Blood glucose is the general term for various monosaccharides in the blood, including glucose, galactose, fructose and mannose, but mainly glucose. In normal people, the blood glucose concentration is 3.9-6.1mmol/L in the early morning when fasting. it is important to maintain a normal blood glucose concentration because all tissues and cells in the body need to get glucose from the blood, especially brain tissue and red blood cells, which have almost no glycogen storage and must be supplied with glucose from the blood at any time to get the energy needed for their own survival, metabolism and function.
Fasting blood glucose concentration below 3.9mmol/L in adults is called hypoglycemia, but blood glucose below a much lower level is what leads to the appearance of some symptoms called hypoglycemia. Hypoglycemia means that, blood glucose is below a specific level and leads to the appearance of a series of symptoms, and the diagnostic criteria are: <50mg/dl (<2.8mmol/L) in men and <45mg/dl (<2.5mmol/ L) (normal male after 72 hours of starvation, lowest value for female), and <40mg/dl (2.2mmol/L) for infants and children. When the blood glucose concentration is lower than 50~60mg/dl (2.8~3.3mmol/L), the early symptoms of hypoglycemia appear (cold limbs, pale face, cold sweat, dizziness, panic, etc.); when the blood glucose concentration is lower than 45mg/dl (<2.5mmol/L), the late symptoms of hypoglycemia appear (convulsions and coma in addition to the early symptoms, etc.).
The causes of diabetic hypoglycemia are generally the following.
1.Pharmacogenic hypoglycemia
It is mainly seen in diabetes treatment, often caused by overuse of insulin, oral hypoglycemic drugs such as sulfonylureas, increased activity after use or unreasonable diet coordination. Insulin lowers blood glucose by increasing the utilization of blood glucose and reducing the source of blood glucose, and its action links are.
1.Promoting the transfer of glucose into the cells of muscle and adipose tissue cells.
2.Accelerating the oxidation and enzymes of glucose.
3.Promoting the synthesis and storage of glycogen.
4.Inhibiting glycogenolysis and allogenesis.
5.Promote the transformation of sugar into fat.
2.Reverse hypoglycemia
It is a kind of hypoglycemia caused by suddenly stopping the infusion of hypertonic glucose. The mechanism may be that the infusion of hypertonic glucose solution stimulates the secretion of insulin in large quantities, and its concentration can be 4-6 times higher than normal. If the infusion of hypertonic glucose solution is suddenly stopped, the blood glucose concentration drops rapidly due to the continuous effect of insulin, and hypoglycemia occurs.
3.Idiopathic hypoglycemia
It is mostly seen in neurotic middle-aged women. It is mainly due to autonomic dysfunction and excessive excitation of vagus nerve. It is caused by excessive insulin secretion, and is a non-organic disease, which occurs 2-3h after meal, and is excessive blood sugar utilization postprandial hypoglycemia.
4.Starvation hypoglycemia
When starving for a long time or unable to eat, the exogenous blood sugar source is cut off and the endogenous liver glycogen reserve is limited, about 70-100g, which is depleted in more than 10 hours, and at this time, it mainly relies on sugar isogenesis to maintain blood sugar concentration. With the prolongation of starvation time, hypoglycemia occurs when there is “oversupply”. People who do not eat breakfast are prone to hypoglycemia, which affects the efficiency of study, work and labor.
5.Exercise hypoglycemia
After continuous strenuous exercise or exercise, due to the large energy consumption, the oxidation and decomposition of glucose is rapid and large, at this time, if the sugar food is not supplemented in time, it can cause hypoglycemia.
6.Alcoholic hypoglycemia
After drinking a lot of alcohol on an empty stomach, due to the oxidation of alcohol in the liver, NAD+ is reduced to NADH excessively, resulting in the inhibition of the reaction of lactic acid into pyruvic acid and the weakening of gluconeogenesis. When the limited hepatic glycogen is used up, hypoglycemia can occur.
Hypoglycemia has a great impact on diabetic patients, and the symptoms of diabetic hypoglycemia must be brought to the attention of patients, because hypoglycemia is more harmful than hyperglycemia when the condition is serious. If hypoglycemia lasts for more than 6 hours, it will cause irreversible damage to brain cells, even if the blood sugar returns to normal later. Even if the blood sugar returns to normal later, it often leaves dementia and other symptoms. For the treatment of hypoglycemic patients, oral glucose or other sugars such as sugar water or candy can be given, and if necessary, intravenous infusion of glucose solution or blood sugar raising drugs can be given to quickly raise the blood sugar concentration and supply basic energy needs. When the symptoms improve, a detailed medical history should be taken to identify the cause and causative factors and carry out cause-specific treatment.