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Endocrinology

Hypoglycemia

Table of contents
Hypoglycemia
Hypoglycemia reasons
Maintaining patients

The hypoglycemia - the most frequent acute complication of treatment of an insulin-dependent diabetes mellitus is also a common problem. Glucose is almost exclusive energy source of a brain. Normal levels of glucose of blood do not fall lower than 3.5 mmol/l since decrease in concentration of glucose of blood causes the neurohumoral answer recovering blood glucose level to norm. The counter-regulating hormones (a glucagon, adrenaline, cortisol and a growth hormone) causing stimulation of a sympathetic nervous system cosecrete. It leads to improvement of supply with brain glucose as a result of increase in emission it liver, reduction of utilization of glucose by peripheries and increases in cordial emission. The characteristic symptom complex (a potootootdeleniye, a shiver, a fever, feeling of hunger) which signals the patient about his state and forces it to eat results. If, despite these efforts, the level of glucose falls lower than 3,0 mmol/l, the neuroglycopenia which is characterized by confusion, a diskoordination and inadequate behavior follows.
The patients with an insulin-dependent diabetes mellitus suffering from frequent repeated episodes of a hypoglycemia, can have erased these reactions, and the neuroglycemia can proceed asymptomatically. It is considered that after "hypo" consciousness can be broken within several days. Because effects of a repeated heavy hypoglycemia at an insulin-dependent diabetes mellitus are prolonged, it is considered that blood glucose at the children sick with an insulin-dependent diabetes mellitus should not fall lower than 4 mmol/l - "the fourth floor" - even while  the lower bound of norm of glucose of blood at healthy people makes 3,5 mmol/l.

Table 1. Hypoglycemia degrees


Easy

Asymptomatic hypoglycemia at the biochemical level. The insignificant symptomatology can be stopped by reception of glucose/food.

Average

Demands serious medical actions from very small children, at more seniors - assistance

Heavy

The attacks, coma, hemiplegia demanding immediate hospitalization and parenteral administration of a glucagon and glucose.

Hypoglycemia average are usually classified as easy, or heavy (Table 1). Lungs korregirutsya independently - meal or the glucose moderate demand some forms of assistance, for example, of the help in food, and heavy when the glucagon or glucose in connection with serious symptomatology with a loss of consciousness are entered parenterally. According to other definitions, heavy "hypo" at adults are classified as need for assistance. However, as a great number of small children rely in providing them with food only on adults even then when they have little signs of a hypoglycemia, this definition is not suitable for this age group. At some children the asymptomatic low level of glucose of capillary blood, a so-called "biochemical hypoglycemia" takes place. Many parents (and some doctors) do not regard it as "hypo" due to the lack of symptomatology. It is wrong. All registered blood glucose indicators below than 4,0 mmol/l are recommended to be considered as a case of a hypoglycemia and they should not be passed.
True prevalence a hypoglycemia is unknown as it usually is not reported about insignificant episodes. Researches of prevalence of a heavy hypoglycemia at children and teenagers showed results from 4 to 86 episodes on 100 patsiyento-flyings (1,2).

Clinical picture

Signs of a hypoglycemia can be very individualized and both the child, and a family with time begin to distinguish these signs. In clinical aspect they can be divided into three main groups: owing to neurohumoral reactions (sweating, a shiver), owing to a neuroglycopenia (confusion, inadequate behavior, difficulty of the speech, a diskoordination, and later - a coma and convulsions) and nonspecific symptoms (nausea, a headache). Some patients with a neuroglycopenia have a passing hemiplegia (often it happens at having migraines), and clinical rehabilitation can lag behind recovery of levels of glucose of blood.
Weakness, dizziness, shiver, pallor, perspiration, tearfulness and irritability were the most frequent symptoms of gipoglikemiya which were observed by parents. Children with for the first time the diagnosed insulin-dependent diabetes mellitus and their tutors have to be informed on symptoms and signs of a hypoglycemia, to be able to distinguish them and to take the appropriate measures. It is also reasonable to warn them that there can be spasms and assure them that it - not epilepsy.



 
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