Diabetes is a chronic condition characterized by high blood sugar levels. The opposite of diabetes would be a condition with low blood sugar levels, known as hypoglycemia. Hypoglycemia can occur in both people with and without diabetes. This article will examine the causes, symptoms, diagnosis, and treatments for hypoglycemia as the opposite metabolic state to diabetes.
What is Hypoglycemia?
Hypoglycemia is a condition in which blood sugar (glucose) levels drop too low to provide enough energy for the body’s activities. The normal range for blood sugar is around 70 to 100 mg/dL before meals and less than 140 mg/dL after meals. Hypoglycemia occurs when blood sugar falls below 70 mg/dL.
Some quick answers to questions about hypoglycemia:
– What is the medical term for low blood sugar? Hypoglycemia.
– At what blood sugar level is hypoglycemia diagnosed? Below 70 mg/dL.
– What are the main symptoms of low blood sugar? Shakiness, sweating, anxiety, hunger, confusion.
– Is hypoglycemia common? It is very common in people with diabetes using insulin or other medications, but can occasionally occur in people without diabetes as well.
Causes
There are several potential causes of hypoglycemia including:
– **Medications** – Hypoglycemia is a common side effect of diabetes medications like insulin and sulfonylureas which increase insulin levels. These medications can cause blood sugar to drop too low if not properly balanced with food intake.
– **Critical illness** – Severe illnesses can cause hypoglycemia due to effects on liver, kidney, and hormone regulation.
– **Hormone deficiencies** – Not having enough of hormones like cortisol and growth hormone that help regulate blood sugar can lead to hypoglycemia.
– **Alcohol** – Drinking alcohol, especially on an empty stomach, can prevent the liver from releasing enough glucose and cause blood sugar to fall.
– **Some cancers** – Tumors that produce excess insulin can lead to low blood sugar.
– **Kidney disorders** – Kidney problems can impair glucose metabolism and lead to hypoglycemia.
– **Liver disease** – Problems with liver glucose metabolism and storage can result in hypoglycemia.
– **Fasting** – Avoiding meals for long periods can eventually lead to critically low blood sugar levels.
– **Malnutrition** – Not getting enough carbohydrates or protein for nourishment can cause drops in blood sugar.
– **Pregnancy** – Hormone changes and malnutrition during pregnancy can trigger hypoglycemia.
– **Reactive hypoglycemia** – In some cases, hypoglycemia occurs a few hours after meals as a rebound due to high insulin secretion. This is called reactive hypoglycemia and is more common in people who have had stomach surgery.
Symptoms
The signs and symptoms of hypoglycemia often come on quickly and may include:
– Shakiness, anxiety, nervousness
– Sweating, chills
– Irritability, mood changes
– Hunger, nausea
– Blurred vision
– Dizziness, weakness
– Confusion, impairment in ability to concentrate
– Palpitations, tachycardia
– Pale skin
– Headache
– Tingling or numbness in the lips or tongue
– Nightmares or crying out during sleep
– Seizures
– Unconsciousness (in cases of severe hypoglycemia)
The symptoms are related to the body’s neurologic and hormonal responses to low blood sugar. If untreated, severe hypoglycemia can potentially be life-threatening.
Who Gets Hypoglycemia?
Hypoglycemia occurs most commonly in people who use insulin or other medications to treat diabetes. Around 25-30% of people with type 1 diabetes and up to 10% of those with type 2 diabetes will experience at least one episode of hypoglycemia.
Hypoglycemia in People with Diabetes
People with diabetes can develop hypoglycemia if the balance between medication dose, food intake, and activity levels becomes disrupted:
– Taking too much insulin or diabetes pills for the amount of carbohydrates consumed
– Delaying or missing a meal after taking diabetes medication
– Getting more physical activity than normal without adjusting treatment
– Drinking alcohol without adjusting diabetes treatment
Certain groups are more susceptible including young children under 5 years old, the elderly, pregnant women, and people with kidney disorders. Hypoglycemia can occur during sleep which is particularly dangerous.
Hypoglycemia in Non-Diabetics
Less commonly, hypoglycemia occurs in people who do not have diabetes. Causes include certain medications, critical illnesses, hormonal disorders, liver or kidney disease, malnutrition, alcohol use, and congenital metabolic disorders.
One type called reactive hypoglycemia occurs a few hours after meals in response to spikes in blood sugar. It is more common in those who have had stomach surgery.
Diagnosing Hypoglycemia
Doctors will diagnose hypoglycemia based on the characteristic symptoms and a blood glucose level below 70 mg/dL.
The Whipple triad is often used to identify the cause of hypoglycemia:
1. Documentation of low blood sugar measured by a glucose meter, lab test, or clinical symptoms.
2. Symptoms consistent with hypoglycemia at the time of the low glucose.
3. Resolution of symptoms once blood sugar is restored to normal range.
Meeting all 3 criteria confirms that low blood sugar is causing the symptoms.
Medical Evaluation
To determine the cause of hypoglycemia, doctors may recommend:
– **Medical history** – Looking for risk factors like diabetes, medications, alcohol use, critical illness.
– **Physical exam** – Checking for signs of liver, kidney, or endocrine dysfunction.
– **Blood tests** – Measuring glucose, insulin, c-peptide, electrolytes, kidney and liver enzymes.
– **Extended fast** – Having the patient fast for up to 72 hours under observation to document hypoglycemia.
– **Oral glucose tolerance test** – The patient drinks a glucose solution then has blood drawn periodically to measure glucose and insulin response.
– **Imaging tests** – CT scans or MRIs to look for tumors of the pancreas.
Identifying the cause will guide appropriate treatment.
Treating Hypoglycemia
The main treatment goal is to quickly raise the blood sugar level back to normal.
For mild to moderate hypoglycemia:
– **Sugar source** – 15-20 grams of rapid acting carbohydrates such as glucose tablets, sugar packets, juice or regular soda (not diet).
– **Wait 15 minutes** – Recheck glucose after 15 minutes, re-treat if still low.
– **Follow with snack** – Once glucose is normalized, eat a snack with protein and complex carbs to maintain it.
For severe hypoglycemia with confusion, seizures, or loss of consciousness:
– **Glucagon** – An injection of glucagon hormones can rapidly raise blood sugar. Must be administered by another person.
– **IV glucose** – If glucagon is not available or effective, IV infusion of glucose solution will correct hypoglycemia.
– **Hospitalization** – Severe cases may require hospitalization for further treatment and monitoring.
Preventing Hypoglycemia
For people with diabetes, prevention is key through:
– Careful medication adjustment
– Following meal plans
– Regular blood sugar monitoring
– Exercise management
– Patient education
– Avoiding alcohol on empty stomach
For reactive hypoglycemia, eating small frequent meals and limiting carbohydrates may help prevent post-meal blood sugar spikes and drops.
Conclusion
In summary, hypoglycemia or low blood sugar is essentially the opposite metabolic state to diabetes characterized by high blood sugar. It occurs when glucose levels fall below 70 mg/dL. Both diabetes patients and non-diabetics can be affected. The causes range from medications, critical illness, hormone deficiencies, alcohol use, kidney disorders and more. Symptoms affect the neurologic, autonomic, and hormonal systems. Diagnosis involves checking glucose and symptoms. Treatments aim to rapidly normalize glucose by giving carbohydrates or glucagon. Prevention in diabetes requires balancing medication with meals and activity. Although hypoglycemia is much less common than diabetes, it also represents a serious and potentially life-threatening metabolic disorder. Being able to recognize the signs and symptoms and promptly treat low blood sugar is essential.