Hypoglycemia-what is hypoglycemia?
Hypoglycemia, blood glucose levels less than normal, and hunger, weakness, sweating, anxiety, palpitation, tremors and other symptoms of sympathetic nerve activity and (or) mental disorders, fear, confusion, hallucinations, amnesia, stuporbrain symptoms of a clinical phenomenon, the cause of a variety of complex pathogenesis. Adult blood glucose less than 2.8mmol / L (50mg/dl), can be considered low blood sugar, but clinical symptoms, and individual differences. Low blood sugar is harmful to humans, especially the harm to elderly patients, low blood sugar worse than high blood sugar.
Hypoglycemia - clinical symptomsThe main clinical symptoms of hypoglycemia syndrome, due to different diseases, the incidence of low blood sugar have their own characteristics. The early response of low blood sugar symptoms of sympathetic overactivity, excessive adrenaline, then the obstacles on the brain function. The severity of symptoms generally were parallel with the extent and speed of the blood sugar drops, but not absolute, parallel, nor is it the blood sugar drops to a value on certain symptoms. Mild decrease in serum glucose of patients, no symptoms; such as falling too fast may also be symptoms. When blood sugar dropped to 2.8-3.3 mmol / l (50-60 mg / dL), the majority of patients the onset of symptoms, but there are exceptions, such as insulinoma patients because of the long-term in the state of low blood sugar, even if the blood sugar to 1.7-2.8 milli-mole / l (30-50 mg / dL) can also be no symptoms, and even blood sugar as low as 1.1 milli-mol / L (20 mg / dL), if the duration is short or may not have symptoms.
When suffering from insulinoma, often in hunger and after exercise, more than occurred in the early morning fasting or after midnight, a small number of patients before lunch or after lunch, three hours to four hours after the occurrence of disease in adult-onset, male and female approximately equal. When the disease may have palpitation, palpitations, hunger, weakness, hand, foot shaking, pale skin, sweating, increased heart rate, blood pressure increased slightly and so on. Brain cells, often accompanied by cerebral hypoxia due to insufficient glucose supply, damage can be mild thinking even coma and death. Energy is not concentrated at first, thinking and language retardation, dizziness, drowsiness, blurred vision, unsteady gait; can be hallucinations, agitation, irritability, bizarre behavior and other mental disorders performance. Condition continues, there may be confusion, childish action, muscle tremors and movement disorders, and even epilepsy-like convulsions, paralysis, disease, and pathological reflex, coma, hypothermia, pupillary light reflex. The slow onset of early mild symptoms, can naturally alleviate after eating, after the onset of increased frequency of symptoms increased. Special common-onset functional hypoglycemia middle-aged women, occurred in 2 to 4 hours after breakfast, may have heart palpitations, palpitation, sweating, pale, hungry, weak, hand, foot tremor, high blood pressure and other symptoms. If still unable to obtain timely rescue, and will eventually lead to death.
The symptoms of low blood sugar can be mild to severe, the time may be longer or shorter, sometimes easy to correct, sometimes more stubborn. The severity of symptoms is not only related with the degree of decline in blood sugar and blood sugar to drop the speed, duration and individual differences have a greater relationship.
In addition, the number of occurrences of low blood sugar more, the symptoms will continue to change and become more typical. The first few years of illness, symptoms of sympathetic nerve activity, palpitation, trembling, sweating, dizziness, hunger, weakness and other obvious symptoms, if timely corrective, rarely hypoglycemia coma. As the elongated course, the sicker the onset of the symptoms of low blood sugar becomes very typical performance in neuropsychiatric disorders as the most important and severe cases, coma.
Insulin-dependent diabetes mellitus (Ⅰ) people can occur when too much insulin injections, malignant hypoglycemia symptoms, much like manic psychosis or epilepsy-like seizures. More serious hypoglycemia encephalopathy, the patient may have monoplegia, hemiplegia, unable to speak, ataxia, said eye askew, if elderly people with diabetes can be easily misdiagnosed as cerebral vascular accident.
Low blood sugar - the type of
Hypoglycemia is divided into drug-induced (the most common cause) and non-drug-induced.
Drug-induced
Insulin, ethanol, sulfonylurea-induced hypoglycemia accounted for the majority of the inpatients.
Non-drug-induced
Including hunger, hypoglycemia, is characterized by symptoms of central nervous system, often fasting or exercise when the attack; reactive hypoglycemia, is characterized by eating adrenergic symptoms of nervous excitement. Hunger hypoglycemia blood sugar level more reactive hypoglycemia lower for longer. Some low blood sugar primarily in children or infants is characterized by some low blood sugar occurred mainly in adults.
Low blood sugar - the cause of
Low blood sugar, excessive dosage of insulin or illness improves without timely reduction of insulin.
2, due to meetings, going to visit long-term do not eat breakfast, and call it a day late and other reasons to eat or snacks than usual delay.
3, the activity significantly increase not corresponding snacks or reduce the dosage of insulin.
4, reduced food intake, not timely and a corresponding reduction in insulin.
5, improper proportion of injection of mixed insulin (PZI than RI 1 to 2 times) and the larger amount, often during the day urine and more while nocturnal hypoglycemia.
6, the strongest moment of the action of insulin before the time eating or snacks.
7, emotions have been strained to the relaxed and happy.
8, after the emergence of ketosis, the increase in the amount of insulin reduced food intake.
9, PZI excessive amount.
10 exacerbated by drugs of low blood sugar.
Low blood sugar - hazards
1, the function of the cardiovascular system damage: the performance of heart rate, pulse pressure increases resting myocardial ischemia, angina, or myocardial infarction.
2, impaired nervous system: cerebral cortex inhibition may be a sense of hazy, orientation discriminating gradually lost, drowsiness, tremor, mental disorders, subcortical inhibition, unrest, mydriasis, and tonic convulsions and even paralysis, drop in blood pressure.
Other: the eyes, kidneys: retinal detachment, retinal hemorrhage. Renal blood flow reduction in glomerular filtration rate, adding to the renal damage injury.
Low blood sugar - diagnostic procedures
Hypoglycemia - diagnosis The first step is to determine whether hypoglycemic episodesAccording to the onset of symptoms and onset of hypoglycemia when blood glucose levels less than 2.8mmol / L, can be diagnosed.
The second step fasting hypoglycemia attack or postprandial attack?Initially identified based on the relationship between low blood sugar attack and eat the functional or organic.
Have been identified for low blood sugar attack patients with low blood sugar attack and eat first question to ask. For episodes of low blood sugar after meals, in most cases is functional. Due to the food stimulation, vagus nerve, pancreatic β cells to release too much insulin causing low blood sugar; the contrary, fasting episodes of hypoglycemia, islet β-cell autonomy to release too much insulin, mostly for organic disease. In particular to be alert to the β-cell tumors.
The third step is to further determine the onset of postprandial hypoglycemia. Hypoglycemia occurred after the onset of the meal should be OK 5-hour oral glucose tolerance test, any time blood glucose concentrations of less than 2.8mmol / L, confirmed that postprandial hypoglycemia; all blood glucose levels greater than 2.8mmol / L should pay attention to whether hypoglycemia clinical performance within five hours. If the clinical manifestations of hypoglycemia should be repeated 5-hour oral glucose tolerance test. Repeated during the test as long as a blood glucose less than 2.8mmol / L, still postprandial hypoglycemia. 5-hour oral glucose tolerance test process blood sugar is always greater than 2.8mmol / L and no hypoglycemia performance can be regarded as normal.
The fourth step to find evidence of organic disease of preprandial hypoglycemia attack.Fasting hypoglycemia-like symptoms first suspected β-cell tumors, followed by pancreatic lesions caused by low blood sugar should be excluded.The first hunger test. Hunger 12 hours to measure blood sugar, if blood glucose greater than 2.8mmol / L was extended to 72 hours, at the same time regular blood test insulin and glucose concentrations and calculation of insulin (μu) and glucose (mg / dL) than the I / G ratio ofI / G below 0.3, blood glucose concentration greater than 2.8mmol / L can be regarded as normal, and follow-up observation.I / G of 0.3 or more, regardless of whether the blood glucose concentration below 2.8mmol / L should be suspected and β cell tumors.If the I / G below 0.3, blood glucose concentration of less than 2.8mmol / L should be based on whether the history of alcohol consumption, nutrient intake, liver function tests to rule out alcoholism, malnutrition, and liver failure due to low blood sugar. The absence of such causes, malignant tumors of the thoracic cavity should be looking for evidence to rule out these tumors produce hypoglycemia caused by insulin-like substance.In addition, check the pituitary, adrenal, excluding Sheehan - Simon syndrome, Addison's disease caused by low blood sugar.
The fifth step further to determine the β-cell tumors.Laboratory examination revealed a low blood patients with hyperinsulinemia, and I / the G ratio greater than 0.3.
Low blood sugar - treatmentLow blood sugar - to correct Table 1, to correct low blood sugar: in the exacerbation of mild carbohydrate diet (such as sugar, candy, or sugar, porridge, etc.) may be given; severe illness can be taken to the intravenous injection or infusion of glucose solution, coma patients can be given intravenous infusion of hydrocortisone.2, the cause of treatment:Functional hypoglycemia (1) to avoid a variety of predisposing factors to prevent mental stimulation, and should be reasonable to adjust their diets, if necessary, supplemented by a small amount of placebo, sedative.(2) subtotal gastrectomy due to low blood sugar, the available high-protein, low sugar and a small amount several times higher than dry food.(3) organic hypoglycemia should be treated for different causes, such as insulin due to be surgical resection for unresectable pancreatic B-cell tumors, the trial streptozotocin; caused due to severe liver disease, active treatment should be liver disease; caused by endocrine dysfunction may be given hormone replacement therapy.
Diet
1, frequent mealsHypoglycemia in patients with the best smaller meals, about 6 to 8 meals eat in - days. Before going to bed to eat a small amount of snacks and refreshments will also help. In addition to the turn of the types of food do not often eat a certain food allergies are often associated with hypoglycemia. Food allergy will worsen the disease, the symptoms more complex.2, a balanced dietThe diet should be a balanced, contains at least 50-60.
Recipe
Functional increase in insulin secretion can cause low blood sugar, emotional hunger, anxiety, such as incidence, onset of a cold sweat, dizziness, or syncope At this point, given the low-sugar drinks can ease.
People with functional hypoglycemia must be limited to the amount of water compounds into, to take a low-carbohydrate, high protein, high fat diet. Carbohydrate food choices should be based on cereal-based, and limit consumption of refined sugar, glucose, granulated sugar, brown sugar, canned food, sweets, drinks. Milk contains lactose have a certain impact on insulin secretion, the daily dosage should not exceed 500 grams. Protein able to stimulate insulin secretion, the role of slow, and therefore help prevent the emergence of low blood sugar. Daily may be given 100 grams to 150 grams of protein, and the rest of the calories by fat supply.
Attention to the supply of inorganic salts and vitamins, diet to prevent vitamin deficiency. To give a reasonable meal times, in addition to three meals a day, need snacks three times or five times. Uniform distribution of meal staple food, and foods containing protein and fat. This is an effective measure to prevent low blood sugar.
Low blood sugar - first aid measuresAn absolute bed rest, the speed of sound to complement the glucose is the key to determining the prognosis. Timely carbohydrate supplement will complete remission of symptoms; delay in medical treatment is irreversible brain damage. Therefore, it should be emphasized that any substances are high in sugar such as biscuits, fruit juice and other hypoglycemic episodes was immediately given. Severe should be noted that the choke into the trachea mistakenly food inhaled into the lungs causing aspiration pneumonia or atelectasis.
2, patients with low blood sugar can eat, the diet should be low-sugar, high protein, high-fat, small meals, if necessary, at midnight plus drink sugar once.
3, intravenous injection of 50% glucose, 40-60ml is a low-glycemic rescue the most commonly used and effective way. If the condition is not serious, still water, resulting in severe brain dysfunction, the symptoms can quickly ease the mind can immediately sober.
Low blood sugar - PreventionCarbohydrates to avoid excessive involving strenuous exercise, time and three meals a day eating. Diabetic patients should ensure adequate intake of complex carbohydrates at each meal (all kinds of staple food), strict meal time. For some special circumstances (such as a trip) to meal time delay, are required to eat soda crackers, bread and water to replenish their energy, to prevent the blood glucose lowering.
2 being applied to patients with insulin should be strictly calculated the proportion of the amount of good regular insulin and long-acting insulin. Close observation of the oral glucose drug use, found that low blood sugar reaction, timely adjustment. Prevent Excessive use.
3, daytime urine output, urine for a long time, and at night often hypoglycemia, you should check whether the injection site malabsorption, and change the injection site.
4, injection of mixed insulin, patients should pay particular attention to time for dinner and a small amount of snacks before sleep to prevent nocturnal hypoglycemia. Patients with hypoglycemia, the staple food to eat before sleep, or eggs, tofu slowly absorbed easily in the rest of the night and early morning with more protein food.
5, make the condition observed and recorded, the urine for several days negative, to consider, where appropriate, to reduce the amount of insulin, and the strongest moment of the action of insulin before a long time in a timely manner snacks and activities.
6, the increase in the amount of labor or activity, in particular a long time, to reduce the amount of insulin or timeliness of snacks. Patients with oral hypoglycemic agents, and also to reduce the dosage or snacks in a timely manner.
7, constant attention to diet, and insulin action echoes, special attention to the observation of the urine changes, before the strongest moment of the action of insulin in a timely manner snacks.
8, all people with diabetes must often carry some fruits, sugar, biscuits, so that at any time to correct the low blood sugar reaction.
9, to the families and comrades around on some knowledge about diabetes low blood sugar, symptoms and treatment of low blood sugar to a better understanding, in order to timely processing of low blood sugar.
10, oral hypoglycemic agents, especially glibenclamide caused by low blood sugar more opportunities should be on guard. Should start small dose every day for 1 up to twice the evening dose should be small.
11, the patient should carry a hard card to indicate the patient's name, diagnosis, disease description, unit address, home address and phone number in order to hypoglycemia, people can pick up when processing information given on the card.
