hypoglycemia
Introduction
Introduction to hypoglycemia Hypoglycemia refers to a syndrome caused by a low blood glucose concentration caused by various causes, generally with a plasma blood glucose concentration <2.8 mmol/L, or a whole blood glucose <2.5 mmol/L for hypoglycemia. The diagnostic criteria for hypoglycemia in children is 1.11 mmol/L lower than the adult value. Severe and long-term hypoglycemia can cause extensive neurological damage and complications. Commonly, there are functional hypoglycemia and hepatogenic hypoglycemia, followed by hypoglycemia caused by insulinoma and other endocrine diseases. After proper treatment, the symptoms can quickly improve. Early identification of the disease is very important, to achieve the purpose of healing, delay diagnosis and treatment will cause permanent neuropathy and irreversible, the consequences are not good. basic knowledge The proportion of sickness: 0.45% Susceptible people: no specific people Mode of infection: non-infectious Complications: cerebral edema
Cause
Cause of hypoglycemia
Excessive glucose utilization (30%):
(1) hyperinsulinemia: insulinoma; neonates with obese diabetics (mother with hyperinsulinemia); drugs (such as excessive use of insulin, sulfonylureas, salicylates, propranolol, double Isopropylamine, monoamine oxidase inhibitor), insulin autoimmune hypoglycemia.
(2) Tumors: such as giant stromal tumors, primary liver cancer, gastrointestinal tumors and lymphosarcoma.
Insufficient glucose production (30%):
(1) Endocrine diseases: anterior pituitary dysfunction; adrenal insufficiency; hypothyroidism.
(2) Hepatic glycogen accumulation disease.
(3) severe liver disease and liver congestion.
(4) End stage renal disease.
(5) Galactosemia (due to deficiencies in galactose 1 phosphate uridine invertase, galactose cannot be converted to glucose).
(6) Others: long-term alcoholism (inhibition of gluconeogenesis); sepsis; starvation; cachexia; strenuous exercise.
Postprandial (reactive) hypoglycemia (30%) :
(1) Functional hypoglycemia (emotional instability and neuroticism, more common in middle-aged women).
(2) trophic insulin hyperfunction: such as a dumping syndrome of gastrectomy; pyrectomy and gastrojejunostomy.
(3) Children with idiopathic spontaneous hypoglycemia.
(4) Mild early diabetes (insulin peak delay).
Prevention
Hypoglycemia prevention
1. Three meals a day must be regular, eat as little as possible or not eat snacks, people are iron, rice is steel, rice is our essential food, appropriate food, cold food, cold drinks, and daily Have enough water and eat more fruits and vegetables.
2, to ensure adequate sleep time (7 to 8 hours is appropriate), to avoid excessive mental stress, and cultivate an optimistic life mood.
3, diet attention to health, do not eat mildew, spoiled food, so as not to cause intestinal inflammation, dysentery and other diseases,
4, morning and evening travel needs to be protected, as the saying goes: "A cold autumn rain, ten autumn rain cotton upper body", clothes can not be increased too much at a time, for most people with better physical conditions, properly frozen, there are Conducive to the body's ability to adapt to the changing climate.
5, outdoor sports more persistent, pay attention to cold-resistant exercise, enhance physical fitness.
6, indoor ventilation and gas forgot to forget.
Complication
Hypoglycemia complications Complications brain edema
First, brain complications
The initial change in hypoglycemia is an increase in the asymmetry of blood flow in the brain tissue, with more increase in gray matter and right hemisphere blood flow. Following the development of brain tissue edema, a severe group of neurohypoglycemia can occur. The above changes can be restored after hypoglycemia correction without permanent damage. If hypoglycemia persists or recurs, it can cause brain cell degeneration and punctate necrosis in the gray matter.
Second, cardiac complications
When hypoglycemia occurs, the sympathetic chromochromic system is excited, resulting in increased heart rate or sinus tachycardia. However, a very small number of patients have combined with sinus bradycardia. Other arrhythmias such as atrial premature beats, supraventricular tachycardia, ventricular premature beats, and short ventricular tachycardia may also occur.
Symptom
Hypoglycemia Symptoms Common symptoms Easy to starve, dizziness, anxiety, simple syncope, fasting, hypoglycemia, sweating, abnormal tachycardia, fainting, hypoglycemia, coma
One. History, symptoms and signs:
It depends on the speed of hypoglycemia, individual differences, age, gender (female tolerance) and primary disease.
1. Patients with acute hypoglycemia and short course of disease present with sympathetic agonism, such as anxiety, hunger, weakness, sweating, tachycardia, elevated systolic blood pressure, decreased diastolic blood pressure, tremor, transient black sputum, disturbance of consciousness Even coma.
2, subacute and slow blood glucose decline in the symptoms of encephalopathy, a variety of forms, but the same patient often presents the same type of symptoms each time, most patients with symptoms of the cerebral cortex and / or cerebellum, such as headache, dizziness, Anxiety, irritability, lethargy, distraction, disorientation, tremor, epileptic seizures or minor episodes, personality changes (cry, noisy, noisy, convulsions), singular behavior, ataxia, etc., finally stunned, long-term severely low Blood sugar can cause permanent brain damage.
two. Auxiliary inspection:
1. Blood sugar <2.8mmol/L (50mg/dl) at the time of onset. Symptoms are relieved after glucose injection. Atypical cases can measure hunger for 16 hours of blood glucose for 3 times. For screening test, such as >3.9mmol/L (70mg/dl) Can rule out fasting hypoglycemia, such as <2.22mmol / L (40mg / dl) affirmative diagnosis;
2, 22-3.9mmol / L (40-70mg / dl) for suspected hypoglycemia, connected to starvation to 72 hours plus exercise until the onset of hypoglycemia.
Examine
Hypoglycemia check
1, inspection
Fasting blood glucose, blood insulin, C-peptide level, calculation of insulin release index (fasting insulin/fasting blood glucose), hunger test if necessary (fasting 12-72h induced hypoglycemia) and insulin release inhibition test (static) Drop R10.1U/kg/h, compare serum C-peptide levels before and after injection).
2, abdominal cavity B-ultrasound
3, X-ray inspection
Patients with suspected insulinoma can be treated with abdominal CT, especially pancreatic CT, portal vein and splenic vein catheter for blood determination, selective pancreatic angiography.
Diagnosis
Hypoglycemia diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
It should be determined as organic or functional hypoglycemia and its etiology. The most common hypoglycemia sequence in clinical practice is functional, insulinoma, early mild diabetes, organic patients are mostly fasting hypoglycemia, and the attack time is longer ( Most >30min), and more intractable, progressive, rare self-healing, functional symptoms of autonomic nervous instability, 1-4h after the meal, each episode <30min, intermittent, non-progressive , can be self-healing.
