Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. It is one of the most common types of hypoglyemia seen in emergency departments and hospitals. In general, it occurs when a treatment to lower the elevated blood glucose of diabetes "overshoots" and causes the glucose to fall to a below-normal level. A space-filling model of glucose Glucose, a simple monosaccharide sugar, is one of the most important carbohydrates and is used as a source of energy in animals and plants. ... Hypoglycemia is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... This article is about the disease that features high blood sugar. ... The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ... A physician visiting the sick in a hospital. ...

A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl (3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can sometimes occur at higher glucose levels, or may fail to occur at lower. This variability is further compounded by the imprecision of glucose meter measurements at low levels, or the ability of glucose levels to change rapidly. A glucose meter is a medical device for determining the approximate amount of glucose in a drop of blood obtained by pricking the skin with a lancet. ...

Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon. Severe hypoglycemic unconsciousness is one form of diabetic coma. A common medical definition of severe hypoglycemia is "hypoglycemia severe enough that the person needs assistance in dealing with it." Carbohydrates (literally hydrates of carbon) are chemical compounds that act as the primary biological means of storing or consuming energy, other forms being fat and protein. ... A space-filling model of glucose Glucose, a simple monosaccharide sugar, is one of the most important carbohydrates and is used as a source of energy in animals and plants. ... Glucagon ball and stick model Glucagon is a 29 amino acid polypeptide acting as an important hormone in carbohydrate metabolism. ... Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic...

Diabetic hypoglycemia can occur in any person with diabetes who takes any medicine to lower his blood glucose, but severe hypoglycemia occurs most often in people with type 1 diabetes who take insulin. Hypoglycemia can also be caused by sulfonylureas in people with type 2 diabetes. Severe hypoglycemia rarely, if ever, occurs in people with diabetes treated only with diet, exercise, or insulin sensitizers. This article is about the disease that features high blood sugar. ... Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... See diabetes mellitus for further general information on diabetes. ...

Symptoms of diabetic hypoglycemia are those of hypoglycemia: neuroglycopenic, adrenergic, and abdominal. Symptoms and effects can be mild, moderate or severe, depending on how low the glucose falls and a variety of other factors. It is rare but possible for diabetic hypoglycemia to result in brain damage or death. The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom may loosely be said to be a physical condition which shows that one has a particular illness or disorder (see... Hypoglycemia is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... Neuroglycopenia is a medical term that refers to a shortage of glucose (glycopenia) in the brain, usually due to hypoglycemia. ... An adrenergic is a drug, or other substance, which has effects similar to, or the same as, epinephrine (adrenaline). ...

In North America a mild episode of diabetic hypoglycemia is often termed a "low" or an "insulin reaction," and in Europe a "hypo". A severe episode is sometimes referred to as "insulin shock".

Treatment

The blood glucose can be raised to normal within minutes with 15-20 grams of carbohydrate. It can be taken as food or drink if the person is conscious and able to swallow. This amount of carbohydrate is contained in about 3-4 ounces (100-120 ml) of orange, apple, or grape juice, about 4-5 ounces (120-150 ml) of regular (non-diet) soda), about one slice of bread, about 4 crackers, or about 1 serving of most starchy foods. Starch is quickly digested to glucose, but adding fat or protein retards digestion. Symptoms should begin to improve within 5 minutes, though full recovery may take 10-20 minutes. Overeating does not speed recovery and will simply produce hyperglycemia afterwards. Carbohydrates (literally hydrates of carbon) are chemical compounds that act as the primary biological means of storing or consuming energy, other forms being fat and protein. ... Starch is a complex carbohydrate which is insoluble in water. ...

If a person is suffering such severe effects of hypoglycemia that they cannot (due to combativeness) or should not (due to seizures or unconsciousness) be given anything by mouth, glucose can be given by intravenous infusion or the blood glucose can be rapidly raised by an injection of glucagon. Glucose is available for intravenous infusion in various concentrations. The highest is 50% dextrose (about 18 grams of glucose in 40 ml of fluid), but this should be given carefully as it is damaging to tissue if the infusion leaks from the vein. A space-filling model of glucose Glucose, a simple monosaccharide sugar, is one of the most important carbohydrates and is used as a source of energy in animals and plants. ...

Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the liver, causing glycogenolysis and release of glucose into the blood. It can raise the glucose by 30-100 mg/dl within minutes in any form of hypoglycemia caused by insulin excess (including all types of diabetic hypoglycemia). It comes in tiny vials containing 1 mg, which is a standard adult dose. The glucagon in the vial is a lyophilized pellet, which must be reconstituted with 1 ml of sterile water, included in the "kit". In the widely used Lilly Emergency Kit, the water is contained in a syringe with a large needle for intramuscular injection and must be injected into the vial with the pellet of glucagon before being injected. Glucagon works if given subcutaneously, but absorption and recovery are faster if it is injected deep into a muscle (usually the middle of the outside of the thigh). It has an even more rapid effect when given intravenously but this is rarely practicable. Side effects of glucagon can include nausea and headache, but these can also occur after severe hypoglycemia even when glucagon is not used. There are no serious risks to glucagon use, and it can usually produce a faster recovery than calling for paramedics and waiting for them to start an intravenous line to give dextrose. Glucagon ball and stick model Glucagon is a 29 amino acid polypeptide acting as an important hormone in carbohydrate metabolism. ... Glycogenolysis is the catabolism of glycogen (requiring removal of glucose unit from glycogen and addition of phosphate) thus producing glucose 1-phosphate, and subsequently reconfigured (C-1 -> C-6) to yield glucose 6-phosphate, a potent reaction intermediary leading to glucose available to the blood and brain, pyruvic acid (yet... External links Eli Lilly and Company website. ...

See also

• Diabetic coma
• Glucagon