Hypoglycemia is defined as a blood glucose concentration often below 3.36 mmol/L (60 mg/dl), and severe and prolonged hypoglycemia can occur with extensive neurological damage and complications. The common ones are functional hypoglycemia and hepatogenic hypoglycemia, followed by insulinoma and other endocrine diseases caused by hypoglycemia. The disease is often misdiagnosed as hysteria, epilepsy, psychosis, brain tumor and encephalitis, etc. After proper treatment, the symptoms can be rapidly improved. Early identification of this disease is very important, and it can be cured. Delayed diagnosis and treatment can cause permanent neuropathy and irreversible, and the consequences are not good.
I. How is hypoglycemia caused
The repeated occurrence of fasting hypoglycemia clinically suggests organic diseases; the reactive hypoglycemia caused after meals is mostly seen in functional diseases.
1, fasting hypoglycemia
(1) Endogenous insulin overproduction: common ones include insulinoma and autoimmune hypoglycemia, etc.
(2) Drug-based: such as insulin injection, sulfonylurea hypoglycemic drugs, salicylic acid, alcohol consumption, etc.
(3)Severe diseases: such as liver failure, heart failure, kidney failure, malnutrition, etc.
(4) Insulin antagonist hormone deficiency: such as glucagon, growth hormone, cortisol deficiency, etc.
(5) Extrapancreatic tumor.
2.Postprandial (reactive) hypoglycemia
(1) Congenital deficiency of sugar metabolizing enzymes: such as hereditary fructose intolerance, etc.
(2) Idiopathic reactive hypoglycemia.
(3) Trophoblastic hypoglycemia (including dumping syndrome).
(4) Functional hypoglycemia.
(5) Late mealtime hypoglycemia that occurs early in type 2 diabetes.
II. Common symptoms
Palpitations, cold sweat, pallor, dizziness, nausea and vomiting, visual disturbance, wood stiffness, coma, seizure, weakness, vertigo, hunger
Hypoglycemia is episodic in nature, the duration and frequency vary with the cause, and the symptoms are highly variable. The clinical manifestations can be summarized into the following two aspects.
1. The manifestation of autonomic (sympathetic) nerve overexcitation
During hypoglycemic attack, due to the release of epinephrine and norepinephrine by sympathetic nerve and adrenal medulla, the clinical manifestations are sweating, hunger, panic, trembling, pallor, etc.
2.The manifestation of brain dysfunction
It is a series of manifestations of dysfunction when the brain lacks sufficient supply of glucose. The initial manifestations are mental symptoms such as inattention, slow thinking and language, dizziness, drowsiness, restlessness, irritability, strange behavior, etc. In severe cases, convulsions, coma and even death may occur.
Third, the examination items
Blood sugar, blood lipid, electrolyte, liver and kidney function
1. Blood glucose: fasting blood glucose concentration is less than 2.8mmol/L in adults and less than 3.9mmol/L in diabetic patients.
2.Plasma insulin measurement: When hypoglycemic attack occurs, if the plasma insulin and C-peptide levels are elevated, it indicates that hypoglycemia is caused by excessive insulin secretion.
3.48～72 hours starvation test: A few undetected hypoglycemia or patients in non-episode period and those with high suspicion of insulinoma should be performed under close observation. Blood specimens should be taken to measure blood glucose, insulin and C-peptide before the start, and every 6 hours thereafter.
IV. Complications
If hypoglycemia cannot be relieved and the blood glucose concentration continues to decrease for more than 6h, it can cause irreversible morphological changes in brain cells, such as congestion, multiple punctate hemorrhage and brain tissue damage, and if correct diagnosis and treatment are not made in time, brain edema, ischemic punctate necrosis, brain softening, dementia, coma, shock and even death can occur. Hypoglycemia is not an independent disease, many causes can cause hypoglycemia, and the cause of hypoglycemia should be checked after the diagnosis is confirmed.
V. Treatment methods
Treatment includes two aspects: one is to relieve the symptoms of hypoglycemia, and the other is to correct the various potential causes of hypoglycemia. For mild to moderate hypoglycemia, it can be relieved by taking sugar water or sugary drinks or eating candies, cookies, bread and buns. For drug hypoglycemia, the relevant drugs should be stopped in time. In heavy cases and patients suspected of hypoglycemic coma, capillary blood glucose should be measured in time, even without blood glucose results, and 50% glucose 40-60ml intravenous injection should be given in time, followed by 5%-10% glucose solution intravenous drip. For those who are confused, do not feed to avoid respiratory asphyxia.