Hypoglycemia

Hypoglycemia is a medical emergency that involves an abnormally diminished content of glucose in the blood. The term literally means "low blood sugar". It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function. Effects can range from dysphoria to more serious issues such as seizures, unconsciousness, and (rarely) permanent brain damage or death.

The most common forms of hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Hypoglycemia is less common in non-diabetic persons, but can occur at any age. Among the causes are excessive insulin produced in the body, inborn error of metabolism, medications and poisons,alcohol, hormone deficiencies, prolonged starvation, alterations of metabolism associated with infection, and organ failure.Hypoglycemia is treated by restoring the blood glucose level to normal by the ingestion or administration of dextrose or carbohydrate foods. It is often self-diagnosed and self-medicated orally by the ingestion of balanced meals. In more severe circumstances, it is treated by injection or infusion of glucagon. Recurrent hypoglycemia may be prevented by reversing or removing the underlying cause, by increasing the frequency of meals, or by surgical removal of much of the pancreas.The precise level of glucose considered low enough to define hypoglycemia is dependent on (1) the measurement method, (2) the age of the person, (3) presence or absence of effects, and (4) the purpose of the definition

Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.

Adrenergic manifestations

Shakiness, anxiety, nervousness

Palpitations, tachycardia

Sweating, feeling of warmth (although sweat glands have muscarinic receptors, thus "adrenergic manifestations" is not entirely accurate)

Pallor, coldness, clamminess

Dilated pupils (mydriasis)

Glucagon manifestations

Hunger, borborygmus

Nausea, vomiting, abdominal discomfort

Headache

Neuroglycopenic manifestations

Abnormal thinking, impaired judgment

Nonspecific dysphoria, moodiness, depression, crying, exaggerated concerns

Feeling of numbness "pins and needles" (paresthesia)

Negativism, irritability, belligerence, combativeness, rage

Personality change, emotional lability

Fatigue, weakness, apathy, lethargy, daydreaming, sleep

Confusion, amnesia, lightheadedness or dizziness, delirium

Staring, "glassy" look, blurred vision, double vision

Flashes of light

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