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Encyclopedia > Hypoglycemia
Hypoglycemia
Classification & external resources
Glucose test
ICD-10 E16.0-E16.2
ICD-9 250.8, 251.0, 251.1, 251.2, 270.3, 775.6, 962.3
DiseasesDB 6431
MedlinePlus 000386
eMedicine emerg/272  med/1123 med/1939 ped/1117
MeSH D007003

Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. The term hypoglycemia literally means "under-sweet blood" (Gr. hypo-, glykys, haima). Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia). Derangements of function can range from vaguely "feeling bad" to coma and (rarely) permanent brain damage or death. Hypoglycemia can arise from many causes and can occur at any age. If the blood sugar level falls too low the liver converts a storage of glycogen into glucose and release it into the bloodstream, to prevent the person going in to a diabetic coma, for a short period of time. The most common forms of moderate and severe hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Hypoglycemia is usually treated by the ingestion or administration of glucose, or foods digestible to glucose. Image File history File linksMetadata Size of this preview: 800 × 600 pixelsFull resolution (2592 × 1944 pixel, file size: 934 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... British English (BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the United Kingdom from forms used elsewhere in the Anglophone world. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Greek ( IPA: or simply IPA: — Hellenic) has a documented history of 3,500 years, the longest of any single language in the Indo-European language family. ... For other uses, see Brain (disambiguation). ... Neuroglycopenia is a medical term that refers to a shortage of glucose (glycopenia) in the brain, usually due to hypoglycemia. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is an anabolic polypeptide hormone that regulates carbohydrate metabolism. ... An oral hypoglycemic agent is a medication (usually a pill or capsule) that can be take by mouth to lower a high blood sugar toward normal. ...


Endocrinologists (specialists in disorders of glucose metabolism) typically consider the following criteria (referred to as Whipple's triad) as proving that an individual's symptoms can be attributed to hypoglycemia: Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. ... A few of the metabolic pathways in a cell. ... Whipples triad is a diagnostic mnemonic used in suspected insulinoma. ... The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ...

  1. Symptoms known to be caused by hypoglycemia
  2. Low glucose at the time the symptoms occur
  3. Reversal or improvement of symptoms or problems when the glucose is restored to normal

However, not everyone has accepted these suggested diagnostic criteria, and even the level of glucose low enough to define hypoglycemia has been a source of controversy in several contexts. For many purposes, plasma glucose levels below 70 mg/dl or 3.9 mmol/L are considered hypoglycemic; these issues are detailed below. Blood plasma is the liquid component of blood, in which the blood cells are suspended. ...

Contents

Defining hypoglycemia

No single glucose value alone serves to define the medical condition termed hypoglycemia for all people and purposes. Throughout the 24 hour cycles of eating, digestion, and fasting, blood plasma glucose levels are generally maintained within a range of 70-140 mg/dL (3.9-7.8 mmol/L) for healthy humans.[1] Although 60 or 70 mg/dL (3.3 or 3.9 mmol/L) is commonly cited as the lower limit of normal glucose, different values (typically below 40, 50, 60, or 70 mg/dL) have been defined as low for different populations, clinical purposes, or circumstances. Blood plasma is the liquid component of blood, in which the blood cells are suspended. ...


The precise level of glucose considered low enough to define hypoglycemia is dependent on (1) the measurement method, (2) the age of the person, (3) presence or absence of effects, and (4) the purpose of the definition. While there is no disagreement as to the normal range of blood sugar, debate continues as to what degree of hypoglycemia warrants medical evaluation or treatment, or can cause harm.[2][3][4]


This article expresses glucose in milligrams per deciliter (mg/dL or mg/100 mL) as is customary in the United States, while millimoles per litre (mmol/L or mM) are the SI (International System) units used in most of the rest of the world. Glucose concentrations expressed as mg/dL can be converted to mmol/L by dividing by 18. For example, a glucose concentration of 90 mg/dL is 5 mmol/L or 5 mM. The litre or liter (see spelling differences) is a unit of volume. ... Look up si, Si, SI in Wiktionary, the free dictionary. ...


Measurement method

Blood glucose levels discussed in this article are venous plasma or serum levels measured by standard, automated glucose oxidase methods used in medical laboratories. For clinical purposes, plasma and serum levels are similar enough to be interchangeable. Arterial plasma or serum levels are slightly higher than venous levels, and capillary levels are typically in between.[5] This difference between arterial and venous levels is small in the fasting state but is amplified and can be greater than 10% in the postprandial state.[6] On the other hand, whole blood glucose levels (e.g., by fingerprick meters) are about 10%-15% lower than venous plasma levels.[5] Furthermore, available fingerstick glucose meters are only warranted to be accurate to within 15% of a simultaneous laboratory value under optimal conditions, and home use in the investigation of hypoglycemia is fraught with misleading low numbers.[7][8] In other words, a meter glucose reading of 39 mg/dL could be properly obtained from a person whose laboratory serum glucose was 53 mg/dL; even wider variations can occur with "real world" home use. In medicine, blood sugar is glucose in the blood. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... The glucose oxidase enzyme (GOx) (EC 1. ... A medical laboratory or clinical laboratory is a laboratory where tests are done on biological specimens in order to get information about the health of a patient. ... Section of an artery For other uses, see Artery (disambiguation). ... This article does not cite any references or sources. ... Four generations of blood glucose meter, c. ... In medicine, some blood tests are conducted on venous blood obtained by fingerprick. ... Four generations of blood glucose meter, c. ...


Two other factors significantly affect glucose measurement: hematocrit and delay after phlebotomy. The disparity between venous and whole blood concentrations is greater when the hematocrit is high,[9] as in newborn infants, or adults with polycythemia. High neonatal hematocrits are particularly likely to confound glucose measurement by meter. Second, unless the specimen is drawn into a fluoride tube or processed immediately to separate the serum or plasma from the cells, the measurable glucose will be gradually lowered by in vitro metabolism of the glucose at a rate of approximately 7 mg/dL/hr, or even more in the presence of leukocytosis.[10][11][12] The hematocrit (Ht or HCT) and packed cell volume (PCV) are measures of the proportion of blood volume that is occupied by red blood cells. ... Polycythemia is a condition in which there is a net increase in the total number of red blood cells in the body. ... Sodium fluoride is an ionic compound with the formula NaF. This colourless solid is the main source of the fluoride ion in diverse applications. ... Leukocytosis is an elevation of the white blood cell count (the leukocyte count) above the normal range. ...


Age differences

Surveys of healthy children and adults show that plasma glucoses below 60 mg/dL (3.3 mM) or above 100 mg/dL (5.6 mM) are found in less than 5% of samples after an overnight fast.[13] In infants and young children up to 10% have been found to be below 60 mg/dL after an overnight fast.[citation needed] As the duration of fasting is extended, plasma glucose levels can fall further, even in healthy people. In other words, many healthy people can occasionally have glucose levels in the hypoglycemic range without symptoms or disease.


The normal range of newborn blood sugars continues to be debated. Surveys and experience have revealed blood sugars often below 40 mg/dL (2.2 mM), rarely below 30 mg/dL (1.7 mM),[citation needed] in apparently healthy full-term infants on the first day of life. It has been proposed that newborn brains are able to use alternate fuels when glucose levels are low more readily than adults. Experts continue to debate the significance and risk of such levels, though the trend has been to recommend maintenance of glucose levels above 60-70 mg/dL after the first day of life. In ill, undersized, or premature newborns, low blood sugars are even more common, but there is a consensus that sugars should be maintained at least above 50 mg/dL[citation needed] (2.8 mM) in such circumstances. Some experts advocate 70 mg/dL[citation needed] as a therapeutic target, especially in circumstances such as hyperinsulinism where alternate fuels may be less available. Intrauterine growth retardation or Intrauterine growth restriction (IUGR) refers to the condition during pregnancy where a fetus is considered to be too small for its gestational age (generally in the 10th percentile). ... Prematurity is the condition of being born before a full gestation. ... Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. ...


Presence or absence of effects

Research in healthy adults shows that mental efficiency declines slightly but measurably as blood glucose falls below 65 mg/dL (3.6 mM) in many people. Hormonal defense mechanisms (adrenaline and glucagon) are activated as it drops below a threshold level (about 55 mg/dL for most people), producing the typical symptoms of shakiness and dysphoria. On the other hand, obvious impairment does not often occur until the glucose falls below 40 mg/dL, and up to 10% of the population may occasionally have glucose levels below 65 in the morning without apparent effects. Brain effects of hypoglycemia, termed neuroglycopenia, determine whether a given low glucose is a "problem" for that person, and hence some people tend to use the term hypoglycemia only when a moderately low glucose is accompanied by symptoms. Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... Glucagon ball and stick model A microscopic image stained for glucagon. ... The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... Look up dysphoria in Wiktionary, the free dictionary. ... Neuroglycopenia is a medical term that refers to a shortage of glucose (glycopenia) in the brain, usually due to hypoglycemia. ...


Even this criterion is complicated by the facts that hypoglycemic symptoms are vague and can be produced by other conditions, that people with persistently or recurrently low glucose levels can lose their threshold symptoms so that severe neuroglycopenic impairment can occur without much warning, and that many of our measurement methods (especially glucose meters) are imprecise at low levels. Four generations of blood glucose meter, c. ...


Diabetic hypoglycemia represents a special case with respect to the relationship of measured glucose and hypoglycemic symptoms for several reasons. Although home glucose meter readings are sometimes misleading, the probability that a low reading accompanied by symptoms represents real hypoglycemia is higher in a person who takes insulin. Second, the hypoglycemia has a greater chance of progressing to more serious impairment if not treated, compared to most other forms of hypoglycemia that occur in adults. Third, because glucose levels are above normal most of the time in people with diabetes, hypoglycemic symptoms may occur at higher thresholds than in people who are normoglycemic most of the time. For all of these reasons, people with diabetes usually use higher meter glucose thresholds to determine hypoglycemia. Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ... Four generations of blood glucose meter, c. ...


Purpose of definition

For all of the reasons explained in the above paragraphs, deciding whether a blood glucose in the borderline range of 45-75 mg/dL (2.5-4.2 mM) represents clinically problematic hypoglycemia is not always simple. This leads people to use different "cutoff levels" of glucose in different contexts and for different purposes.


Pathophysiology

Like most animal tissues, brain metabolism depends primarily on glucose for fuel in most circumstances. A limited amount of glucose can be derived from glycogen stored in astrocytes, but it is consumed within minutes. For most practical purposes, the brain is dependent on a continual supply of glucose diffusing from the blood into the interstitial tissue within the central nervous system and into the neurons themselves. For other uses, see Brain (disambiguation). ... A few of the metabolic pathways in a cell. ... This article does not cite any references or sources. ... Astrocytes, also known as astroglia, are characteristic star-shaped glial cells in the brain. ... A diagram showing the CNS: 1. ... Drawing by Santiago Ramón y Cajal of neurons in the pigeon cerebellum. ...


Therefore, if the amount of glucose supplied by the blood falls, the brain is one of the first organs affected. In most people, subtle reduction of mental efficiency can be observed when the glucose falls below 65 mg/dl (3.6 mM). Impairment of action and judgement usually becomes obvious below 40 mg/dl (2.2 mM). Seizures may occur as the glucose falls further. As blood glucose levels fall below 10 mg/dl (0.55 mM), most neurons become electrically silent and nonfunctional, resulting in coma. These brain effects are collectively referred to as neuroglycopenia. This article is about epileptic seizures. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... Neuroglycopenia is a medical term that refers to a shortage of glucose (glycopenia) in the brain, usually due to hypoglycemia. ...


The importance of an adequate supply of glucose to the brain is apparent from the number of nervous, hormonal and metabolic responses to a falling glucose. Most of these are defensive or adaptive, tending to raise the blood sugar via glycogenolysis and gluconeogenesis or provide alternative fuels. A diagram showing the CNS: 1. ... Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Glycogen Glucose Glucose-6-phosphate Glycogenolysis is the catabolism of glycogen by removal of a glucose monomer and addition of phosphate to produce glucose-1-phosphate. ... Pyruvic acid Oxaloacetic acid Phosphoenolpyruvate Fructose 1,6-bisphosphate Fructose 6-phosphate Glucose-6-phosphate Glucose Gluconeogenesis is the generation of glucose from non-sugar carbon substrates like pyruvate, lactate, glycerol, and amino acids (primarily alanine and glutamine). ...


Brief or mild hypoglycemia produces no lasting effects on the brain, though it can temporarily alter brain responses to additional hypoglycemia. Prolonged, severe hypoglycemia can produce lasting damage of a wide range. This can include impairment of cognitive function, motor control, or even consciousness. The likelihood of permanent brain damage from any given instance of severe hypoglycemia is difficult to estimate, and depends on a multitude of factors such as age, recent blood and brain glucose experience, concurrent problems such as hypoxia, and availability of alternative fuels. The vast majority of symptomatic hypoglycemic episodes result in no detectable permanent harm.[14]


Signs and symptoms

Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar. Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... Glucagon ball and stick model A microscopic image stained for glucagon. ...


Adrenergic manifestations

This article does not cite any references or sources. ... This article or section does not cite any references or sources. ... SWEAT is an OLN/TSN show hosted by Julie Zwillich that aired in 2003-2004. ... The human eye The pupil is the central transparent area (showing as black). ...

Glucagon manifestations

Hunger is a feeling experienced when the glycogen level of the liver falls below a threshold, usually followed by a desire to eat. ... Borborygmus (plural borborygmi) is the rumbling sound produced by the movement of gas through the intestines of animals. ... For other uses, see Nausea (disambiguation). ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ...

Neuroglycopenic manifestations

Not all of the above manifestations occur in every case of hypoglycemia. There is no consistent order to the appearance of the symptoms. Specific manifestations vary by age and by severity of the hypoglycemia. In young children vomiting often accompanies morning hypoglycemia with ketosis. In older children and adults, moderately severe hypoglycemia can resemble mania, mental illness, drug intoxication, or drunkenness. In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise. The symptoms of a single person do tend to be similar from episode to episode. Look up dysphoria in Wiktionary, the free dictionary. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... This article or section is in need of attention from an expert on the subject. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ... Fatigue is a feeling of excessive tiredness or lethargy, with a desire to rest, perhaps to sleep. ... For other uses, see Sleep (disambiguation). ... For other uses, see Amnesia (disambiguation). ... This article is about the mental state and medical condition. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... Automatism, from the Greek automatismos or self action, is the spontaneous production of often purposeless verbal or motor behavior without conscious self-control or self-censorship. ... For other uses, see Ataxia (disambiguation). ... This article does not cite any references or sources. ... This article does not cite any references or sources. ... Hemiparesis is the partial paralysis of one side of the body. ... Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep (but not directly related to the phenomenon of... A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... This article is about epileptic seizures. ... Ketosis (IPA pronunciation: ) is a stage in metabolism occurring when the liver converts fat into fatty acids and ketone bodies which can be used by the body for energy. ... Mania is a severe medical condition characterized by extremely elevated mood, energy, and thought patterns. ... This article does not cite any references or sources. ... For other uses, see Stroke (disambiguation). ...


In newborns, hypoglycemia can produce irritability, jitters, myoclonic jerks, cyanosis, respiratory distress, apneic episodes, sweating, hypothermia, somnolence, hypotonia, refusal to feed, and seizures or "spells". Hypoglycemia can resemble asphyxia, hypocalcemia, sepsis, or heart failure. A myoclonic jerk is a sudden, involuntary twitch of a muscle. ... Cyanosis refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. ... Apnea (British spelling - apnoea) (Greek απνοια, from α-, privative, πνεειν, to breathe) is a technical term for suspension of external breathing. ... Hypothermia refers to any condition in which the temperature of a body drops below the level required for normal metabolism and/or bodily function to take place. ... Hypotonia is a condition of abnormally low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. ... Suffocation redirects here, for the band, see Suffocation (band). ... In medicine, hypocalcaemia is the presence of less than a total calcium of 2. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...


In both young and old patients, the brain may habituate to low glucose levels, with a reduction of noticeable symptoms despite neuroglycopenic impairment. In insulin-dependent diabetic patients this phenomenon is termed hypoglycemia unawareness and is a significant clinical problem when improved glycemic control is attempted. Another aspect of this phenomenon occurs in type I glycogenosis, when chronic hypoglycemia before diagnosis may be better tolerated than acute hypoglycemia after treatment is underway. This article is about the management of diabetes mellitus. ... Glycogen storage disease is any one of several inborn errors of metabolism that result from enzyme defects that affect the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. ...


Nearly always, hypoglycemia severe enough to cause seizures or unconsciousness can be reversed without obvious harm to the brain. Cases of death or permanent neurological damage occurring with a single episode have usually involved prolonged, untreated unconsciousness, interference with breathing, severe concurrent disease, or some other type of vulnerability. Nevertheless, brain damage or death has occasionally resulted from severe hypoglycemia.


Determining the cause

Hundreds of conditions can cause hypoglycemia. Common causes by age are listed below. While many aspects of the medical history and physical examination may be informative, the two best guides to the cause of unexplained hypoglycemia are usually The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ...

  1. the circumstances
  2. a critical sample of blood obtained at the time of hypoglycemia, before it is reversed.

The circumstances of hypoglycemia provide most of the clues to diagnosis

Circumstances include the age of the patient, time of day, time since last meal, previous episodes, nutritional status, physical and mental development, drugs or toxins (especially insulin or other diabetes drugs), diseases of other organ systems, family history, and response to treatment. When hypoglycemia occurs repeatedly, a record or "diary" of the spells over several months, noting the circumstances of each spell (time of day, relation to last meal, nature of last meal, response to carbohydrate, and so forth) may be useful in recognizing the nature and cause of the hypoglycemia.


An especially important aspect is whether the patient is seriously ill with another problem. Severe disease of nearly all major organ systems can cause hypoglycemia as a secondary problem. Hospitalized patients, especially in intensive care units or those prevented from eating, can suffer hypoglycemia from a variety of circumstances related to the care of their primary disease. Hypoglycemia in these circumstances is often multifactorial or even iatrogenic. Once identified, these types of hypoglycemia are readily reversed and prevented, and the underlying disease becomes the primary problem. For the record label, see Hospital Records. ... An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ... Ancient Greek painting in a vase, showing a physician (iatros) bleeding a patient. ...


Apart from determining nutritional status and identifying whether there is likely to be an underlying disease more serious than hypoglycemia, the physical examination of the patient is only occasionally helpful. Macrosomia in infancy usually indicates hyperinsulinism. A few syndromes and metabolic diseases may be recognizable by clues such as hepatomegaly or micropenis. Macrosomia, sometimes also called big baby syndrome, is a potential complication during childbirth and the latter stages of pregnancy. ... Congenital hyperinsulinism is a medical term referring to a variety of congenital disorders in which hypoglycemia is caused by excessive insulin secretion. ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. ... Hepatomegaly is the condition of having an enlarged liver. ... This article does not cite any references or sources. ...


Response to treatment, especially the amount of carbohydrate needed to reverse or prevent recurrence of hypoglycemia, may provide important clues as well. When 15-30 grams of sugar or starch are given by mouth, a low blood glucose will usually rise by 18-36 mg/dl (1-2 mmol/l) within 5-10 minutes, relieving hypoglycemic symptoms within 10 minutes[citation needed]. It may take longer to recover from severe hypoglycemia with unconsciousness or seizure even after restoration of normal blood glucose. When a person has not been unconscious, failure of carbohydrate to reverse the symptoms in 10-15 minutes increases the likelihood that hypoglycemia was not the cause of the symptoms. When severe hypoglycemia has persisted in a hospitalized patient, the amount of glucose required to maintain satisfactory blood glucose levels becomes an important clue to the underlying etiology. Glucose requirements above 10 mg/kg/minute in infants, or 6 mg/kg/minute in children and adults are strong evidence for hyperinsulinism. In this context this is referred to as the glucose infusion rate (GIR). Finally, the blood glucose response to glucagon given when the glucose is low can also help distinguish among various types of hypoglycemia. A rise of blood glucose by more than 30 mg/dl (1.70 mmol/l) suggests insulin excess as the probable cause of the hypoglycemia. Glucagon ball and stick model A microscopic image stained for glucagon. ... Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. ...


In less obvious cases, a "critical sample" may provide the diagnosis

In the majority of children and adults with recurrent, unexplained hypoglycemia, the diagnosis may be determined by obtaining a sample of blood during hypoglycemia. If this critical sample is obtained at the time of hypoglycemia, before it is reversed, it can provide information that would otherwise require a several-thousand-dollar hospital admission and unpleasant starvation testing. Perhaps the most common inadequacy of emergency department care in cases of unexplained hypoglycemia is the failure to obtain at least a basic sample before giving glucose to reverse it. For the record label, see Hospital Records. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and...


Part of the value of the critical sample may simply be the proof that the symptoms are indeed due to hypoglycemia. More often, measurement of certain hormones and metabolites at the time of hypoglycemia indicates which organs and body systems are responding appropriately and which are functioning abnormally. For example, when the blood glucose is low, hormones which raise the glucose should be rising and insulin secretion should be completely suppressed. Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is an anabolic polypeptide hormone that regulates carbohydrate metabolism. ...


The following is a brief list of hormones and metabolites which may be measured in a critical sample. Not all tests are checked on every patient. A "basic version" would include insulin, cortisol, and electrolytes, with C-peptide and drug screen for adults and growth hormone in children. The value of additional specific tests depends on the most likely diagnoses for an individual patient, based on the circumstances described above. Many of these levels change within minutes, especially if glucose is given, and there is no value in measuring them after the hypoglycemia is reversed. Others, especially those lower in the list, remain abnormal even after hypoglycemia is reversed, and can be usefully measured even if a critical specimen is missed. Although interpretation in difficult cases is beyond the scope of this article, for most of the tests, the primary significance is briefly noted.

  • Glucose: needed to document actual hypoglycemia
  • Insulin: any detectable amount is abnormal during hypoglycemia, but physician must know assay characteristics
  • Cortisol: should be high during hypoglycemia if pituitary and adrenals are functioning normally
  • Growth hormone: should rise after hypoglycemia if pituitary is functioning normally
  • Electrolytes and total carbon dioxide: electrolyte abnormalities may suggest renal or adrenal disease; mild acidosis is normal with starvation hypoglycemia; usually no acidosis with hyperinsulinism
  • Liver enzymes: elevation suggests liver disease
  • Ketones: should be high during fasting and hypoglycemia; low levels suggest hyperinsulinism or fatty acid oxidation disorder
  • Beta-hydroxybutyrate: should be high during fasting and hypoglycemia; low levels suggest hyperinsulinism or fatty acid oxidation disorder
  • Free fatty acids: should be high during fasting and hypoglycemia; low levels suggest hyperinsulinism; high with low ketones suggests fatty acid oxidation disorder
  • Lactic acid: high levels suggest sepsis or an inborn error of gluconeogenesis such as glycogen storage disease
  • Ammonia: if elevated suggests hyperinsulinism due to glutamate dehydrogenase deficiency, Reye syndrome, or certain types of liver failure
  • C-peptide: should be undetectable; if elevated suggests hyperinsulinism; low c-peptide with high insulin suggests exogenous (injected) insulin
  • Proinsulin: detectable levels suggest hyperinsulinism; levels disproportionate to a detectabe insulin level suggest insulinoma
  • Ethanol: suggests alcohol intoxication
  • Toxicology screen: can detect many drugs causing hypoglycemia, especially for sulfonylureas
  • Insulin antibodies: if positive suggests repeated insulin injection or antibody-mediated hypoglycemia
  • Urine organic acids: elevated in various characteristic patterns in several types of organic aciduria
  • Carnitine, free and total: low in certain disorders of fatty acid metabolism and certain types of drug toxicity and pancreatic disease
  • Thyroxine and TSH: low T4 without elevated TSH suggests hypopituitarism or malnutrition
  • Acylglycine: elevation suggests a disorder of fatty acid oxidation
  • Epinephrine: should be elevated during hypoglycemia
  • Glucagon: should be elevated during hypoglycemia
  • IGF-1: low levels suggest hypopituitarism or chronic malnutrition
  • IGF-2: low levels suggest hypopituitarism; high levels suggest non-pancreatic tumor hypoglycemia
  • ACTH: should be elevated during hypoglycemia; unusually high ACTH with low cortisol suggests Addison's disease
  • Alanine or other plasma amino acids: abnormal patterns may suggest certain inborn errors of amino acid metabolism or gluconeogenesis

Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is an anabolic polypeptide hormone that regulates carbohydrate metabolism. ... Cortisol is a corticosteroid hormone produced by the adrenal cortex (in the adrenal gland). ... Growth hormone (GH or somatotropin) is a 191-amino acid, single chain polypeptide hormone which is synthesised, stored and secreted by the somatotroph cells within the lateral wings of the anterior pituitary gland, which stimulates growth and cell reproduction in humans and other animals. ... An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... Ketone group A ketone (pronounced as key tone) is either the functional group characterized by a carbonyl group (O=C) linked to two other carbon atoms or a chemical compound that contains this functional group. ... Beta-hydroxybutyrate, acetoacetate, and acetone collectively are called ketone bodies. ... In chemistry, especially biochemistry, a fatty acid is a carboxylic acid (or organic acid), often with a long aliphatic tail (long chains), either saturated or unsaturated. ... For the production of milk by mammals, see Lactation. ... For other uses, see Ammonia (disambiguation). ... C-peptide is a peptide which is made when proinsulin is split into insulin and C-peptide. ... Proinsulin is the substance made first in the pancreas that is then made into insulin. ... Ethanol, also known as ethyl alcohol, drinking alcohol or grain alcohol, is a flammable, colorless, slightly toxic chemical compound, and is best known as the alcohol found in alcoholic beverages. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Urine organic acids is a medical diagnostic test used to exclude the possibility that a person has an inborn error of metabolism, usually one of the organic acidoses. ... Organic acidurias are a class of inherited metabolic diseases characterized by urinary excretion of abnormal amounts or types of organic acids. ... This article or section contains information that has not been verified and thus might not be reliable. ... Thyroxine, or 3:5,3:5 tetra­iodothyronine (often abbreviated as T4) is the major hormone secreted by the follicular cells of the thyroid gland. ... Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a hormone produced by thyrotrope cells in the anterior pituitary gland which regulates the endocrine function of the thyroid gland. ... “Adrenaline” redirects here. ... Glucagon ball and stick model A microscopic image stained for glucagon. ... The insulin-like growth factors (IGFs) are polypeptides with high sequence similarity to insulin. ... Insulin-like growth factor 2 (IGF-2) is a protein hormone similar in molecular structure to insulin. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ... Alanine (Ala, A) also 2-aminopropanoic acid is a non-essential α-amino acid. ... Phenylalanine is one of the standard amino acids. ...

Further diagnostic steps

When suspected hypoglycemia recurs and a critical specimen has not been obtained, the diagnostic evaluation may take several paths.


When general health is good, the symptoms are not severe, and the person can fast normally through the night, experimentation with diet (extra snacks with fat or protein, reduced sugar) may be enough to solve the problem. If it is uncertain whether "spells" are indeed due to hypoglycemia, some physicians will recommend use of a home glucose meter to test at the time of the spells to confirm that glucoses are low. This approach may be most useful when spells are fairly frequent or the patient is confident that he or she can provoke a spell. The principal drawback of this approach is the high rate of false positive or equivocal levels due to the imprecision of the currently available meters: both physician and patient need an accurate understanding of what a meter can and cannot do to avoid frustrating and inconclusive results. Four generations of blood glucose meter, c. ...


In cases of recurrent hypoglycemia with severe symptoms, the best method of excluding dangerous conditions is often a diagnostic fast. This is usually conducted in the hospital, and the duration depends on the age of the patient and response to the fast. A healthy adult can usually maintain a glucose level above 50 mg/dl (2.8 mM) for 72 hours, a child for 36 hours, and an infant for 24 hours. The purpose of the fast is to determine whether the person can maintain his or her blood glucose as long as normal, and can respond to fasting with the appropriate metabolic changes. At the end of the fast the insulin should be nearly undetectable and ketosis should be fully established. The patient's blood glucose levels are monitored and a critical specimen is obtained if the glucose falls. Despite its unpleasantness and expense, a diagnostic fast may be the only effective way to confirm or refute a number of serious forms of hypoglycemia, especially those involving excessive insulin. Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. ...


A traditional method for investigating suspected hypoglycemia is the oral glucose tolerance test, especially when prolonged to 3, 4, or 5 hours. Although quite popular in the United States in the 1960s, repeated research studies have demonstrated that many healthy people will have glucose levels below 70 or 60 during a prolonged test, and that many types of significant hypoglycemia may go undetected with it. This combination of poor sensitivity and specificity has resulted in its abandonment for this purpose by physicians experienced in disorders of glucose metabolism. A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...


Causes

There are several ways to classify hypoglycemia. The following is a list of the more common causes and factors which may contribute to hypoglycemia grouped by age, followed by some causes that are relatively age-independent. See causes of hypoglycemia for a more complete list grouped by etiology. This list of causes of hypoglycemia is separated from the main article because of its length. ...


Hypoglycemia in newborn infants

Hypoglycemia is a common problem in critically ill or extremely low birthweight infants. If not due to maternal hyperglycemia, in most cases it is multifactorial, transient and easily supported. In a minority of cases hypoglycemia turns out to be due to significant hyperinsulinism, hypopituitarism or an inborn error of metabolism and presents more of a management challenge.

Prematurity is the condition of being born before a full gestation. ... Intrauterine growth retardation or Intrauterine growth restriction (IUGR) refers to the condition during pregnancy where a fetus is considered to be too small for its gestational age (generally in the 10th percentile). ... Perinatal asphyxia is the medical condition resulting from deprivation of oxygen (hypoxia) to a newborn infant long enough to cause apparent harm. ... This article is about the disease that features high blood sugar. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... Congenital hyperinsulinism is a medical term referring to a variety of congenital disorders in which hypoglycemia is caused by excessive insulin secretion. ... Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. ... Glycogen storage disease is any one of several inborn errors of metabolism that result from enzyme defects that affect the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. ...

Hypoglycemia in young children

Single episodes of hypoglycemia due to gastroenteritis or fasting, but recurrent episodes nearly always indicate either an inborn error of metabolism, congenital hypopituitarism, or congenital hyperinsulinism Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. ...

Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... This article or section does not adequately cite its references or sources. ... Gastroenteritis involves diarrhea or vomiting, with noninflammatory infection of the upper small bowel, or inflammatory infection of the colon, both part of the gastrointestinal tract. ... Ketotic hypoglycemia is a medical term used in two ways: (1) broadly, to refer to any circumstance in which low blood glucose is accompanied by ketosis, and (2) in a much more restrictive way to refer to recurrent episodes of hypoglycemic symptoms with ketosis and, often, vomiting, in young children. ... Growth hormone deficiency is the medical condition of inadequate production of growth hormone (GH) and its effects on children and adults. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. ... Congenital hyperinsulinism is a medical term referring to a variety of congenital disorders in which hypoglycemia is caused by excessive insulin secretion. ... Gastric dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine, the jejunum, fills too quickly with undigested food from the stomach. ... Maple syrup urine disease (MSUD) is an autosomal recessive metabolic disorder of amino acid metabolism. ... Organic acidurias are a class of inherited metabolic diseases characterized by urinary excretion of abnormal amounts or types of organic acids. ... Glycogen storage disease is any one of several inborn errors of metabolism that result from enzyme defects that affect the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. ... Numerous genetic disorders are caused by errors in fatty acid metabolism. ... Medium-chain acyl-coenzyme A dehydrogenase deficiency is one of a group of conditions that is associated with inborn errors of metabolism in fatty acid oxidation. ... Medium chain acyl dehydrogenase Deficiency is one of a group of conditions that is associated with inborn errors of metabolism in fatty acid oxidation. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... Propranolol (INN) (IPA: ) is a non-selective beta blocker mainly used in the treatment of hypertension. ... Ethanol, also known as ethyl alcohol, drinking alcohol or grain alcohol, is a flammable, colorless, slightly toxic chemical compound, and is best known as the alcohol found in alcoholic beverages. ...

Hypoglycemia in older children and young adults

By far the most common cause of severe hypoglycemia in this age range is insulin injected for type 1 diabetes. Circumstances should provide clues fairly quickly for the new diseases causing severe hypoglycemia. All of the congenital metabolic defects, congenital forms of hyperinsulinism, and congenital hypopituitarism are likely to have already been diagnosed or are unlikely to start causing new hypoglycemia at this age. Body mass is large enough to make starvation hypoglycemia and idiopathic ketotic hypoglycemia quite uncommon. Recurrent mild hypoglycemia may fit a reactive hypoglycemia pattern, but this is also the peak age for idiopathic postprandial syndrome, and recurrent "spells" in this age group can be traced to orthostatic hypotension or hyperventilation as often as demonstrable hypoglycemia. This article is about the disease that features high blood sugar. ... Ketotic hypoglycemia is a medical term used in two ways: (1) broadly, to refer to any circumstance in which low blood glucose is accompanied by ketosis, and (2) in a much more restrictive way to refer to recurrent episodes of hypoglycemic symptoms with ketosis and, often, vomiting, in young children. ... Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ... Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low glucose levels. ... Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest. ... In medicine, hyperventilation (or hyperpnea) is the state of breathing faster or deeper (hyper) than necessary, and thereby reducing the carbon dioxide concentration of the blood below normal. ...

This article is about the self-inflicted factitious disorder. ... Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ... Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low glucose levels. ... Addisons disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...

Hypoglycemia in older adults

The incidence of hypoglycemia due to complex drug interactions, especially involving oral hypoglycemic agents and insulin for diabetes rises with age. Though much rarer, the incidence of insulin-producing tumors also rises with advancing age. Most tumors causing hypoglycemia by mechanisms other than insulin excess occur in adults. An oral hypoglycemic agent is a medication (usually a pill or capsule) that can be take by mouth to lower a high blood sugar toward normal. ...

This article is about the self-inflicted factitious disorder. ... The dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine fills too quickly with undigested food from the stomach. ... Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ... Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low glucose levels. ... This list of causes of hypoglycemia is separated from the main article because of its length. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ...

Treatment and prevention

Management of hypoglycemia involves immediately raising the blood sugar to normal, determining the cause, and taking measures to prevent future episodes.


Reversing acute hypoglycemia

The blood glucose can be raised to normal within minutes by taking (or receiving) 10-20 grams of carbohydrate. It can be taken as food or drink if the person is conscious and able to swallow. This amount of carbohydrate is contained in about 3-4 ounces (100-120 ml) of orange, apple, or grape juice, about 4-5 ounces (120-150 ml) of regular (non-diet) soda, about one slice of bread, about 4 crackers, or about 1 serving of most starchy foods. Starch is quickly digested to glucose (unless the person is taking acarbose), but adding fat or protein retards digestion. Symptoms should begin to improve within 5 minutes, though full recovery may take 10-20 minutes. Overfeeding does not speed recovery and if the person has diabetes will simply produce hyperglycemia afterwards. Lactose is a disaccharide found in milk. ... Starch (CAS# 9005-25-8) is a complex carbohydrate which is insoluble in water; it is used by plants as a way to store excess glucose. ... Acarbose is a drug used to treat type 2 diabetes mellitus. ...


If a person is suffering such severe effects of hypoglycemia that they cannot (due to combativeness) or should not (due to seizures or unconsciousness) be given anything by mouth, glucose can be given by intravenous infusion or the glucose can be rapidly raised by an injection of glucagon. Further details of glucagon use are provided in the article on diabetic hypoglycemia. Glucagon ball and stick model A microscopic image stained for glucagon. ... Glucagon ball and stick model A microscopic image stained for glucagon. ... Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ...


One situation where starch may be less effective than glucose or sucrose is when a person is taking acarbose. Since acarbose and other alpha-glucosidase inhibitors prevents starch and other sugars from being broken down into monosaccharides that can be absorbed by the body, patients taking these medications should consume monosaccharide-containing foods such as glucose tablets, honey, or juice to reverse hypoglycemia. Acarbose is a drug used to treat type 2 diabetes mellitus. ... Alpha-glucosidase inhibitors are oral anti-diabetic drugs used for diabetes mellitus type 2 that work by preventing the digestion of carbohydrates (such as starch). ... Monosaccharides are the simplest form of carbohydrates. ...


Prevention

The most effective means of preventing further episodes of hypoglycemia depends on the cause.


The risk of further episodes of diabetic hypoglycemia can often be reduced by lowering the dose of insulin or other medications, or by more meticulous attention to blood sugar balance during unusual hours, higher levels of exercise, or alcohol intake. Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ...


Many of the inborn errors of metabolism require avoidance or shortening of fasting intervals, or extra carbohydrates. For the more severe disorders, such as type 1 glycogen storage disease, this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion. Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. ... Glycogen storage disease is any one of several inborn errors of metabolism that result from enzyme defects that affect the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. ... Products treated with cornstarch Cornstarch, or cornflour, is the starch of the maize grain, commonly known as corn. ...


Several treatments are used for hyperinsulinemic hypoglycemia, depending on the exact form and severity. Some forms of congenital hyperinsulinism respond to diazoxide or octreotide. Surgical removal of the overactive part of the pancreas is curative with minimal risk when hyperinsulinism is focal or due to a benign insulin-producing tumor of the pancreas. When congenital hyperinsulinism is diffuse and refractory to medications, near-total pancreatectomy may be the treatment of last resort, but in this condition is less consistently effective and fraught with more complications. Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. ... Congenital hyperinsulinism is a medical term referring to a variety of congenital disorders in which hypoglycemia is caused by excessive insulin secretion. ... Diazoxide is a potassium channel activator, which causes local relaxation in smooth muscle by increasing membrane permeability to potassium ions. ... Somatostatin is a hormone. ...


Hypoglycemia due to hormone deficiencies such as hypopituitarism or adrenal insufficiency usually ceases when the appropriate hormone is replaced. Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ...


Hypoglycemia due to dumping syndrome and other post-surgical conditions is best dealt with by altering diet. Including fat and protein with carbohydrates may slow digestion and reduce early insulin secretion. Some forms of this respond to treatment with a glucosidase inhibitor, which slows starch digestion. The dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine fills too quickly with undigested food from the stomach. ... Starch (CAS# 9005-25-8) is a complex carbohydrate which is insoluble in water; it is used by plants as a way to store excess glucose. ...


Reactive hypoglycemia with demonstrably low blood glucose levels is most often a predictable nuisance which can be avoided by consuming fat and protein with carbohydrates, by adding morning or afternoon snacks, and reducing alcohol intake. Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ...


Idiopathic postprandial syndrome without demonstrably low glucose levels at the time of symptoms can be more of a management challenge. Many people find improvement by changing eating patterns (smaller meals, avoiding excessive sugar, mixed meals rather than carbohydrates by themselves), reducing intake of stimulants such as caffeine, or by making lifestyle changes to reduce stress. See the following section of this article. Caffeine is a xanthine alkaloid compound that acts as a stimulant in humans. ...


Hypoglycemia as American folk medicine

Hypoglycemia is also a term of contemporary American folk medicine which refers to a recurrent state of symptoms of altered mood and subjective cognitive efficiency, sometimes accompanied by adrenergic symptoms, but not necessarily by measured low blood glucose. Symptoms are primarily those of altered mood, behavior, and mental efficiency. This condition is usually treated by dietary changes which range from simple to elaborate. A traditional healer in Côte dIvoire Folk medicine refers collectively to procedures traditionally used for treatment of illness and injury, aid to childbirth, and maintenance of wellness. ... An adrenergic is a drug, or other substance, which has effects similar to, or the same as, epinephrine (adrenaline). ...


This condition therefore overlaps with the definition and forms of hypoglycemia described in the other sections of this article but is not entirely congruent. When low glucose levels can be measured, this condition is usually described by physicians as idiopathic reactive hypoglycemia. When glucose levels are not low enough to distinguish the patient's glucose from normal levels, this type of "hypoglycemia" does not carry the same risks of coma or brain damage as measurable hypoglycemia that meets the Whipple criteria. A variety of terms have been used in the medical literature: functional hypoglycemia, idiopathic postprandial syndrome, pseudohypoglycemia, nonhypoglycemia, and "hypoglycemia". The terms range from favorable to pejorative and reflect the range of attitudes of physicians as much as the nature of the condition. Idiopathic means arising spontaneously or from an obscure or unknown cause. ... Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ... Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low glucose levels. ...


Advising people on management of this condition is a significant "sub-industry" of alternative medicine. More information about this form of "hypoglycemia", with far more elaborate dietary recommendations, is available on the internet and in health food stores. Most of these websites and books describe a conflated mixture of reactive hypoglycemia and idiopathic postprandial syndrome but do not recognize a distinction. The value of most of their recommendations is unproven from a scientific perspective. Alternative medicine is defined as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Complementary medicine is defined as any of the practices (as acupuncture) of alternative medicine accepted...


References

  1. ^ Philip E. Cryer (1997). Hypoglycemia: pathophysiology, diagnosis, and treatment. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-511325-X. 
  2. ^ Koh TH, Eyre JA, Aynsley-Green A (1988). "Neonatal hypoglycaemia--the controversy regarding definition". Arch. Dis. Child. 63 (11): 1386-8. PMID 3202648. 
  3. ^ Cornblath M, Schwartz R, Aynsley-Green A, Lloyd JK (1990). "Hypoglycemia in infancy: the need for a rational definition. A Ciba Foundation discussion meeting". Pediatrics 85 (5): 834-7. PMID 2330247. 
  4. ^ Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, Kalhan SC (2000). "Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds". Pediatrics 105 (5): 1141-5. PMID 10790476. 
  5. ^ a b Tustison WA, Bowen AJ, Crampton JH (1966). "Clinical interpretation of plasma glucose values". Diabetes 15 (11): 775-7. PMID 5924610. 
  6. ^ [edited by] John Bernard Henry (1979). Clinical diagnosis and management by laboratory methods. Philadelphia: Saunders. ISBN 0-7216-4639-5. 
  7. ^ Clarke WL, Cox D, Gonder-Frederick LA, Carter W, Pohl SL (1987). "Evaluating clinical accuracy of systems for self-monitoring of blood glucose". Diabetes Care 10 (5): 622-8. PMID 3677983. 
  8. ^ Gama R, Anderson NR, Marks V (2000). "'Glucose meter hypoglycaemia': often a non-disease". Ann. Clin. Biochem. 37 ( Pt 5): 731-2. PMID 11026531. 
  9. ^ [edited by] John Bernard Henry (1979). Clinical diagnosis and management by laboratory methods. Philadelphia: Saunders. ISBN 0-7216-4639-5. 
  10. ^ de Pasqua A, Mattock MB, Phillips R, Keen H (1984). "Errors in blood glucose determination". Lancet 2 (8412): 1165. PMID 6150231. 
  11. ^ Horwitz DL (1989). "Factitious and artifactual hypoglycemia". Endocrinol. Metab. Clin. North Am. 18 (1): 203-10. PMID 2645127. 
  12. ^ [edited by] John Bernard Henry (1979). Clinical diagnosis and management by laboratory methods. Philadelphia: Saunders. ISBN 0-7216-4639-5. 
  13. ^ Samuel Meites, editor-in-chief; contributing editors, Gregory J. Buffone... [et al.] (1989). Pediatric clinical chemistry: reference (normal) values. Washington, D.C: AACC Press. ISBN 0-915274-47-7. 
  14. ^ edited by Allen I. Arieff, Robert C. Griggs (1992). Metabolic brain dysfunction in systemic disorders. Boston: Little, Brown. ISBN 0-316-05067-9. 
  15. ^ The Hypoglycemic states - Hypoglycemia. The Hypoglycemic states. Armenian Medical Network (2007).

See also

Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... This article is about the disease that features high blood sugar. ... Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic... Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ... Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. ... Congenital hyperinsulinism is a medical term referring to a variety of congenital disorders in which hypoglycemia is caused by excessive insulin secretion. ... Idiopathic or common hypoglycemia is a condition in which the glucose level in the blood (blood glucose) is abnormally low. ... Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low glucose levels. ... Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ...

External links

  • The National Diabetes Information Clearinghouse

  Results from FactBites:
 
Hypoglycemia - My Child Has - Children's Hospital Boston (776 words)
Hypoglycemia is the condition of having a glucose (blood sugar) level that is too low to effectively fuel the body's cells.
Hypoglycemia may be a condition by itself, or may be a complication of diabetes or another disorder.
Hypoglycemia in the newborn can be caused by conditions that: lower the amount of glucose in the bloodstream, prevent or lessen storage of glucose, use up glycogen stores (sugar stored in the liver), inhibit the use of glucose by the body.
Hypoglycemia Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com (583 words)
Despite significant advances in diabetes treatment, hypoglycemia (low blood sugar or glucose) is still a common problem among patients who are trying to achieve better control of their blood sugar.
Hypoglycemia is the clinical syndrome that results from low blood sugar.
Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range.
  More results at FactBites »

 
 

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