Hypoglycemia occurs due to an excess of insulin in the blood resulting in low blood sugar levels. Blood sugar levels can cause symptoms of hypoglycemia, varies between one another.
At first the body responds to low blood sugar levels by releasing epinephrine (adrenaline) from the adrenal glands and certain nerve endings. Epinephrine stimulates the release of sugar from body reserves but also causes symptoms that resemble anxiety attacks (sweating, restlessness, trembling, fainting, palpitations, and sometimes hunger). More severe hypoglycemia cause a reduction of glucose to the brain and cause dizziness, confusion, fatigue, weakness, headache, unusual behavior, inability to concentrate, impaired vision, convulsions and coma. Prolonged hypoglycemia can cause permanent brain damage. Symptoms that resemble anxiety and disruption of brain function can begin slowly or suddenly. It most often occurs in people who take insulin or oral hypoglycemic drugs. In patients with insulin-producing pancreatic tumor, symptoms occurred on the morning after an overnight fast, especially if the blood sugar stores are depleted by exercise before breakfast. At first only occasional episodes of hypoglycemia-time, but after a long time the attacks become more frequent and more severe.
Signs and symptoms of hypoglycemia consists of two phases include:
- The first phase of the symptoms that arise as a result of activation of the autonomic centers in the hypothalamus so that the release of the hormone epinephrine. Symptoms include palpitations, out a lot of sweat, tremors, fear, hunger and nausea (glucose by 50 mg%).
- The second phase is the symptoms that occur as a result of the start of the disruption of brain function, symptoms such as dizziness, blurred vision, decreased mental acuity, loss of fine motor skills, loss of consciousness, seizures and coma (blood glucose of 20 mg%).
- Changes in behavior.
- Syncope sudden attack.
- Headache in the morning, which will disappear with the morning meal.
- Excessive sweating bedtime.
- Waking from sleep at night to eat.
- Hemiplegia / aphasia passing.
- Angina pectoris without coronary artery abnormalities.
Research on people who are not diabetic indicate a disturbance in brain function that is ahead of phase I and in the call subliminal brain dysfunction, in addition to symptoms that are not typical.
Sometimes symptoms do not appear adrenergic phase and direct patients away in the phase disruption of brain function, there are two types of loss of alertness, namely acute and chronic.
Acute example: in patients with type 1 diabetes mellitus with blood glucose control is very tight near normal, the neuropathy autonomic in a patient who had been suffering from diabetes, and use of beta-blockers are nonselective, loss of alertness that chronicles usually irreversible and is considered a complication of diabetes serious.
As a basic diagnosis of Whipple's triad can be used, ie hypoglycaemia with symptoms of central nervous, glucose levels less than 50 mg% and the symptoms will disappear with the administration of glucose.
Hypoglycemia in diabetes is more common than ketoacidosis, although most spread are those of insulin dependence. Onset of hypoglycemia is much faster and manifestations are more varied, often in ways that are not clear so as to deflect the attention of a person until the person does not realize what is actually happening and not being able to find a treatment that does not fit, so the reactions of hypoglycaemia due to insulin may occurred in the midst of everyday life of the patient. Although significant recovery, and hypoglycemia can be rapid and complete within a few minutes after an appropriate treatment, many patients are emotionally (psychologically possibility) remain shaken for several hours or even for several days after an insulin reaction. Finally, in conditions of extreme hypoglycemia, still has the possibility to cause permanent brain damage and even fatal. (Ester, 2000 :).
In the quotation from Karen Bruke 2005 there are few clinical signs and symptoms that include:
- Hungry.
- Nausea and vomiting.
- Pale, cold skin.
- Headache.
- Rapid pulse.
- Hypotension.
- Irritability.
Manifestations cause changes in cerebral function:
- Headache.
- Coma.
- Difficulty in thinking.
- Inability to concentrate.
- Changes in attitude emotion.
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