Hypoglycemia (hypoglycemia) is a syndrome of low plasma glucose (blood glucose) concentration caused by various etiologies, and the diagnosis of hypoglycemia is generally based on plasma glucose concentration <2.8 mmol/L; for diabetic patients, as long as the blood glucose is ≤3.9 mmol/L, it can be diagnosed as hypoglycemia. Hypoglycemia is also a sign of health problems, how to correctly identify and deal with it? Let's learn -
I. What are the manifestations of hypoglycemia?
When blood sugar drops to 2.8~3.0 mmol/L, due to the inhibition of insulin secretion and the increase of glucagon secretion (glucagon, adrenaline, growth hormone and glucocorticoid), sympathetic excitation symptoms will appear, which are manifested as sweating, trembling, palpitation, nervousness, anxiety, hunger, salivation, weakness, pale face, accelerated heart rate, cold limbs and mildly elevated systolic blood pressure.
When blood glucose drops to 2.5~2.8 mmol/L, the cerebral cortex is inhibited, manifesting as mental inattention, slow thinking and language, dizziness, drowsiness, blurred vision, unsteady gait, hallucinations, restlessness, irritability, strange behavior and other psychiatric symptoms; then it spreads to subcortical centers including basal ganglia, hypothalamus and autonomic centers, which may show agitation, even tonic convulsions and positive vertebral signs. The patient may experience agitation and even tonic convulsions and positive vertebral signs.
If the hypoglycemia is corrected, the patient can recover in the reverse order as mentioned above; if the hypoglycemia is not corrected continuously, it can lead to irreversible brain cell death.
Second, how to diagnose?
1.If there is obvious hypoglycemic triad (Whipple triad), the diagnosis of hypoglycemia can generally be determined–
① Hypoglycemic symptoms occur during fasting or 3-4h after meal or physical load;
②Checking blood glucose 2.0-2.8 mmol/L or less during hypoglycemic episodes;
③After intravenous injection of 50% glucose, the attack will be relieved soon.
However, some patients have hypoglycemia but no obvious symptoms, which often go unnoticed and are very likely to progress into severe hypoglycemia and fall into coma or convulsions called unnoticed hypoglycemia.
2. The diagnosis procedure of hypoglycemia can be divided into the following “three steps” (with the flow chart of treatment).
① Determine whether there are symptoms of hypoglycemia;
② Determine the type of hypoglycemia;
③ Determine the cause of hypoglycemia.
What diseases can cause hypoglycemia?
1. Several common clinical hypoglycemia
For diabetic patients, the most common cause of hypoglycemia is diabetes treatment drugs, because the application of hypoglycemic drugs or insulin is inevitable in order to correct the blood sugar level. The occurrence of hypoglycemia in non-diabetic patients is uncommon and requires active search for potential causes.
2. Laboratory tests for common hypoglycemia
IV. Treatment, treating the symptoms as well as the root cause
For hypoglycemic emergencies and acute episodes of hypoglycemia, the emergency state should be lifted quickly. Treatment includes relieving the symptoms of neurological glucose deficiency and correcting the underlying causes of hypoglycemia.
For those with mild symptoms, oral glucose water, sugary drinks or high-sugar foods such as buns, bread and candy can relieve them, and blood glucose levels should be rechecked 15 minutes after treatment. If the blood glucose is still below 70 mg/dL (3.9 mmol/L), continue the above treatment again and continue to monitor the blood glucose level after 15 minutes after treatment until the blood glucose reaches 70 mg/dL (3.9 mmol/L).
For severe cases and coma, 50% glucose solution 20 ml can be given by static push or glucagon 0.5-1 mg by intramuscular injection. During the treatment, blood glucose concentration needs to be continuously monitored until the hypoglycemia is resolved.