Hypoglycemia

Hypoglycemia:  deficiency of glucose concentration
in the blood, which may lead to nervousness, hypothermia, headache, confusion,
and sometimes convulsions and coma.  Hypoglycemia is characterized
by an abnormally low glucose level, hypoglycemia occurs when glucose is
used too rapidly, when the glucose release rate falls behind tissue demands,
or when excessive insulin enters the blood stream.  This deficiency
is classified as reactive or fasting. Reactive
hypoglycemia results from the reaction to the disposition of meals
or the administration of excessive amount of insulin.  Fasting
hypoglycemia causes discomfort during long periods of not eating food,
for example: in the early morning hours before breakfast.  Hypoglycemia
is a specific endocrine imbalance, its symptoms are often vague and depend
on how quickly the patient’s glucose levels drop.  If not treated
properly, severe hypoglycemia may result in coma and irreversible brain
damage.

Cause:  Reactive hypoglycemia can result from too much insulin
or oral hypoglycemic medication in diabetic patients.  It can also
result form impaired glucose tolerance, with early hyperglycemia followed
by a delayed rise in insulin levels: rapid small intestine glucose absorption
caused by gastrectomy or other GI procedures; and it can be idiopathic.

Fasting hypoglycemia can be  caused by exogenous factors, such
as alcohol or drug ingestion, or endogenous factors caused by organ damage,
such as pancreatic tumor, hepatic disease, or renal disease.

Symptoms:

Weakness

Hunger

Cold sweats

Shakiness

Trembling

Headache

Irritability

Tachycardia

Pallor

Blurred vision

Confusion

Motor weakness

Hemiplegia

Convulsions

Coma

Treatment:

For acute hypoglycemia:  First priority is to bring the patient’s
glucose level back to normal.

Effective long term treatment of reactive hypoglycemia requires dietary
modification.

If conscious, the patient needs a fast acting carbohydrate, such as
sweetened orange juice or candy (than follow with doctors orders)

If unconscious:  Medical emergency – Go see a doctor or ER promptly. 
The doctor may prescribed glucagon I.M. or S.C. or an I.V. bolus of 50
ml of dextrose 50% is usually administered first.

For fasting hypoglycemia:  surgery and drug therapy are usually
required.

Precipitating factors:  Delayed or omitted
meal, insulin overdose, excessive exercise without food or insulin adjustments.

Symptom onset:  Rapid – can be minutes to hours

Signs and symptoms:  Skin and Mucous membranes: 
Cold, clammy skin, pallor, profuse sweating, normal mucous membranes.

Neurologic status:   Initial state –Irritability,
nervousness, hand tremors, may have difficulty speaking, and concentrating,
difficulty focusing, and coordinating. – Late state- – Dilated pupils,
hyper-reflexia, Coma.

Muscle strength:  Normal or reduced

GI:  None

Temperature:  Normal, if in deep coma- may be subnormal

Pulse:  Tachycardic (abnormally rapid pulse rate), if in
deep coma – bradycardic (abnormally low pulse rate)

Blood pressure:  Normal to above normal

Respirations:  Initial state:  normal to rapid. –
Late
state: slow

Breath odor:  Normal

Other:  Hunger

Treatment:  Glucose, glucagon, epinephrine

Precipitating factors:  Undiagnosed diabetes,
Neglected treatment, infection, cardiovascular disorders, physical stress,
emotional stress, and Exercise in uncontrolled diabetes

Symptom onset:  Slow – can be hours to days

Signs and symptoms:  Skin and Mucous membranes: 
Warm, flushed, dry, loose skin; dry, crusty mucous membranes; soft eyeballs

Neurologic status:  Initial state:  dullness, confusion,
lethargy; diminished reflexes. –Late state: coma

Muscle strength:  Extremely weak

GI:  Anorexia, nausea, vomiting, diarrhea, abdominal tenderness
and pain

Temperature:  Hypothermia, Patient may have a fever – from
dehydration or infection.

Pulse:  Mildly tachycardic, weak

Blood pressure:  Subnormal

Respirations:  Initial state:  deep, fast. – Late
state:  Kussmaul’s (deep rapid respiration)

Breath odor:  Fruity, acetone

Other:  Thirst

Treatment:  Insulin, fluid replacement, electrolyte replacement,
anti acidosis therapy (if needed)

 

Precipitating factors:  Undiagnosed diabetes, infection
or other stress, acute or chronic illnesses, certain drugs and medical
procedures, severe burns treated with high glucose concentrations

Symptom onset:  Slow – can be hours to days, but
more gradual than DKA

Signs and symptoms:  Skin and Mucous membranes: 
Warm, flushed, dry, extremely loose skin; dry, crusty mucous membranes;
soft eyeballs

Neurologic status:  Initial state:  dullness, confusion,
lethargy, diminished reflexes. – Late state:  Coma

Muscle strength:  Extremely weak

GI:   None

Temperature:  May have a fever (usually from dehydration
or infection)

Pulse:  Usually rapid

Blood pressure:  Subnormal

Respirations:  Rapid (not like DKA)

Breath odor:  Normal

Other:  Initial – Thirst  – Late- Thirst may be absent

Treatment:  Fluid replacement, insulin, electrolyte replacement