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Introduction[edit | edit source]


Hypoglycaemia, sometimes called a hypo or low, is a condition that occurs when a person’s blood glucose level (BGL) has dropped too low, below 4mmol/L. Glucose is the body's main energy source[1]. Hypoglycemia is more dangerous than hyperglycemia. You can afford to have increased blood sugar levels sometimes but hypoglycemia (low blood sugar) can be life threatening[2].

Image1: 3D medical animation still showing low blood sugar level(L) and normal blood sugar level(R).

  • It is important to treat a hypo quickly to stop the BGL from falling even lower and the person becoming seriously unwell[3].
  • Signs and symptoms may not occur until plasma glucose concentrations drop below 3mmol/L
Diabetes monitor.jpeg

Glucose is the primary metabolic fuel for the brain under physiologic conditions. Unlike other tissues of the body, the brain is very limited in supplying its glucose. Expectedly, the brain requires a steady supply of arterial glucose for adequate metabolic function. Potential complications can arise from an interruption in the glucose supply[4].

Hypoglycemia is common with type 1 diabetes, particularly in those patients receiving intensive insulin therapy. Patients with type II diabetes experience hypoglycemia relatively less frequently compared to patients with type I diabetes[4].

Pathophysiology[edit | edit source]

Glucose insulin day.png

The body has inherent counter-regulatory mechanisms to prevent hypoglycemic episodes. All of these counter-regulatory mechanisms include an interplay of hormones and neural signals to regulate the release of endogenous insulin, to increase hepatic glucose output, and to alter peripheral glucose utilization. Among the counter-regulatory mechanisms, the regulation of insulin production plays a major role. Decreases in insulin production as a response to low serum glucose are the body's first line of defense against hypoglycemia.

Image 3: Idealized curves of human blood glucose and insulin concentrations during the course of a day containing three meals; in addition, effect of sugar-rich meal is highlighted

The decrease in insulin production occurs while the glucose level is in the low-normal range. This serves as a distinctive feature compared to other counter-regulatory measures. Additional counter-regulatory measures typically occur once the serum glucose levels decrease beyond the physiologic range. Among the additional counter-regulatory mechanisms, pancreatic alpha cell secretion of glucagon is the next line of defense against hypoglycemia. Should increased glucagon fail to achieve normal blood sugar levels, adrenomedullary epinephrine is secreted. All three counter-regulatory measures occur in the acute stage of hypoglycemia.

The previously mentioned counter-regulatory mechanisms may fail to resolve the hypoglycemia. Further counter-regulatory measures are employed in the form of growth hormone and cortisol. Both the release of growth hormone and cortisol are seen in prolonged hypoglycemic states.[4]

Education[edit | edit source]

Patient education remains a pivotal component in the prevention of hypoglycemic episodes. Focus on preventing hypoglycemia should include patient education on signs and symptoms that constitute hypoglycemia and early recognition of these signs and symptoms. Patients may also need counsel on meal plans and exercise to manage their condition.[4]

Etiology[edit | edit source]

Most hypoglycemia cases occur in diabetic patients who are undergoing therapeutic intervention with meglitinides, sulfonylureas, or insulin. Drugs are the most common cause of hypoglycemia. In patients who do not have diabetes, hypoglycemia is uncommon, but when it occurs, there are a few major causes of hypoglycemia[4].

Causes of hypoglycemia include:

  • Critical illness states, end-stage liver disease, sepsis, or renal failure were glucose utilization exceeds glucose intake, glycogenolysis, and/or gluconeogenesis[4].
  • Long-term starvation, as can occur in the eating disorder anorexia nervosa
  • Too much insulin or other glucose lowering diabetes tablets
  • Delaying or missing a meal
  • Not eating enough carbohydrate
  • Unplanned physical activity
  • More strenuous exercise than usual
  • Drinking alcohol – Alcohol inhibits gluconeogenesis in the body but does not affect glycogenolysis. Thus, hypoglycemia occurs after several days of alcohol consumption, and after glycogen stores are depleted.[4][3]

Symptoms[edit | edit source]

If blood sugar levels become too low, signs and symptoms can include:

  • An irregular or fast heartbeat
  • Fatigue
  • Pale skin
  • Shakiness
  • Anxiety
  • Sweating
  • Hunger
  • Irritability
  • Tingling or numbness of the lips, tongue or cheek

As hypoglycemia worsens, signs and symptoms can include:

  • Confusion, abnormal behavior or both, such as the inability to complete routine tasks
  • Visual disturbances, such as blurred vision
  • Seizures
  • Loss of consciousness[1]

Treatment[edit | edit source]

Clinicians in Intensive Care Unit.jpg

Treatment involves quickly getting blood sugar back to normal either with high-sugar foods or drinks or with medications. Long-term treatment requires identifying and treating the cause of hypoglycemia[1].

  • Severe hypoglycemia can be treated with intravenous (IV) dextrose followed by infusion of glucose.
  • For conscious patients able to take oral (PO) medications, readily absorbable carbohydrate sources (such as fruit juice) should be given.
  • For patients unable to take oral agents, a 1-mg intramuscular (IM) injection of glucagon can be administered.
  • Once the patient is more awake, a complex carbohydrate food source should be given to the patient to achieve sustained normal blood glucose levels. More frequent blood glucose monitoring should occur to rule out further drops in blood sugar[4].

Physiotherapy[edit | edit source]

When treating diabetic clients monitor whilst exercising. The therapist should watch the patient for symptoms of hypoglycemia see above. A 30 minute exercise routine everyday can work wonders for sugar control.[2]

References[edit | edit source]

  1. 1.0 1.1 1.2 Mayo Clinic Hypoglycemia Available: https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685 (accessed 27.9.2021)
  2. 2.0 2.1 Thrombocyte Hypoglycemia https://www.thrombocyte.com/blood-sugar-levels/ (accessed 27.9.2021)
  3. 3.0 3.1 Diabetes Australia Hypoglycemia Available: https://www.diabetesaustralia.com.au/living-with-diabetes/managing-your-diabetes/hypoglycaemia/ (accessed 26.9.2021)
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Mathew P, Thoppil D. Hypoglycemia.2018 Available: https://www.ncbi.nlm.nih.gov/books/NBK534841/ (accessed 26.9.2021)