بحث شامل عن hypoglycemia

[أ/محمد ابراهيم]

بحث شامل عن hypoglycemia

hypoglycemia

What is hypoglycemia?

Hypoglycemia is low blood sugar. It occurs when the level of sugar, or glucose, in the blood drops too low to fuel the body.
Hypoglycemia is not a disease but a condition that results from a variety of causes. The main types of hypoglycemia are:

• Fasting low blood sugar (hypoglycemia). This type occurs when you have not eaten for many hours, such as overnight. It is frequently associated with having too much insulin in the blood, some medications, alcohol use, hereditary problems with the ****bolizing of carbohydrates, and other health conditions.

• Non fasting low blood sugar (also called reactive or postprandial hypoglycemia). This type develops within 3 to 4 hours after eating. It can be caused by hereditary enzyme deficiencies such as galactosemia or by surgery to remove all or part of the stomach. Sometimes the cause is unknown. Nonfasting hypoglycemia within 1 to 2 hours after a meal (alimentary hypoglycemia) can occur if stomach contents empty into the intestines too rapidly.
Fasting hypoglycemia may develop because of a serious underlying condition, while nonfasting hypoglycemia (if you haven't had previous intestinal surgery) does not involve serious illness.

What should I do in an emergency?

It is important to know what to do in an emergency when you have low blood sugar.
• Emergency care for low blood sugar for people who are not taking insulin includes consuming some kind of quick-sugar food, such as fruit juice, as long as you are able to swallow. (Use this information if you do not know whether a person with hypoglycemia takes insulin.)
• Emergency care for low blood sugar for people who are taking insulin may also include consuming a quick-sugar food or giving a shot of glucagon.

What causes hypoglycemia?

Hypoglycemia is most commonly a complication of diabetes treatment (diabetic hypoglycemia). You can develop hypoglycemia by taking too much insulin or other diabetes medications.
Hypoglycemia also may result from less common causes, including medications, such as monoamine oxidase inhibitors (MAOIs), quinine sulfate, and salicylates (including aspirin); diseases that affect the pancreas, liver, kidneys, or other organs; and inherited problems with ****bolism.

What are the symptoms of hypoglycemia?

The symptoms of low blood sugar may vary from episode to episode because it can be mild, moderate, or severe.

Mild hypoglycemia can cause nausea, a jittery or nervous feeling, cold and clammy skin, and a rapid heartbeat.
Moderate hypoglycemia often makes you feel irritable, anxious, or confused. You may have blurred vision, feel unsteady, and have difficulty walking.
Severe hypoglycemia can lead to loss of consciousness, seizures, and coma and may be fatal.
Some medications may mask symptoms of low blood sugar, including beta-blockers, which are often used to treat heart conditions and high blood pressure.
Some people may develop hypoglycemia unawareness, which is the inability to recognize early symptoms of low blood sugar until they become severe. Family members, coworkers, and friends should learn to recognize symptoms of low blood sugar and how to treat it.

How is hypoglycemia diagnosed?

Health professionals diagnose hypoglycemia using a medical history, physical examination, and tests to check blood sugar levels. Generally, you are diagnosed with the condition if a blood test shows you have low blood sugar and you have symptoms of hypoglycemia that go away after you eat sugar or other food.
During a medical history, your health professional will ask about your symptoms—when and how often they occur and how long they last. You also will be asked about any medications you are taking and whether you have recently lost or gained weight.
A physical examination will also help to rule out other causes of your symptoms.
Health professionals rely on laboratory tests to confirm low blood sugar. Although it would be best to do these tests when you are having symptoms, it usually isn't possible. Instead, tests are done to try to reproduce your symptoms.

How is hypoglycemia treated?

Treatment for a sudden (acute) episode of hypoglycemia involves eating or drinking some form of sugar to restore your blood sugar to a normal level. Episodes of hypoglycemia caused by a long-term (chronic) health condition are treated the same way, but prevention of future episodes requires treatment or cure of the underlying condition.
Although eating food or drinking beverages that contain sugar is all you need to do to treat many cases of acute hypoglycemia, you will need help if the condition is severe. Family members, coworkers, and friends should be aware of your condition and should call 101 or other emergency services if you become sleepy or unconscious.

If you have diabetes and take insulin, you may be able to teach those close to you how to give you an injection of glucagon in an emergency.

Symptoms:

The symptoms of hypoglycemia may vary from episode to episode because low blood sugar can be mild, moderate, or severe. Increasingly severe symptoms appear as the blood sugar level falls.
In healthy people, blood sugar levels when fasting (between meals) are usually between 70 and 110 milligrams per deciliter (mg/dL).

Mild hypoglycemia:

Symptoms of mild low blood sugar usually develop when blood sugar falls below 60 to 65 mg/dL and may include:

• Nausea.
• Extreme hunger.
• Feeling nervous or jittery.
• Cold, clammy, wet skin; excessive sweating not caused by exercise.
• A rapid heart beat (tachycardia).
• Numbness or tingling of the fingertips or lips.
• Trembling.

Moderate hypoglycemia:

If blood sugar continues to fall, the nervous system will be affected. Symptoms usually develop when the blood sugar falls below 50 mg/dL and may include:

• Mood changes, such as irritability, anxiety, restlessness, or anger.
• Confusion, difficulty in thinking, or inability to concentrate.
• Blurred vision, dizziness, or headache.
• Weakness, lack of energy.
• Poor coordination.
• Difficulty walking or talking, such as staggering or slurred speech.
• Fatigue, lethargy, or drowsiness.

Severe hypoglycemia:

The symptoms of severe low blood sugar develop when blood sugar falls below 30 mg/dL and may include:
• Seizures or convulsions.
• Loss of consciousness, coma.
• Low body temperature (hypothermia).

Prolonged severe hypoglycemia can cause irreversible brain damage and heart problems, especially in people who already have coronary artery disease. If emergency medical treatment is not provided, severe hypoglycemia can be fatal.
Some medications may mask symptoms of low blood sugar, including beta-blockers, which are often used to treat heart conditions and high blood pressure. Frequent and significant drops in blood sugar can keep you from noticing early symptoms of low blood sugar (hypoglycemia unawareness), such as tremor, fast heartbeat, and sweating. However, if you have hypoglycemia unawareness, you will notice later symptoms of the central nervous system—including irritability and confusion—if your blood sugar drops low enough.
If you have hypoglycemia unawareness, it is important for you and your family to watch for changes in your mental state that signal hypoglycemia so the condition can be treated before loss of consciousness or seizures occur. You may want to check your blood sugar more frequently than usual.

What to think about:

Different people may develop symptoms of mild, moderate, or severe hypoglycemia at varying blood sugar levels. While the blood sugar levels listed above are typical, they may not apply to everyone. If your blood sugar drops suddenly, you may develop symptoms even if your level is in the normal range.
A number of medical conditions can cause symptoms similar to those of hypoglycemia. Your health professional will use blood tests and other measures to make sure another condition isn't causing your symptoms.

Exams and Tests:

Health professionals diagnose hypoglycemia using a medical history, physical examination, and tests to check the blood sugar level.
Generally, you are diagnosed with hypoglycemia if you have a low blood sugar level and symptoms that go away after you have taken glucose to restore your blood sugar level.

Medical history:

Your doctor will ask questions about:

• What symptoms you experience—how long they last, when they occur, how often they occur, and what happens to your symptoms when you eat something.
• Past medical treatments, any current medical conditions, and whether you are taking medications (bring all medications—both pre******ion and nonpre******ion—to your appointment for review) or receiving other treatment.
• Diet and nutrition, such as what and when you eat, and whether you have had recent changes in your eating or bowel habits.
• Whether you have gained or lost weight recently.
Because an episode of hypoglycemia can impair mental functioning, your health professional may also want to talk to friends or relatives who have observed your symptoms.

Physical examination:

Your health professional also will look for conditions that may cause hypoglycemia, including signs of:

• Liver disease, such as an enlarged liver.
• Kidney disease, such as swelling (edema) and too much urea in the blood.
• Malnutrition, such as extreme weight loss.
• Adrenal gland disease, such as too much pigment, or color, in the skin and low blood pressure.

However, between hypoglycemic episodes, you usually will have normal blood sugar levels and no symptoms.

Primary laboratory tests:

Often times hypoglycemia is a complication of diabetes treatment. If you are not being treated for diabetes or another obvious cause of low blood sugar, you will have laboratory tests to confirm hypoglycemia. Ideally, your health professional would like to do these tests when you are experiencing symptoms. But because this is usually not possible, you probably will have tests that attempt to reproduce symptoms. These tests are usually done in a clinic or a hospital.
In some cases, home glucose monitors, which are often used by people who have diabetes, may be used to evaluate possible hypoglycemia. However, a low blood sugar reading needs to be confirmed by these formal laboratory tests:

• Prolonged supervised fast. The primary test for hypoglycemia is a prolonged (48- to 72-hour) supervised fast. You will be asked to fast until the symptoms of moderate low blood sugar develop. If at the end of 72 hours you do not have low blood sugar, you may be asked to exercise for 30 minutes. This test also can help determine why confirmed hypoglycemia is occurring.

• Mixed meal test. This test may be used if you have symptoms of non fasting (postprandial) hypoglycemia within 3 to 4 hours of eating. You eat a meal similar to one that led to symptoms in the past. Your blood sugar levels are tested every 30 minutes for up to 5 hours while you are observed for symptoms of hypoglycemia. If the mixed meal test produces symptoms, you may be asked to do the prolonged supervised fast as well.

During both tests, your blood is drawn at regular intervals to monitor how well your body controls blood sugar levels. Various laboratory tests measure substances in the blood, such as glucose, insulin, and C-peptide.

Other tests:

A urine test is done to look for substances called ketones that the body produces when it breaks down fat for energy. Insulin prevents the production of ketones. If you have low blood sugar from too much insulin, your body will not produce ketones. In people who have normal insulin levels, prolonged fasting causes ketone production.
Tests also may done to look for a tumor of the pancreas or an endocrine disorder.
If the suspected cause is rapid emptying of the stomach after a meal (alimentary hypoglycemia) or a tumor in the pancreas or other part of the body, you may have imaging tests, such as ultrasound or MRI, to examine your stomach, pancreas, or other internal organs. In some cases pancreatic tumors are quite small, so an imaging test in which a dye is injected into the blood vessels (angiography) may be used to locate the tumor. Other imaging tests use radioactive proteins that bind to tumors to locate them. Imaging tests may be needed regularly for several years because such tumors can be hard to locate.

What to think about:

The oral glucose tolerance test should not be used to evaluate possible non fasting (postprandial) hypoglycemia. This test does not provide consistent and reliable results when it is used to screen for hypoglycemia.

Treatment Overview:

You can treat a sudden (acute) episode of hypoglycemia by eating or drinking some form of sugar to return your blood sugar to a normal range. This treatment is usually all that is necessary for an isolated episode of hypoglycemia, such as from prolonged fasting or strenuous exercise without adequate food.
Hypoglycemia caused by a long-term (chronic) health condition requires treatment of the underlying condition.

Treatment of acute hypoglycemia:

If you are conscious and able to respond when symptoms develop, eat or drink some form of sugar. Drink fruit juice or sugared (non-diet) soda pop or eat sugar in the form of candy, cubes, or tablets, or other quick-sugar foods.
Make sure your family members, coworkers, and others close to you are aware that you may have episodes of hypoglycemia so they can help you. Immediate hypoglycemia treatment for someone with diabetes who cannot take sugar orally can include an injection of the hormone glucagon. Emergency treatment for people who do not use insulin usually does not require glucagon; however, it may be needed in rare cases.
Tell the people close to you that they should call 101 or other emergency services if you become sleepy or unconscious. They also should seek emergency help if you are not unconscious but they do not know how to give you an injection of glucagon. Always have a medical ***** bracelet or tag with you. Medical ***** jewelry can be bought in pharmacies or on the Internet.
Severe cases of hypoglycemia may require hospitalization. You may be given additional glucose in a vein (intravenously) until your blood sugar level is stable in the normal range. This could take several days. For prolonged severe hypoglycemia, additional treatment may be necessary if brain swelling (edema) or damage has occurred or if there are other complications.
Future episodes of low blood sugar may be avoided by changing the behavior or situation that led to the hypoglycemia. If medication causes hypoglycemia, you may be able to stop using it or change how it is used. Talk to your health professional about how to avoid future episodes of low blood sugar.

Treatment of hypoglycemia caused by another condition:

If you have low blood sugar caused by a chronic health condition, your symptoms will be treated the same as those of acute hypoglycemia. Once you have recovered from the immediate symptoms, you will need treatment for the underlying cause of hypoglycemia. In many situations, once the cause is identified, new episodes of hypoglycemia can be prevented.
Low blood sugar may have a long-term cause that can be cured, such as some endocrine disorders or diseases of the liver, adrenal glands, or pancreas. Some conditions that cause low blood sugar, such as alimentary hypoglycemia related to stomach problems, may require surgery. Effective long-term treatment of an insulin-producing tumor in the pancreas (insulinoma) usually requires surgery.
Even if the condition that is causing your hypoglycemia is not curable, treatment often can prevent episodes of low blood sugar. Talk to your doctor about whether you can modify your diet (what, when, or how much you eat), change the dosage or types of medications you take, or modify your physical activity (such as when and how hard you exercise).
This type of management is most common for people who have diabetes, other chronic health conditions that may require long-term treatment (liver disease, kidney failure, or endocrine disorders), and inherited enzyme or hormone deficiencies. It may also be useful for people who have alcohol-related illnesses.

Home Treatment:

If you are at risk for developing hypoglycemia, you need to know about health conditions or situations that may lead to low blood sugar and how to deal with them. Proper attention to your health and lifestyle can help you prevent hypoglycemia.
You should learn to recognize the early symptoms of hypoglycemia and to take steps for dealing with low blood sugar immediately.
When your blood sugar drops too low, drink fruit juice or sugared (non-diet) soda pop; eat sugar in the form of candy, cubes, or tablets; or eat other quick-sugar foods.
Members of your household, close friends, and coworkers also should know the symptoms of low blood sugar and learn about emergency care. Wear medical information on a badge or bracelet if you are at risk for developing moderate or severe hypoglycemia in case an episode occurs when you are away from family, friends, or caregivers.

Emergency care:

• Emergency care for low blood sugar for people who are not taking insulin, which includes consuming some kind of quick-sugar food, such as fruit juice, as long as you are able to swallow. (Use this information if you do not know whether a person with hypoglycemia takes insulin.)
• Emergency care for low blood sugar for people who are taking insulin, which may also include consuming a quick-sugar food or giving a shot of glucagon.

Health and lifestyle management to avoid hypoglycemia:

When hypoglycemia occurs because of an isolated, short-term cause such as prolonged fasting or strenuous exercise, further medical treatment is usually not needed. You may simply need to talk with your health professional about how to avoid such behaviors or situations.
When hypoglycemia has a chronic cause that is not curable, treatment of the condition often can prevent episodes of low blood sugar. Talk with your health professional about:
• Modifying your diet with a long-term meal plan (what, when, and how much you eat).
• Changing the dosage or types of medications you take.
• Modifying the timing and level of physical activity (such as when and how hard you exercise).
• Keeping a diary of low blood sugar episodes (when they occur and what and when you last ate).
Managing your diet to prevent hypoglycemia is particularly important if you have diabetes, inherited enzyme or hormone deficiencies, or non fasting (postprandial) hypoglycemia.
Your health professional will want to see you for annual physical examinations, more often if your symptoms become frequent. You and your health professional will discuss your home blood sugar monitoring records and your diary of episodes

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