| Hypoglycemia is a condition in which blood sugar (glucose) levels are abnormally low. It is a serious condition because the body uses glucose for fuel, and when levels are too low, many organ systems (particularly the brain and nervous system) malfunction.
Hypoglycemia can result when an individual with diabetes mellitus (a diabetic) accidentally takes too much of the medicine (insulin, sulfonylureas) he or she uses to reduce glucose levels. Diabetics may also lose the ability to secrete major counter-regulatory hormones such as glucagon and epinephrine, which help control insulin levels. Many other drugs that are not related to treatment of diabetes can also cause hypoglycemia.
Meals high in refined carbohydrates, excessive alcohol consumption, and certain types of gastrointestinal surgery can produce an episode of hypoglycemia. Starvation and strenuous exercise can lead to hypoglycemia in rare instances, but this usually happens in individuals with some other underlying disease (e.g., pituitary or adrenal gland disease, liver disease). Those with hypopituitarism may become hypoglycemic due to deficiencies in growth hormone and cortisol production.
Excessive production of insulin (usually caused by a tumor of certain cells in the pancreas), kidney failure, heart failure, malnutrition, cancer, shock, severe infection, and extensive liver disease can all produce hypoglycemia.
Although normal blood sugar levels vary depending on whether the individual has been fasting, blood glucose levels below 45 mg/dL in women or below 55mg/dL in men may indicate hypoglycemia. However, certain individuals, particularly those that are young and female, can tolerate blood sugar levels as low as 20 mg/dL without experiencing symptoms; thus, it is possible that the relative speed and drop in blood sugar is more important in triggering hypoglycemic symptoms than the absolute blood sugar level itself.Risk: Hypoglycemia is more commonly reported in women and older individuals. Incidence and Prevalence: Because hypoglycemia is not a disease itself but rather a sign of some other illness, incidence and prevalence are difficult to establish. One report suggests that approximately 5% to 10% of individuals presenting with symptoms of hypoglycemia have blood sugar levels below 50 mg/dL (Snow). |
Source: Medical Disability Advisor
| History: The individual may have a history of passing out or complain of hunger, headache, weakness, a pounding in the chest (cardiac palpitations), sweating, feelings of anxiousness, and difficulty concentrating. Family members may notice confusion or personality changes in the individual. Monitoring the timing of these symptoms in relation to food consumption is important. Physical exam: On examination, the heart rate may be above 100 beats per minute (tachycardia), and the blood pressure may be high (hypertension). The skin will be pale and feel cool and clammy. The individual may be unconscious or have involuntary muscle jerking (convulsions). Tests: A blood test reveals abnormally low levels of glucose. This result is definitive for this condition. The physician may order a test to measure blood glucose level after eating (nonfasting or postprandial) or after 12 hours of fasting. A 72 hour fasting protocol may be necessary to definitively rule out fasting hypoglycemia. Insulin levels should also be measured in all cases during an episode, if possible. Insulin levels are not helpful if the simultaneous glucose level is not low.
Examination of blood insulin-glucose ratios, proinsulin levels, and visualization studies such as angiography may help diagnose the presence of a pancreatic tumor secreting excess insulin (insulinoma). |
Source: Medical Disability Advisor
| Hypoglycemia is treated by having the individual (if conscious) consume sugar in any form (candy, fruit juice, glucose tablets, milk). This is often followed by more sustaining carbohydrates, such as crackers with peanut butter. If the individual is unconscious, intravenous glucose is given. These methods successfully restore glucose levels within minutes.
Long-term treatment includes education on the symptoms for early detection and intervention. If the individual is diagnosed as a diabetic, education and a thorough understanding of the disease and its treatment are perhaps the best therapy. Dietary changes may include small, frequent meals instead of three large meals per day. Those at risk for severe episodes of hypoglycemia may benefit from having a hormone called glucagon handy at all times. This medication is given by injection and returns glucose levels to normal within minutes.
Oral diazoxide may be helpful to lower insulin secretion if a pancreatic tumor is present, but in the extremely rare cases of a tumor, surgical removal is indicated. |
Source: Medical Disability Advisor
| With early intervention, the outcome is good. Patient education and dietary changes are very effective in preventing or limiting episodes of hypoglycemia. In cases in which glucagon is administered, hypoglycemia will generally resolve within minutes.
When surgical removal of pancreatic tumors is necessary, the outcome will depend on the skill of the surgeon, the ability of the surgeon to locate and remove all tumors, the presence of surgical complications, and the individual's response to the surgery.
The long-term outcome is based on the underlying cause and the individual's response to treatment. |
Source: Medical Disability Advisor
| Complications may include seizures, coma, or death if hypoglycemia is left untreated. Complications are based on degree and timing of medical intervention and the severity of the underlying cause. |
Source: Medical Disability Advisor
| Accommodations include flexibility in work schedule to allow for prevention or response to symptoms of hypoglycemia. Other restrictions may include working at consistent levels of physical exertion, limiting work in high places, and limiting operation of vehicles or high-speed equipment. Individuals should not work in isolated areas or without a coworker. Due to the risk of losing consciousness, sedentary positions might be preferable. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has hypoglycemia been confirmed?
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Have conditions with similar symptoms been ruled out?
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Has underlying cause of hypoglycemia been identified? If cause is undetermined, is inpatient observation and testing beneficial?
Regarding treatment:
- If at risk for hypoglycemic episodes, does individual recognize early symptoms?
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Does individual carry a form of glucose or glucagon with him/her at all times?
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Is individual eating small, frequent meals instead of three large meals a day? Does regular diet include longer-lasting carbohydrates such as bread or crackers? Would individual benefit from consultation with a nutritionist?
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Is surgical removal of insulin-secreting tumors an option? Is surgeon a specialist experienced in this type of tumor?
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If symptoms persist despite treatment, is it possible that not all the tumors were removed?
Regarding prognosis:
- Is individual diligent in preventing hypoglycemic episodes? If episodes do occur, does individual recognize early symptoms and seek appropriate intervention?
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Does individual wear a medical ID tag to alert emergency medical personnel about hypoglycemic condition?
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Has primary cause of hypoglycemia been identified?
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Has treatment of underlying condition been effective in reducing hypoglycemic episodes?
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If symptoms persist despite treatment, does diagnosis need to be revisited?
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Would individual benefit from evaluation by an endocrinologist?
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Source: Medical Disability Advisor
| Snow, Kenneth J. "Hypoglycemia." eMedicine. Eds. David S. Schade, et al. 3 Jun. 2004. Medscape. 3 Jan. 2005 <http://emedicine.com/med/topic1123.htm>. |
Source: Medical Disability Advisor
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