The source of human blood glucose is divided into endogenous and exogenous. Endogenous blood glucose is mainly derived from the breakdown of liver glycogen and gluconeogenesis (i.e. the conversion of protein, free fatty acids and other non-sugar substances into glucose), which is the main source of fasting blood glucose; exogenous blood glucose is mainly derived from food digested and absorbed by the body, which is the main source of postprandial blood glucose. The main role of blood glucose is to break down energy to meet the body’s metabolic needs, and the excess glucose is stored in the liver and kidneys in the form of glycogen. Hypoglycemia can occur when the source of blood glucose is insufficient and/or overused for some reason.
Etiology
Under normal circumstances, fasting blood glucose fluctuates between 3.9 and 6.1 mmol/L, while blood glucose 2 hours after meal is slightly higher but generally does not exceed 7.8 mmol/L. A relatively constant blood glucose value is particularly important for ensuring the energy supply of the brain and maintaining the normal activity of brain tissue.
There are many causes of hypoglycemia, among which the most common one in diabetic patients is “pharmacogenic hypoglycemia”. It is mainly due to the patient’s failure to coordinate the relationship between medication, diet and exercise.
It is common in the following cases:
1, inappropriate application of hypoglycemic drugs
Mainly seen in:
(1) excessive doses of hypoglycemic drugs (including oral hypoglycemic drugs and insulin);
② Failure to adjust the dose of hypoglycemic drugs in time with the improvement of the disease;
③When switching from animal insulin to human insulin, the insulin dosage was not adjusted downward accordingly;
④Incorrect insulin ratio during premixed insulin therapy;
⑤ Not eating on time after insulin injection;
⑥Decrease in food intake or increase in exercise without corresponding decrease in dose. Among various hypoglycemic drugs, insulin-induced hypoglycemia is the most common and serious (especially in patients receiving intensive therapy); followed by sulfonylureas, represented by euglycemia. Other types of hypoglycemic drugs (such as α-glucosidase inhibitors, biguanides) do not cause hypoglycemia when applied alone, but also cause hypoglycemia when combined with insulin or sulfonylureas.
2.Incorrect diet
Mainly seen in:
①Diet control is too strict, the amount of food is not enough;
② Eating irregularly, not regular and quantitative;
③Neglect to add meals between two meals and before bedtime;
④ Delayed or no meal after medication;
(⑤) exercise increased and did not add meals in time; etc.
3.Inappropriate exercise arrangement
Exercise in the morning on an empty stomach, too much exercise intensity, too long exercise time, etc., can lead to hypoglycemia.
4. Reactive hypoglycemia
In the early stage of type 2 diabetes, insulin secretion and blood glucose changes are not synchronized due to the delay of insulin secretion in the early phase. When blood glucose peaks, insulin does not reach the peak, but when blood glucose gradually falls, insulin secretion reaches the peak, resulting in hypoglycemia 4-5 hours after meal (i.e., before the next meal).
Dangers
Short-term, mild hypoglycemia only causes hunger, panic, cold sweat, weakness, trembling and other physical discomfort, and generally does not cause much harm to human body. However, severe (or long-term) hypoglycemia will cause more harm to human body, mainly as follows:
1. Repeated episodes of hypoglycemia will lead to loss of control of the disease. Because when hypoglycemia, the secretion of various glucose-raising hormones in the body increases, resulting in rebound hyperglycemia after hypoglycemia (Sumuje reaction), thus causing significant fluctuations in blood sugar.
2. The discomfort brought by frequent hypoglycemia will increase the fear of patients, and some patients even refuse treatment because of this.
3. Hypoglycemia can cause serious brain damage. The energy metabolism of brain tissue all depends on glucose in the blood for energy supply, and the glucose stored in the brain tissue itself is very limited,
It is only enough to maintain the energy supply of brain cells for 5 to 10 minutes. Therefore, when hypoglycemia occurs, the glucose in the blood decreases, and of course, the glucose entering the brain tissue also decreases, which makes the brain tissue very vulnerable to damage. Long-term chronic hypoglycemia can make the patient inattentive, abnormal personality and behavior, memory loss, mental decline and even dementia; while acute severe hypoglycemia can lead to mental confusion, convulsions and convulsions, coma and even death.
4, hypoglycemia can induce serious cardiovascular events and increase the mortality of patients. Hypoglycemia can stimulate sympathetic nerves, leading to arrhythmia, increased heart rate, increased myocardial oxygen consumption, increasing the incidence of cardiovascular events (such as angina pectoris, myocardial infarction, arrhythmia, stroke) and all-cause mortality of patients with coronary heart disease.
5. Severe hypoglycemia can cause death. Generally speaking, mild hypoglycemia can only be manifested as sympathetic excitation symptoms. With the aggravation of the disease, patients will gradually appear different degrees of brain dysfunction symptoms.
Sympathetic excitation symptoms: mainly manifested as panic, cold sweat, pale face, muscle weakness, trembling limbs, hunger, dizziness, nausea, etc.
Neurological sugar deficiency symptoms :
Patients may show various mental abnormalities, such as inattention, unresponsiveness, gibberish, non-answer, excitement and agitation, abnormal behavior, trance, hallucinations, drowsiness, etc., which are often mistaken for psychosis and delayed treatment.