in patients with diabetes mellitus (DM), and an emerging association between the two diseases is more than coincidental base ind on recent research. Approximately 25% of patients with DM experience different types of seizures.
The signs of a diabetic seizure are as follows:
•Confusion or drowsiness.
•Sweating.
•Irregular emotional swings.
•Muscle weakness.
•Vision loss or changes (i.e. double vision)
•Difficulty speaking/loss of ability to speak.
Hypoglycemic seizures can cause brain damage.
Hypoglycemia can quickly result in seizures, coma, and even death if not treated immediately.
Brain damage due to diabetic hypoglycaemia:
The lower your blood sugar and the longer it takes before you receive treatment, the more likely you are to suffer moderate or severe brain injury from this type of episodes.
In this study, severe hypoglycemia was shown to cause brain damage in the cortex and the hippocampus, and the extent of damage was closely correlated to the presence of seizure-like activity.
A diabetic seizure occurs when the sugar levels in the blood are extremely low (below 30 mg/dL). The brain needs glucose to function properly. When there is a drop in blood sugar, the actions of the neurons in the brain decrease and the person experiences a seizure.
You can have a diabetic seizure while sleeping:
Very low blood-sugar levels can cause seizures or even, in rare cases, death. People with type-I diabetes often sense warning signs of low blood sugar when they are awake, but not during sleep, explaining why 75 % of diabetic seizures occur at night.
Signs when blood sugar gets too low while sleeping:
These include shakiness, sweating, confusion, erratic behavior, headache, and light -headedness. With night time hypoglycemia, you may wake up with these symptoms or with a higher blood sugar reading that results from the body's response to an overnight low.
Diabetics do wake up in early morning with low blood sugar:
Low blood sugar, also called hypoglycemia, happens when your body doesn't have enough glucose to use for energy. people with diabetes mellitus may have low blood sugar in the morning due to too much long-acting insulin, also called" background insulin" and "basal insulin" or long acting insulin.For example Glargine.
If you've had hypoglycemia during the night, you may wake up tired or with a headache. And you may have nightmares. Or you may sweat so much during the night that your pajamas or sheets are damp when you wake up.
Diabetics often wake up at 3 am due to hypoglycaemia.
These early morning wake-up calls often are simply one of many low blood sugar symptoms. Sleeping through the night represents a long period without food when blood sugar can drop too low. This is bad news for the brain, which depends on glucose for energy.
The first line of treatment of diabetic hypoglycaemia:
15 :15 rule for hypoglycemia:
For low blood sugar between 55-69 mg/dL, raise it by following the 15-15 rule.
Let you have 15 grams of carbs (Glucose or table sugar)and check your blood sugar after 15 minutes. If it's still below your target range, have another serving. Repeat these steps until it's in your target range.If you have hypoglycemia symptoms, do the following: Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods or drinks without protein or fat that are easily converted to sugar in the body. Try glucose tablets or gel, fruit juice, regular (not diet) soda, honey, or sugary candy.
Hospitalisation in severe cases:
Most cases of hypoglycemia in diabetes are treatable at home. However, severe hypoglycemia needs emergency care at a hospital to prevent long-term complications.
Glucagon a hormone that raises blood glucose levels
is used to treat severe hypoglycemia. Glucagon is taken as a spray into the nose or an injection administered under the skin. If you use insulin or a sulfonylurea to manage your diabetes, it's a good idea to keep a glucagon kit with you in case of emergencies.
IV (intravenous) dextrose is the best treatment for in patients and for patients found by emergency medical services personnel. IV dextrose is available in different concentrations. Concentrated IV dextrose 50% (D 50 W) is most appropriate for severe hypoglycemia, providing 25 g of dextrose in a standard 50-mL bag(25 gm dextrose/ 50ml that's 50%).
Author: Dr. Bhairavsinh Raol
