Symptomatic hypoglycemia can be clinically divided into two situations, one is hypoglycemic, that is, the blood glucose value meets the current biochemical criteria for hypoglycemia, and the other is non-hypoglycemic, that is, the blood glucose is still within the normal range (most of them fall at the low end of the normal range), but it is much lower than its own “previous” blood glucose value, and The symptoms may be mild or severe, but they do not lead to coma.
It is seen in patients with long-term hyperglycemia, because the body has relatively adapted to the hyperglycemic environment, and in the process of treatment with hypoglycemic drugs, because the blood glucose drops too fast, when the blood glucose drops to a certain threshold (although it is still within the normal range), the originally established homeostasis is broken, and it is difficult to adapt to the new internal environmental changes, so that the symptoms similar to hypoglycemia appear, which is a kind of alternative “hypoglycemia”. “Strictly speaking, it does not belong to the current medical definition of “hypoglycemia”, so we may call this situation “hypoglycemia-like reaction”.
The treatment of this condition is relatively simple, and the principle is to gradually bring the blood sugar to the standard. In the first 1-2 weeks, or a longer period of time, first relax the blood sugar target, and then gradually increase the dose of hypoglycemic drugs until the target is reached. Don’t be too hasty, otherwise you will not be able to reach the goal if you want to do it quickly.
Asymptomatic hypoglycemia means that the blood glucose is very low when tested, meeting the current biochemical standards for hypoglycemia, but there are no detectable symptoms, or the symptoms are so mild that they do not cause the patient to be alerted. The harm of asymptomatic hypoglycemia is far greater than that of symptomatic hypoglycemia, because the patient does not notice it and cannot be treated in time, which can easily induce life-threatening cardiovascular and cerebrovascular events, such as angina pectoris and even myocardial infarction and stroke, and should be highly concerned.
The current medical definition of “hypoglycemia” is as follows: a diabetic patient is diagnosed with hypoglycemia when his blood sugar is equal to or lower than 3.9 mmol/L at any time, while a non-diabetic patient is diagnosed with hypoglycemia when his blood sugar is lower than 2.8 mmol/L.
What are the manifestations of hypoglycemia?
The manifestation of sympathetic nerve overexcitation
During hypoglycemic attack, due to the release of epinephrine and norepinephrine from sympathetic nerve and adrenal medulla, clinical manifestations include cold sweat on face, limbs and even whole body, hunger, panic, trembling of limbs or whole body, pale face and cold skin.
Manifestations of brain dysfunction
When the brain lacks sufficient supply of glucose, the initial manifestation is mental inattention, slow thinking and speech, dizziness, drowsiness, restlessness, irritability, strange behavior (such as defecating, spitting, running away, not recognizing family members, babbling, moving objects indiscriminately) and other mental symptoms, and in serious cases, convulsions, coma or even death.
How to detect hypoglycemia? Diabetic patients should test their blood sugar immediately whenever any of the above-mentioned manifestations occur in their daily life. Regular daily monitoring of blood sugar is a good strategy to detect hypoglycemia.
What should I do after hypoglycemia occurs?
Let’s first look at how the body saves itself when hypoglycemia occurs in a normal person under certain circumstances.
In the course of a person’s life, he or she will experience hypoglycemia to a greater or lesser extent, such as delayed meals, which are corrected by timely and active feeding without leaving any physical or intellectual disability “traces”. If trapped in a geological disaster for a long time without food intake, blood sugar will gradually drop, and when it reaches a certain threshold, the body will quickly respond to “self-help”, first of all, insulin secretion rapidly decreases, then muscle, liver and adipose tissue, which normally take in glucose from the blood circulation, will be “the big family” due to insulin secretion. At this time, muscles, liver and fatty tissues, which are usually the “major households” of glucose intake from blood circulation, are closed due to the weakened role of insulin, and the “channels” for glucose delivery are temporarily forced to “cut off food” to ensure the limited supply of blood sugar to the brain, which is very sensitive to hypoglycemia. People can fall into coma within minutes of the onset of hypoglycemia.
However, unlike these tissues, the brain’s “channels” for glucose uptake are always open and are minimally affected by insulin levels. At the same time, hormones that raise blood glucose are rapidly secreted so that glycogen stored in the liver is quickly broken down into glucose and transported into the blood to replenish blood glucose, so that the brain does not lose vitality in the short term. Nevertheless, this is only a stopgap measure. The liver stores only 100-150 grams of glycogen, while the brain consumes about 4-6 grams of glucose per hour, which is depleted in more than 10 hours. We have often heard of people trapped in the earthquake for days without food and drink and “unharmed”, how do they “survive” over?
The body also has another channel for energy support, which is to open the body’s “granary”, that is, the breakdown of fat and muscle tissue. Fatty acids from adipose tissue can be directly “burned” oxidation for energy, fatty acid metabolism process produces intermediate products – “ketone bodies”, the latter can partially replace the glucose by the brain at its fingertips to “fill the hunger “The latter can partially replace glucose at the brain’s fingertips. Protein in muscle tissue is decomposed into amino acids into the blood circulation, where the “sugar-forming” amino acids are converted into glucose by the liver and released into the blood, so that hypoglycemia is further relieved and life can be maintained in a limited way. This is also the reason why the bones are as thin as a bone after a long period of starvation.
The causes of hypoglycemia in diabetic patients are very different from those in non-diabetic patients, and are characterized by
It usually occurs in the process of applying hypoglycemic drugs. If a normal person has hypoglycemia, the insulin secreted by the body itself immediately “stops”, while the insulin level in the blood circulation of diabetic patients who are taking insulin promoters or are being treated with insulin at the moment does not decrease accordingly, and the above three “big families” when hypoglycemia occurs When hypoglycemia occurs, the three “big families” mentioned above still take in glucose from the blood circulation and do not care that the brain is in a critical situation.
At the same time, the secretion of the reverse hormone that counteracts the effect of insulin, i.e., the hormone related to the ascending blood sugar, is impaired, so that both hepatic glycogenolysis and gluconeogenesis are insufficient, and the ability of the body to endogenously replenish blood sugar by itself is weakened; due to advanced age, long disease duration and many complications, such as diabetic neuropathy, the neural reflex arc of hypoglycemia is out of order and the response is slow, and the symptoms of hypoglycemia are often atypical or even absent, when hypoglycemia occurs, especially When hypoglycemia occurs, especially nocturnal hypoglycemia is often unnoticed and ignored; a variety of diseases are mixed together, and the symptoms of hypoglycemia are often covered by other diseases; people with combined heart disease and hypertension often take metoprolol extended-release tablets or bisoprolol tablets together, and these drugs all have the effect of suppressing heart rate, which slows down the heart rate, and a very important warning symptom of hypoglycemia – heartburn – often does not appear. In a word, the self-protection mechanism is partially or completely deprived when hypoglycemia occurs in diabetic patients, often endangering their lives because they cannot be rescued in time.
The way to deal with hypoglycemia.
1, prevention is the main focus, prevention is better than cure. Diabetic patients remember three things when they go out, one is to carry an appropriate amount of fast food, such as individually wrapped small sugar cubes or cookies, it is best to spare a small bottle of drinking water, a travel companion would be perfect; simple blood glucose testing tools; put a thick piece of paper in the outer pocket of your clothes that can identify you, marked with name, address, disease name, family phone number, in case you need good people can help you.
Second, watch out for hypoglycemic symptoms. Hypoglycemia often occurs at the peak of the effect of hypoglycemic drugs, after activities, before meals, before bedtime and at night, so you should pay special attention to whether hypoglycemic symptoms are present at these points in time. If necessary, it is necessary to add meals early and reduce the amount of activity, so as not to be caught off guard when the symptoms become severe. Third, eat on time. When you cannot eat on time due to objective reasons, such as being on a transportation carrier or traveling, you must start using the fast food you carry with you in time.
Because the last, or the previous day’s use of hypoglycemic drugs have not been completely cleared from the body, still playing a certain hypoglycemic effect, delaying the meal time is very likely to incur hypoglycemia occurrence, should try to avoid. Finally, monitor your blood sugar regularly, accumulate life experience and be your own best health care doctor. It is easier to detect blood glucose during daytime, and those who are treated with long-acting or medium-acting insulin and oral long-acting hypoglycemic drugs should pay particular attention to monitoring blood glucose at night (usually measuring blood glucose at 1 to 3 points, such as 10:00 a.m., 0:00 a.m. and 3:00 a.m. before bedtime), in order to detect hypoglycemia that is not detected at night.
It is recommended that you use a palm-sized book (too big to carry and keep) to do a little homework (record: the specific time of hypoglycemia or hyperglycemia, what you ate at the previous meal, whether you ate less or more than yesterday, how long you were active, etc. The amount of food, the type of food, the length and intensity of exercise are all related to blood sugar, so that you can make self-adjustment from it). When you sit down at leisure, you can open it and analyze it, and you may be surprised to find that you can find out the reasons for low blood sugar and high blood sugar, and you can finally be your own doctor! You can finally be your own doctor! A long illness becomes a good doctor, and people with a heart will eventually have unexpected returns.
2. Emergency treatment for hypoglycemia.
Stop all the work in your hands immediately when any one of the symptoms of hypoglycemia appears, measure blood sugar once when there are simple blood sugar testing tools around, take out the fast food you carry with you or any other food that can replenish energy (sugar is better) to add meals quickly, and test again after 15 minutes, if the blood sugar is still lower than 3.9mmol/L, eat the same amount of food again and continue to monitor. There are many manufacturers of instant cookies sold in the market that are made into individual packages, each packet is packed with two pieces.
I have bought several manufacturers’ products to compare, the total calorie of two packets is about 50 kcal (about 210 kJ), patients should pay attention to the label above when purchasing. It is appropriate to eat two pieces when hypoglycemia occurs. If your blood sugar is lower than 5.0mmol/L, especially for elderly patients, you may want to eat one of these cookies to prevent hypoglycemia. There is no need to wait until hypoglycemia occurs before rushing to find food, everything will be too late. When the patient is hospitalized, the situation will be much better, the rescue means are at hand, if necessary, intravenous hypertonic glucose solution can be injected immediately.
If the symptoms are too severe to measure blood glucose for the time being, the patient should be tested after eating first. If there is no condition to measure blood glucose, it will be treated as hypoglycemia first according to the principle of life first. Some people may worry that what if the symptoms are not caused by hypoglycemia but by hyperglycemia, what if they eat? Remember: the threat of hypoglycemia to life is measured in minutes, which can be fatal immediately and is urgent, while the threat of hyperglycemia to life is measured in days (such as hyperglycemia hypertonic state) or years (chronic complications caused by long-term hyperglycemia state), which is less important is clear.
To take a step back, even if it is hyperglycemia, if you “wrongly” add some meals due to improper judgment, although the blood sugar will further increase, it will not be fatal immediately, and there is still a chance to go to hospital for treatment, but not hypoglycemia. Therefore, it is worthwhile to “take this risk”.
What should I do if I pass out from hypoglycemia?
This is a very serious condition, which is common in elderly people who are alone or live alone, or travel alone, usually because they have no experience in treating hypoglycemia and have no common sense in treating hypoglycemia. This situation should be scrambled and actively resuscitated on the spot. When family members or bystanders find out, the first response should be to call 120 and 110 for help. 120 emergency vehicles are equipped with emergency supplies, including glucose. Send the patient to the nearest hospital or medical office in the fastest way possible, and immediately administer intravenous hypertonic glucose solution.
What family members or bystanders can do before the paramedics arrive: never try to feed the patient any food to avoid accidentally inhaling the airway and causing asphyxiation; when the patient vomits, place a small pillow or other obtainable soft object under the neck so that the head is tilted back and to the side, and the mouth should be cleared of vomit to avoid food residue being inhaled into the airway. It is suggested that a small spoon of white sugar, or a small piece of sugar under the patient’s tongue, because the oral mucosa also has a certain absorption function, to win the first opportunity for successful rescue, but must be closely monitored, to prevent accidental aspiration.
Some foreign diabetic patients often carry first aid kits with them when they go out, and the kits are equipped with one to two glucagon, disposable syringes and sealed sterilized alcohol cotton balls. When hypoglycemia occurs, if there is no quick food, one glucagon (1mg each) can be injected subcutaneously immediately, and the next person will assist in the injection when the patient is unconscious. Glucagon can quickly break down the glycogen stored in the liver into glucose and transport it into the blood to solve the urgent problem. At present, there is no manufacturer of glucagon in China, so we cannot expect it yet.
Some people in hypoglycemic coma can sometimes recover on their own with the help of their body’s self-help mechanism, but such an experience is like a trip to the ghost gate, so don’t have a second one.
After recovering from hypoglycemia treatment, it is best to continue to observe for a period of time, because sometimes hypoglycemia can last for more than a few days, while looking for the cause of hypoglycemia, and those caused by hypoglycemic drugs should be temporarily discontinued. Because the drugs have not been eliminated from the body, hypoglycemia can happen again and again, so do not take it lightly. I once treated a diabetic patient with persistent hypoglycemia for more than one week, who was determined to be hypoglycemic after going to the emergency department because of coma.
This case had diabetes mellitus of 16 years’ duration, which had been combined with various complications, and hypoglycemia caused by long-term treatment with glibenclamide. The hypoglycemia was caused by long-term treatment with glibenclamide. The degenerative function of organs in the elderly and diabetic nephropathy slow down the metabolism of drugs and accumulate in the body, which invariably amplifies the effect of drugs and easily causes serious hypoglycemia, and the hypoglycemia patients need to have their future glucose-lowering programs carefully re-examined, and the goal of glucose control should be individualized and appropriately relaxed. “Otherwise, it will only be wishful thinking, and will be too late once the accident occurs.
Hypoglycemia often comes and goes in a hurry, and those who can be treated in time can recover immediately, while prolonged or recurrent hypoglycemia can cause great damage to the brain, such as dementia or other disabilities, or becoming a vegetable, or even worse, being separated from the world.
One serious hypoglycemia can ruin the patient’s lifelong efforts to reduce sugar. Therefore, diabetic patients should not only focus on how to lower their sugar, but also learn how to identify hypoglycemia and how to prevent and control it, and they should have a better grasp of the latter.