Hypoglycemia is a condition of the body that is characterized by a drop in the glucose level in the blood to such indicators that, in the first place, brain cells and the entire body experience energy starvation, due to insufficient amount of glucose. This violates their functions, which are manifested by various clinical symptoms.
Hypoglycemia is true and false (no less dangerous). With false hypoglycemia, blood sugar can be either normal or elevated. Usually this is due to a rapid decrease in blood sugar levels from fairly high values to low values, for example, from 20-25 to 10-15 mmol / l.
True hypoglycemia is characterized by blood sugar levels below 3.3 mmol / l, so it can be argued that hypoglycemia is a peculiar reaction of the body to a rapid drop in blood sugar levels below the usual values. When blood sugar is reduced, the formation of glucose from glycogen, as well as the action of insulin, is suppressed. Then there is the inclusion of some mechanisms that help the body to further form carbohydrates, so the consciousness is gradually restored even without appropriate treatment. However, this does not mean that hypoglycemia should not be treated, because for all tissues and organs, especially for the brain, there is a fast, which is characterized by a peculiar symptomatic picture.
Hypoglycemia develops for a number of reasons, including increased insulin production in the pancreas; a rather high index of insulin, as well as other medications in patients with diabetes mellitus; change in the pituitary and adrenal glands; violation of carbohydrate metabolism in the liver.
Also hypoglycemia can be conditionally divided into a dependent disease from medicines and not. Typically, hypoglycemia, which depends on medications, is found among patients with a diagnosis of diabetes mellitus . The second variant of the pathological condition is observed as fasting hypoglycemia, which occurs after hunger, and in the form of a reactive form of hypoglycemia that occurs after taking carbohydrate food.
Very often hypoglycemia can be caused by insulin or sulfonylureas, which are prescribed to patients with diabetes to reduce blood sugar levels. At too high a dose of the drug in relation to the eaten food, the drug is able to lower the sugar to too low values. Patients with a severe form of diabetes, in general, are at risk of hypoglycemia. As a rule, this is due to the inadequate production of islet cells of the pancreas of glucagon, and adrenal glands is adrenaline. But it is these hormones that play a direct role in the mechanisms of the first defense against this hypoglycemia. This disease can be caused by other drugs.
Very often hypoglycemia is diagnosed in mentally unbalanced people who secretly take sugar-lowering medications or independently administer insulin. This is explained by free access to medicines.
Sufficiently severe hypoglycemia, and sometimes stupor, can occur in persons with alcoholic intoxication, as well as abusing alcoholic drinks and neglecting proper nutrition. As a result, the carbohydrate supply ends in the liver.
Stupor in hypoglycemia can occur even with a small amount of alcohol in the blood, but below the level that is allowed for automobile driving. Therefore, it is not always possible for the road police inspector or medical professional to determine that a person has a stupor as a result of the disease, and not a symptom of drunkenness.
Sometimes hypoglycemia can also occur in a healthy person who has had intense physical activity. With prolonged starvation, the symptoms of hypoglycemia can occur simultaneously with the pathology of the adrenal glands or the pituitary gland, as well as after alcohol abuse. In this case, there is a strong depletion of carbohydrates, which can not maintain a normal blood glucose level. But in some cases, hypoglycemia appears immediately after fasting. In children, with the breakdown of any enzyme system of the liver, signs of hypoglycemia occur between the breakfast, lunch and dinner.
Alimentary form of hypoglycemia occurs in people who underwent gastrectomy. In this case, too rapid absorption of sugar, which stimulates the production of insulin, which in large quantities causes a decrease in blood sugar. If hypoglycemia of the alimentary type develops for no apparent reason, then it is idiopathic alimentary hypoglycemia.
To the causes that cause the disease can be attributed and some products with the content of fructose or galactose, preventing the release of glucose from the liver. And leucine is involved in stimulating excess amounts of insulin in the pancreas. Thus, these foods reduce blood sugar after a certain amount of time after eating.
In addition, insulinomas can provoke hypoglycemia as a result of excessive insulin production. Very rarely can cause the development of a tumor disease that is not localized in the pancreas.
A rare cause of hypoglycemia is a disease associated with an autoimmune abnormality. In this case, the body tries to produce insulin antibodies, which leads to a sharp fluctuation, since the pancreas produces an excessive amount of insulin to neutralize the antibodies. This condition can be met both in patients with diabetes mellitus, and in those who are not ill with this disease.
On the development of hypoglycemia can affect cardiac or renal failure, severe infections, malignant pathologies in the form of tumors, irrational and malnutrition, shock, viral hepatitis and cirrhosis. All these diseases can cause a hypoglycemic condition.
The clinical picture for hypoglycemia consists of symptoms that can be divided into certain categories. They are characterized by common disorders, vegetative, neurological and metabolic. They are not always able to differentiate and make a correlation between blood sugar levels. But there is a certain pattern: when hypoglycemia, the glucose concentration is reduced to almost 3 mmol / l. It is then that common symptoms appear and vegetative, with a small number of neurological manifestations. But with a sugar concentration of 2.3 to 2.7 mmol / l develops hypoglycemic coma.
The general symptoms of hypoglycemia are characterized by anxiety, headaches, irritation, nervousness, constant hunger and burning in the epigastric region. However, all these symptoms can not confirm hypoglycemia, but with their complex combination, a hypoglycemic condition can be diagnosed.
Vagetagic disorders are caused by tachycardia and the appearance of tremors in the muscles. Then there is a pulsation in the head and on the periphery of the body, which is associated with rapid movement of blood.
Among the vegetative disorders are adrenergic and parasympathetic symptoms. In the first case, the clinic of hypoglycemia consists of the appearance of tachycardia, arrhythmia with a predisposition to it, pallor of the skin, tremor of hands (tremor), hypertension and frequency of respiration. But the symptomatology of the parasympathetic clinic consists of feeling hungry, rumbling in the abdomen, as a result of increased peristalsis in the stomach and intestines, as well as the appearance of burning in the epigastric region. This whole clinical picture is typical for the very beginning of hypoglycemia, therefore it is very important to always differentiate these symptoms with different pathologies of metabolism.
With neurological symptoms of hypoglycemia, there is a feeling of relative energy deficiency in the brain, which is characterized by dizziness, pain in the head and pulsation in the vessels. Then the disease turns into a severe form, so parts of the cerebral cortex are partially cut off. Focal symptoms are noted in the form of sensitivity disorders in some parts of the body, and sometimes motor activity is partially lost.
One of the most severe disorders in hypoglycemia is a hypoglycemic coma, which develops as a result of a sharp decrease in glucose. This causes loss of consciousness with a lack of sensitivity to various forms of irritation, even pain. After exiting from a coma, patients have pain in the head , weakness in the whole body, dizziness , a sense of fear and disorientation, trembling in the muscles, inadequacy in behavior, pathological reflexes appear. Sometimes, with deep damage to the cerebral cortex, patients do not remember everything that was before the onset of hypoglycemic coma.
All this symptomatology is observed before loss of consciousness. But the patient does not have time to notice it, since the consciousness is disconnected quite swiftly. It is this clinical picture that makes it possible to differentiate hypoglycemic coma with hyperglycemic, ketoacidotic and hyperosmolar coma. They are characterized by a gradual switch-off of consciousness with a number of neurological, general and metabolic symptoms.
Symptoms of hypoglycemia
In hypoglycemia, hypoglycemic condition and hypoglycemic coma are distinguished. The signs of the disease do not always appear gradually. Sometimes, even suddenly, a co-occurring manifestation of hypoglycemia, seizures or an acute form of psychotic syndrome occurs.
Signs of the initial stage of hypoglycemia are severe hunger, tremor of hands and vegetative disorders in the form of sweating, pain in the head, general weakness, increased heart rate, causeless irritability, aggressiveness and fear. If untimely elimination of these signs with food products in which easily absorbed carbohydrates are found, some other characteristics characteristic of this state are amplified or appear. Among them can be distinguished such as trembling in the body, perspiration profuznogo properties, double vision, fixed look and hemiplegia.
Hypoglycemia is characterized by signs of mental reactions, namely: aggression, an agitated state, inability to orientate around, and sometimes hallucinate. Very often, these signs are taken for intoxication, as a result of alcohol, or hysteria. If the hypoglycemic condition is not eliminated at this stage, then convulsive contractions of some muscle groups appear, in particular in the face area, and the excited state becomes worse, vomiting with one or two-sided symptom of Babinsky, clonic and tonic convulsions that provoke epilepsy also occurs and then comes a coma.
A characteristic sign of hypoglycemia is a change in the cardiovascular system, which is manifested in a decrease in blood pressure, the appearance of an increased heart rate, arrhythmia in the form of extraordinary cardiac contractions, less frequent low heart rhythm, and sinus arrhythmia. And on the ECG, depression of the S-T segment is noted, and the amplitude of the T wave decreases. Attacks of angina pectoris are observed in patients with IHD with a sharp decrease in blood sugar level. In the blood there is a slight leukocytosis and lymphocytosis, and sometimes leukopenia.
With a compensated form of diabetes mellitus, hypoglycemia has negative values of sugar in the urine and a reaction to acetone. But hypoglycemia of decompensated diabetes is characterized by an increase in such hormones as glucocorticoids, STH, catecholamines and ACTH, which help develop ketoacidosis and form in urine acetone.
Another sign of hypoglycemia is hypoglycemic coma, which is characterized by sweating, skin moisture, pallor of the face, increased muscle tone, trembling, increased tendon reflexes and convulsions. Also decreases, in particular, diastolic blood pressure, pupils dilate, eyeballs in normal tone or slightly reduced, there are psychic signs with delusional hallucinations. The blood sugar levels are low enough and there is no acetone in the urine. Sometimes in studies at the beginning of the disease, a small amount of sugar in the urine can be found about 1%. And repeated laboratory tests after 30 minutes give a negative response with urinary sediment unchanged.
Hypoglycemia in children
This condition in children does not belong to a rare pathology. Very often, the causes of childhood hypoglycemia can be various diseases of the nervous and endocrine systems, as well as stress, exercise and unbalanced nutrition.
Symptomatic hypoglycemic state in children is manifested in the form of lethargy, drowsiness, irritability, pallor, sweating, hunger and heart rhythm disturbances. The values of blood sugar level are on the figures less than 2.2 mmol / l.
Hypoglycemia is very dangerous for a child's life, as it disrupts the metabolism in the body and coordinates movement, provokes pain in the head, promotes the appearance of convulsions and fainting. Frequent hypoglycemic attacks adversely affect the mental and physical development of children.
As a rule, hypoglycemia in children can proceed according to the type of other diseases. Therefore, it is necessary to fully examine the child, since the smaller his age, the more likely to cause dangerous damage to the nervous system, mental retardation or epileptic seizures as a result of the sensitivity of his nerve cells to the variability of sugar in the blood.
Children in the elderly experience such symptoms of hypoglycemia as adults. They have this manifested in the form of anxiety, pallor of the face, chills in the whole body, impaired vision and impaired coordination. In addition, convulsions appear, tachycardia becomes more frequent, they experience a strong sense of hunger and lose consciousness.
There are two main reasons for the development of childhood hypoglycemia, such as increased ketone bodies in the blood and leucine intolerance.
When hypoglycemia in children in the blood appears acetone in the form of ketone bodies, which is characterized by a peculiar acetone odor from the mouth. Since acetone refers to a toxic substance, the corresponding signs of its action on the nervous system is poisoning with nausea, vomiting, dizziness and fainting. In this situation, the child is washed with a soda solution or mineral water, causing vomiting. And to make up glucose, give a little honey or sugar, and you can also tableted glutamic acid. After the seizure, the child should be under the supervision of a specialist, he needs to constantly measure blood sugar, and also make urine analysis on the available ketone bodies.
To treat patients with hypoglycemia, children are used a balanced diet with the exception of animal fats and simple carbohydrates. Preference is given to dairy products and seafood, juices, fruits and vegetables. Food is important to take seven times a day and in small quantities.
In rare cases, as a result of metabolic disorders of a congenital nature, the incompatibility of the organism with the leucine amino acid, which is a part of proteins, is noted in children. This phenomenon has received the name, as leucine hypoglycemia, which occurs mainly in young children. A small amount of something sweet can improve the patient's position a little. But a balanced diet with this form of hypoglycemia is very difficult to observe, since the growing body needs protein constantly. As a rule, it is necessary to exclude eggs and milk, as well as pasta, nuts and fish. Therefore, in order to make a diet for sick children with leucine hypoglycemia, the help of a dietitian is necessary.
It is important to remember that early detection of symptoms of hypoglycemia in a child will allow to discover its causes as soon as possible, and this will lead to a successful outcome of treatment. Also, to avoid complications in childhood hypoglycemia, it is necessary to monitor the amount of sugar and its stable content.
The period of treatment of hypoglycemia in the first stage, prior to hospitalization of the patient, consists in a sufficient intake of food, which contains carbohydrates and enters the usual diet of the patient with the presence of sweet tea and fruit juices.
At the second stage of hypoglycemia, it is necessary to immediately use foods with digestible carbohydrates, such as jam, compote with sugar, sweet tea, sweets, fruit syrup. As a rule, such food with the content of fructose and sucrose, prevents the progression of the hypoglycemic state and normalizes the level of glycemia and the patient's condition. Without certain indications, patients are not hospitalized.
In the third stage of hypoglycemia, in order to provide effective emergency care, you must immediately inject intravenously 40% glucose solution to 100 ml to avoid the onset of swelling of the brain. The patient, as a rule, is hospitalized in such a state to prevent the early consequences of hypoglycemia and to correct the sugar-lowering therapy.
Hypoglycemic coma or the fourth and fifth stages of hypoglycemia are treated either in the intensive care unit or in the intensive care unit. With this form of hypoglycemia, an intravenous jet injection of 80-100 ml of a 40% solution of glucose is first prescribed and intramuscular - 1 ml of glucagon, followed by an intravenous drop of 5% glucose solution from 200 to 400 ml. Be sure to maintain blood sugar levels ranging from 6 to 9 mmol / l. If it is not possible to achieve efficiency in treatment, adrenaline is injected subcutaneously. Basically, all these manipulations restore the consciousness of the patient. It is only important to remember that the hormones introduced are closely related to the action of endogenous glucose, as well as glycogen from the liver. Therefore, it is often not recommended to use these drugs, as this can lead to a worsening of the patient's condition.
If the measures taken do not restore the patient's consciousness, then intramuscularly or intravenously inject hydrocortisone. As a rule, after this, the patient's condition stabilizes, but consciousness does not come back right away. In this case, the introduction of glucose and insulin continues, and preparations of potassium are taken. To improve the utilization of glucose, Ascorbic acid is administered.
With the prophylactic purpose of cerebral edema, intravenous slow administration of magnesium sulphate or intravenous drip of Mannitol from 200 to 250 ml is used. Patients are also given oxygen therapy. Sometimes fresh blood is poured.
As soon as the patient is taken out of a coma, he is prescribed drugs that improve the processes of microcirculation and stimulation of proteins, carbohydrates in the cells of the central nervous system. These include Glutamic acid, Cerebrolysin, Aminalon, Cavinton for three to six weeks, according to the indications.
For the prevention of hypoglycemia, it is necessary to prescribe an adequate sugar reduction therapy with Insulin, so avoid overdosing of the drug. And the second component of prevention is the correct distribution of carbohydrates in the diet, as well as moderate regulation of physical activity throughout the day and additional use of carbohydrates.
Diet for hypoglycemia
It is believed that the hypoglycemia after eating is favorably affected by the limited intake of carbohydrates in the diet. Although methods of such control in dietary treatment have never been conducted. However, if you look from the point of view of physiology, then this approach can have positive results, because the attacks of hypoglycemia develop, as a rule, after eating glucose-containing foods.
Dietary interventions can help most patients, especially in the first stages of the disease, in which medication is indicated in rare cases.
There are some disagreements in the question, which is related to the degree of restriction of carbohydrates. One category of authors adheres to a diet with a fairly small amount of carbohydrates, about one hundred grams. But they become the cause of ketosis, violate patience for glucose and reduce the postponement of amino acids after consuming proteins in food. Incredibly, even healthy people who adhere to such a diet, under heavy load, glucose can become a hostage of hypoglycemia. It is for this reason that the intake of carbohydrates can not be completely ruled out, since this can provoke the emergence of characteristic clinical symptoms if one does not follow a diet. Therefore, treatment begins with a slight restriction of carbohydrates from 120 to 150 g.
It is very important to limit not only the amount of carbohydrates, but also the type of foods in which they are contained. It is absolutely necessary to exclude simple sugars. Carbohydrates should be used as starch in foods such as pasta, bread, potatoes, rice, which should be consumed up to three times a day in small portions with the same number of snacks in the form of snacks. If you can not succeed with the use of such dietary nutrition, then resort to a greater restriction of carbohydrates.
In some cases, the diet does not have any positive results at all, and sometimes even worsens the symptoms of hypoglycemia, which should cause the doctor to watch for hypoglycemia on an empty stomach or, in general, talk about the absence of the disease with the corresponding complaints of the patient. If dietary nutrition is ineffective in limiting carbohydrates and in the absence of hypoglycemic genesis, drug therapy is prescribed.
As a rule, with hypoglycemia, diet № 9 is prescribed. In this case, create conditions that normalize the metabolism of carbohydrates in the body. Dishes are prepared from certain food products, in which there is an insignificant amount of both carbohydrates and fats. Categorically you can not use sugar, honey and jam, as well as various sweets and confectionery. These products are used to stop attacks of hypoglycemia, or as a snack before significant physical exertion.
The peculiarity of the diet for hypoglycemia is that it is necessary to keep a daily diary with the calculation of the amount of fats, carbohydrates and proteins in food. It is also important to control the chemical composition of foods.
In patients diagnosed with diabetes mellitus, in general, significantly increased appetite, and they are in a state of constant hunger. Thus, patients with such a diagnosis should use such dishes that saturate the stomach, contain a large amount of fiber, but with a small calorie, that is, vegetables.
In the daily diet menu for the treatment of hypoglycemia in diabetes should include products such as black (240 g) or white bread (180 g), butter (15 g), vegetable oil (10 g), carrots (200 g) or apples, potatoes (200 g) , macaroni (20 g), cereals (60 g), cheese (20 g), egg (1 pc.), fish, boiled or baked meat. Sugars are replaced with sugar substitutes.
The products are subjected to conventional cooking, but it is advisable to limit the use of fried foods and not to overeat the food. In addition, the body must receive in sufficient quantities vitamins, especially from group B and ascorbic acid. Food should be fractional and frequent. Almost half of the diet should include carbohydrates, and this is legumes, cereals, fruits, grains, pasta. Of course, it is better to give preference to foods that are rich in fiber, since they gradually increase the amount of glucose in the blood.