Hypoglycemia has been a fairly common
topic for me. But after reading this article, I do realize that I
have covered parts of hypoglycemia rather than to entire topic.
Therefore, I will be splitting this into four parts rather than
having a very long blog.
When you think about diabetes and blood
glucose control, the first thing that comes to mind is probably
avoiding high blood glucose levels. After all, the hallmark of
diabetes is high blood glucose, or hyperglycemia. But controlling
blood glucose is more than just managing the “highs”; it also
involves preventing and managing the “lows,” or hypoglycemia.
Most people are aware that keeping
blood glucose levels as close to normal as possible helps prevent
damage to the blood vessels and nerves in the body. But keeping
blood glucose levels near normal carries some risks as well. People
who maintain “tight” blood glucose control are more likely to
experience episodes of hypoglycemia, and frequent episodes of
hypoglycemia — even mild hypoglycemia and even in people who don’t
keep blood glucose levels close to normal — deplete the liver of
stored glucose (called glycogen), which is what the body normally
draws upon to raise blood glucose levels when they are low. Once
liver stores of glycogen are low, severe hypoglycemia is more likely
to develop, and research shows that severe hypoglycemia can be
harmful. In children, frequent severe hypoglycemia can lead to
impairment of intellectual function. In children and adults, severe
hypoglycemia can lead to accidents. And in adults with cardiovascular
disease, it can lead to strokes and heart attacks.
To keep yourself as healthy as
possible, you need to learn how to balance food intake, physical
activity, and any diabetes medicines or insulin you use to keep your
blood glucose as close to normal as is safe for you without going too
low. This article explains how hypoglycemia develops and how to treat
and prevent it.
Blood glucose levels vary throughout
the day depending on what you eat, how active you are, and any
diabetes medicines or insulin you take. Other things, such as
hormone fluctuations, can affect blood glucose levels as well. In
people who don’t have diabetes, blood glucose levels generally
range from 65 mg/dl to 140 mg/dl, but in diabetes, the body’s
natural control is disrupted, and blood glucose levels can go too
high or too low. For people with diabetes, a blood glucose level of
70 mg/dl or less is considered low, and treatment is recommended to
prevent it from dropping even lower.
Under normal circumstances, glucose is
the brain’s sole energy source, making it particularly sensitive to
any decrease in blood glucose level. When blood glucose levels drop
too low, the body tries to increase the amount of glucose available
in the bloodstream by releasing hormones such as glucagon and
epinephrine (also called adrenaline) that stimulate the release of
glycogen from the liver.
Some of the symptoms of hypoglycemia
are caused by the brain’s lack of glucose; other symptoms are
caused by the hormones, primarily epinephrine, released to help
increase blood glucose levels. Epinephrine can cause feelings of
weakness, shakiness, clamminess, and hunger and an increased heart
rate. These are often called the “warning signs” of hypoglycemia.
Lack of glucose to the brain can cause trouble concentrating,
changes in vision, slurred speech, lack of coordination, headaches,
dizziness, and drowsiness. Hypoglycemia can also cause changes in
emotions and mood. Feelings of nervousness and irritability,
becoming argumentative, showing aggression, and crying are common,
although some people experience euphoria and giddiness.
Recognizing emotional changes that may
signal hypoglycemia is especially important in young children, who
may not be able to understand or communicate other symptoms of
hypoglycemia to adults. If hypoglycemia is not promptly treated with
a form of sugar or glucose to bring blood glucose level up, the brain
can become dangerously depleted of glucose, potentially causing
severe confusion, seizures, and loss of consciousness.
Some people are at higher risk of
developing hypoglycemia than others. Hypoglycemia is not a concern
for people who manage their diabetes with only exercise and a meal
plan. People who use insulin or certain types of oral diabetes
medications have a much greater chance of developing hypoglycemia and
therefore need to be more careful to avoid it. Other risk factors
for hypoglycemia include the following:
- Maintaining very “tight” (near-normal) blood glucose targets.
- Decreased kidney function. The kidneys help to degrade and remove insulin from the bloodstream. When the kidneys are not functioning well, insulin action can be unpredictable, and low blood glucose levels may result.
- Alcohol use.
- Conditions such as gastropathy (slowed stomach emptying) that cause variable rates of digestion and absorption of food.
- Having autonomic neuropathy, which can decrease symptoms when blood glucose levels drop. (Autonomic neuropathy is damage to nerves that control involuntary functions.)
- Pregnancy in women with preexisting diabetes, especially during the first trimester.
End of part 1 of 4 parts.
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