Hypoglycemia:what is it,clinical feature,how to manage?

HYPOGLYCEMIA:- It is a clinical syndrome with diverse causes in which low plasma glucose concentration leads to signs and symptoms and are resolved when plasma glucose reverts back to normal level.

CAUSES:-
It is most commonly seen in type I diabetic patients cause they are under insulin therapy and anti diabetic drugs which lowers blood glucose level.It mainly occurs due to errors in dose ,schedule ,administration or poorly designed insulin regime.
Other causes of hypoglycemia are-
1.Missed ,delayed or inadequate meal
2.Unexpected,unusual strenuous physical activity
3.Alcohol
4.Malabsoorption of glucose
5.Gastroparesis which causes abnormal absorption of carbohydrate
6.Breastfeeding
7.Unrecognised endocrine disorders like Addison's disease .

Risk factors:-
1.Strict glycemic control
2.Impaired awareness of hypoglycemia
3.Age(very young and very old age)
4.Long duration of diabetes
5.Genetic factors
6.Sleep disorders
7.Renal impairment

Clinical feature
●Usually it follows a missed meal,too much insulin or heavy exercise .
●Symptoms occur with a plasma glucose level below 60mg/dl in non-diabtetics and in diabetics below 80mg/dl.
●Symptoms are divided into two categories -
1.Autonomic symptoms :-Sweating ,Trembling,Pounding heart,Hunger ,Anxiety
2.Central nervous system symptoms :-Confusion,Dizziness,Speech difficulty ,Inability to concentrate ,Incoordination of movements,Irritability ,Anger
●Other symptoms like headache ,Nausea ,tiredness also seen.

Management:-
●Treatment of hypoglycemia depends on its severity and ability to swallow.
●If recognised early ,it may be corrected by ingestion of carbohydrates ,preferably in absorbable forms like glucose powder ,sugar or ORS, or sweets .Honey or sweet gel or jam may also applied to buccal mucosa.
●Intravenous dextrose is considered in severe hypoglycemia where mental function is impaired .As soon as patient is able to eat oral carbohydrate is prefered.Initially 50%of 50ml dextrose is given followed by 5-10% dextrose.
●In severe hypoglycemia IM glucagon (1mg,0.5mg in children) is given.
●Octreotide is effective for patients who develop recurrent hypoglycemia.
●Preventive measures-
•Patient education is fundamental to the prevention of hypoglycemia.Patient as well as his or her friends should be made aware of the signs and symptoms and informed about immediate measures.
•Patient should always keep glucose drink or confectionery with him.This should be followed by a snack containing carbohydrate .
•It is always advisable to to check blood glucose level frequently .

Do share your views and experiences .

Thank you.