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Hypoglycemia
Blood Sugar Level Decreased
Hypoglycemia is a condition characterized by an abnormally low level of blood glucose.

Images

WIKIDATA, CC BY-SA 3.0

Presentation

Recognizing these psychiatric presentations is crucial in order to stabilize patients and prevent unnecessary testing. [ncbi.nlm.nih.gov]

Entire Body System

  • Weakness

    shaky, or lightheaded If you suddenly feel weak, shaky, or lightheaded—or you even faint–you could be experiencing these common signs of hypoglycemia. [healthcentral.com]

    Symptoms of Hypoglycemia Symptoms of hypoglycemia include the following: Sweating Rapid pulse Shakiness, dizziness, weakness Decreased coordination Difficulty concentrating Blurred vision Headache Trouble performing routine tasks Note: Symptoms can vary [visionaware.org]

    A 50-year-old woman with a large right breast mass was emergently hospitalized for generalized weakness and fatigue. A histological examination of tumor biopsy specimens revealed a phyllodes tumor (PT). [ncbi.nlm.nih.gov]

    Signs include hunger shakiness dizziness confusion difficulty speaking feeling anxious or weak in people with diabetes, hypoglycemia is often a side effect of diabetes medicines. Eating or drinking something with carbohydrates can help. [icd9data.com]

    Weakness or shaking. Moist skin, sweating. Fast heartbeat. Dizziness. Sudden hunger. Confusion. Pale skin. Numbness in mouth or tongue. Irritability, nervousness. Unsteadiness. Nightmares, bad dreams, restless sleep. [my.clevelandclinic.org]

  • Falling

    Diabetics are more prone to hypoglycemia and are advised to carry such food items at all times in case of a falling blood sugar that needs urgent correction. [news-medical.net]

    Causes Hypoglycemia occurs when your blood sugar (glucose) level falls too low for bodily functions to continue. There are several reasons why this can happen. [mayoclinic.org]

    In certain situations, plasma glucose may fall to a dangerous level. When plasma glucose falls, hormonal and sympathoadrenal mechanisms get activated to restore glucose levels to normal. [medlink.com]

    Blood sugar levels in someone with diabetes are considered low when they fall below the target range. [kidshealth.org]

  • Unconsciousness

    A 53-year-old woman fell unconscious during postprandial exercises. [ncbi.nlm.nih.gov]

    Severe low blood sugars are those less than 40 mg., those requiring help from another person, or those which cause you to have a convulsion or become unconscious. [uihc.org]

    It is equally important to avoid unconsciousness and seizures caused by hypoglycemia, not only because of the increased risk for accidents, but because of the potential for brain damage related to repeated severe hypoglycemia. [joslin.org]

  • Fatigue

    Sugar and Adrenal Fatigue For this reason, it is common for those with Stage 3 and beyond Adrenal Fatigue to require sugar replenishment every 2-3 hours. A small snack usually suffices. In fact, as Adrenal Fatigue recovers, this period lengthens. [drlam.com]

    With each plunge their adrenal fatigue can increase and their hypoglycemia may worsen. To the body, hypoglycemia is a strong stressor, an emergency call to action that can further drain already fatigued adrenals. [adrenalfatigue.org]

    It comes from being inside an office building without natural ventilation and natural light, resulting in a general feeling of malaise or fatigue. Dr. [thebalance.com]

    A system‑wide disturbance is created that results in one of the endocrine fatigue syndromes we call hypoglycemia. The standard for diagnosis has been the five-hour glucose tolerance test (GTT). [fibromyalgiatreatment.com]

    — Sy Mukherjee, Fortune, "A $43 Billion Biotech Now Has a Female CEO: Brainstorm Health," 25 July 2019 Firshein begins by looking for underlying causes of fatigue or the ability to focus, such as hormone imbalance or conditions such as hypothyroidism [merriam-webster.com]

  • Malnutrition

    Physicians should be aware of the possibility of carnitine deficiency and/or severe hypoglycemia, especially in hemodialysis patients with malnutrition. [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

    Alcohol together with liver disease (cirrhosis) and malnutrition Medical drugs + predisposition see list ( Drugs ) factitious hypoglycaemia Insulin or anti-diabetic drugs (beta-cytotropic agents, i.e. sulfonylureas) extreme physical activity extreme athletics [web.archive.org]

    If glucose is abnormally low, and no cause can be identified from history (eg, drugs, adrenal insufficiency, severe malnutrition, organ failure or sepsis), serum insulin, insulin antibodies and sulfonylurea level should be checked. [merckmanuals.com]

    Disorders of glucose underproduction Inadequate glucose stores are associated with prematurity, infants who are small for gestational age, malnutrition, and ketotic hypoglycemia. [emedicine.com]

Gastrointestinal

  • Nausea

    Few hours later, she developed a strong food craving, nausea, abdominal pain, and a headache. The lowest recorded serum glucose was 44 mg/dl (2.4 mmol/l) 14 h post-ingestion. [ncbi.nlm.nih.gov]

    We present a 45-fold overdose of liraglutide (confirmed by P-liraglutide measurements) leading to nausea and vomiting, but no hypoglycaemia and no sign of pancreatitis. [pure.au.dk]

    Hypoglycemia may be associated with symptoms such as anxiety, sweating, tremor, palpitations, nausea, and pallor. Hypoglycemia also starves the brain of glucose energy, which is essential for proper brain function. [rxlist.com]

    […] with type 1 diabetes—whether it’s been diagnosed or not—may experience one or more of the following: Sweating and shaking Blurry vision Poor coordination Dizziness or feeling lightheaded Difficulty concentrating Feeling anxious or irritable Hunger or nausea [jdrf.org]

  • Vomiting

    We present a 45-fold overdose of liraglutide (confirmed by P-liraglutide measurements) leading to nausea and vomiting, but no hypoglycaemia and no sign of pancreatitis. [pure.au.dk]

    A 66-year-old woman presented to an urgent care clinic for 2 to 3 weeks of general malaise, nausea/vomiting, night sweats, and dyspnea. [ncbi.nlm.nih.gov]

    Children may vomit. Causes/Pathophysiology : Currently idiopathic. [pedclerk.bsd.uchicago.edu]

    Vomiting (vomiting more than 4-5 times in a 24 hour period). Diarrhea (4-6 episodes in a 24-hour period), unrelieved with taking anti-diarrhea medication and diet modification. Severe constipation, unrelieved by laxatives, lasting 2 to 3 days. [chemocare.com]

    […] responsive subtypes; classic form presents in the first week of life with ketoacidosis, hypoglycemia, emesis, neonatal seizures, and hypertonia; the intermediate and intermittent forms present in childhood or later with acute episodes of ataxia and vomiting [icd9data.com]

  • Failure to Thrive

    At 3 months of age, she had ichthyosis, growth retardation, and failure to thrive. She had not cytopenia. Ultrasonography (US) showed pancreatic diffuse high echogenicity. [ncbi.nlm.nih.gov]

    Hepatomegaly, jaundice, cataracts, failure to thrive, sepsis ( E. coli ), diarrhea, vomiting, pseudotumor cerebri, mental retardation and renal Fanconi syndrome. Usually presents in first few days of life, or after milk exposure. [pedclerk.bsd.uchicago.edu]

Cardiovascular

  • Palpitations

    Hypoglycemia may be associated with symptoms such as anxiety, sweating, tremor, palpitations, nausea, and pallor. Hypoglycemia also starves the brain of glucose energy, which is essential for proper brain function. [rxlist.com]

    Hypoglycemia, which is characterized mainly by palpitations, dizziness, and sweating, is common and easy to identify. [ncbi.nlm.nih.gov]

    Autonomic Neuroglycopenic General malaise Sweating Palpitations Shaking Hunger Confusion Drowsiness Odd behavior Speech difficulty Incoordination Headache Nausea Table 4. Edinburgh hypoglycemia scale. 8. [intechopen.com]

    Some examples of such symptoms include: Tremors Sweating Palpitations Anxiety and feeling of dread Restlessness Dizziness The brain is particularly vulnerable during a hypoglycemic event as it has very limited reserves of glucose and depends almost entirely [news-medical.net]

    Common Symptoms of Hypoglycemia: Fine tremors Excessive sweating Dizziness Palpitations Fatigue Pale skin Confusion Loss of consciousness Coma Risk factors for Hypoglycemia: Low blood sugar can happen to anyone. [rxdx.in]

  • Hypertension

    On hospital day 8 the patient developed hypertensive emergency and was taken to the operating room for exploratory laparotomy. Twenty-two poorly wrapped packages were removed from the bowel. [ncbi.nlm.nih.gov]

    Dr.Mehra has vast experience in diagnosing and medically treating all kinds of ailments and medical conditions like Diabetes, Hypertension, Thyroid Disorders, Asthma, Emphysema and other chronic medical conditions in patients of all ages. [rxdx.in]

    Hyperinsulinemia can also result from in utero or perinatal stress (eg, maternal hypertension, prematurity, small for gestational age, hypoxia, Caesarian delivery). [5] These infants have no genetic mutations. [emedicine.com]

    Hsu et al[ 31 ] performed a nationwide cohort study, and suggested that comorbidities such as hypertension and renal disease are associated with hypoglycemic episodes. [doi.org]

  • Heart Failure

    A CASE REPORT: The authors describe a case of a 39-year-old female with so far untreated advanced AN, admitted to hospital due to profound hypoglycemia (17 mg/dl), cachexia (BMI 11) and with heart failure. [ncbi.nlm.nih.gov]

    They include kidney, liver, or heart failure, infection, low levels of certain hormones (such as cortisol or growth hormone), certain tumors, some types of stomach surgery, and starvation. [jamanetwork.com]

    Nondiabetic patients [2][3] Causes of hypoglycemia in nondiabetic patients Critical illness Hepatic disease Renal failure Heart failure Malnutrition Sepsis Trauma Burns Drugs that cause hypoglycemia [3] Nonselective beta blockers Antimalarial drugs: quinine [amboss.com]

  • Tachycardia

    Signs and symptoms include tachypnea, respiratory distress, tachycardia or bradycardia, lethargy, and seizures 775.6 Excludes infant of mother with diabetes mellitus ( 775.0 ) ICD-9-CM Coding Information 775.6 is only applicable to newborns of age 0 years [icd9data.com]

    The typical patient presenting with acute hypoglycemia will have an altered mental status and exhibit tachycardia and diaphoresis. [saem.org]

    Hypoglycemia manifests with autonomic symptoms (i.e., hunger, sweating, tachycardia) and neuroglycopenic symptoms (i.e., confusion, behavioral changes, somnolence). [amboss.com]

    The primary hormone that produces tachycardia and pale, cool and clammy skin in the shock patient is epinephrine, which is also released in the hypoglycemic patient producing similar signs. [ems1.com]

    Tachycardia, the medical name for an especially fast heartbeat, has also been reported. Cold sweats are another reported symptom. [lifeseasons.com]

  • Hypotension

    WARNINGS AND PRECAUTIONS Hypotension: Empagliflozin causes intravascular volume contraction and symptomatic hypotension may occur. [jardiancehcp.com]

    In AN various cardiac complications may occur: hypotension, bradycardia, life-threatening ventricular arrhythmias, pericardial effusion, reduction of left ventricular mass and impairment of its function. [ncbi.nlm.nih.gov]

    Symptoms of a serious allergic reaction to GlucaGen ® may include rash, difficulty breathing, or low blood pressure (hypotension) The most common side effects of GlucaGen ® include: nausea vomiting temporary fast heartbeat or pounding in your chest (tachycardia [glucagenhypokit.com]

Skin

  • Sweating

    Severe hypoglycemia eventually lead to glucose deprivation of the central nervous system resulting in hunger; sweating; paresthesia; impaired mental function; seizures; coma; and even death Abnormally low blood sugar Abnormally low level of glucose in [icd9data.com]

    Extreme fatigue, especially when the symptoms of shakiness, dizziness, or sweating are present, could be a warning sign of reactive hypoglycemia. [thebalance.com]

    you may have clammy, visibly pale skin, and break out in a cold sweat, even when you're not overheated. [healthcentral.com]

    Hypoglycemia causes hunger, sweating, shakiness, weakness, and makes it hard to think clearly If you have diabetes, you're more likely to get hypoglycemia—it can happen if you take too much medicine, don’t eat enough, or exercise too much To treat hypoglycemia [merckmanuals.com]

    Hypoglycemia causes hunger, sweating, shakiness, and weakness, and makes it hard to think clearly If you have diabetes, you're more likely to get hypoglycemia—it can happen if you take too much medicine, don’t eat enough, or exercise too much To treat [msdmanuals.com]

Musculoskeletal

  • Muscle Cramp

    Certain drugs other than those for diabetes, most notably pentamidine, used to treat a form of pneumonia that occurs most often as part of AIDS, and quinine, used to treat muscle cramps, occasionally cause hypoglycemia. [merckmanuals.com]

  • Muscle Twitch

    Symptoms of muscle twitching, irritability, and/or increased urination. Poor appetite that does not improve. If you notice excessive sleepiness, confusion. [chemocare.com]

Eyes

  • Blurred Vision

    This can cause dizziness, headache, blurred vision, difficulty concentrating and other neurological symptoms. Hypoglycemia also triggers the release of body hormones, such as epinephrine and norepinephrine. [health.harvard.edu]

    You have blurred vision or vision changes. You feel very tired and weak. You are sweating more than usual for you. You have a fast heartbeat. You feel dizzy, lightheaded, and shaky. You have questions about your condition or care. [drugs.com]

    More severe hypoglycemia—for example, blood glucose concentrations less than 45 mg per 100 ml (2.5 mmol/l)—causes blurred vision, impaired thinking and consciousness, confusion, seizures, and coma. [britannica.com]

    These types of headaches can be accompanied by nausea, blurred vision, irritability, confusion, and fatigue. Early warning signs to watch for include sweating, mood changes, yawning, and craving sweet foods. [vanquishheadacherelief.com]

  • Diplopia

    It may also present with transient hemiplegia, hypothermia or hyperthermia, convulsions, diplopia and strabismus [ 9 ]. If untreated, it can progress to stupor, coma and, exceptionally, death. [patient.info]

    […] contents) autonomic symptoms (sympathetic activation) Diaphoresis Tremulousness, anxiety Tachycardia, palpitations, increased blood pressure Hunger brain dysfunction is usually the most obvious clinical finding Confusion Visual changes (blurred vision, diplopia [emcrit.org]

    It can also include transient focal neurological deficits such as diplopia, hemiparesis. Neurogenic and neuroglycopenic symptoms are manifested by the activation of the sympatho-adrenal system and brain’s glucose deprivation. [intechopen.com]

Neurologic

  • Confusion

    What you will feel is probably: shaky, a bit confused, a little uncoordinated, sweaty, some peoples eyes go funny. [web.archive.org]

    In some cases, people with normal blood glucose levels experience symptoms that can be confused with hypoglycemia. [merckmanuals.com]

    You may become very confused and unable to manage your condition. In severe cases, you may even lose consciousness, have a seizure, or go into a coma. [hormone.org]

  • Seizure

    Severe hypoglycemia eventually lead to glucose deprivation of the central nervous system resulting in hunger; sweating; paresthesia; impaired mental function; seizures; coma; and even death Abnormally low blood sugar Abnormally low level of glucose in [icd9data.com]

    He demonstrated progressive encephalopathy, seizure activity, second-degree atrioventricular block type I, respiratory failure, hypotension, hypothermia, and hypoglycemia. [ncbi.nlm.nih.gov]

    However, not all are aware that these symptoms can rapidly progress to seizures, coma and even death if hypoglycemia is severe. [hopkinsmedicine.org]

    Tell your diabetes care team if you ever have a severe hypo that caused you to have a seizure or fit. [nhs.uk]

  • Dizziness

    Extreme fatigue, especially when the symptoms of shakiness, dizziness, or sweating are present, could be a warning sign of reactive hypoglycemia. [thebalance.com]

    This can cause dizziness, headache, blurred vision, difficulty concentrating and other neurological symptoms. Hypoglycemia also triggers the release of body hormones, such as epinephrine and norepinephrine. [health.harvard.edu]

    The challenge is to recognize the mild symptoms, which can vary in different people, but might include dizziness, sweating, drowsiness and a pounding heartbeat. Severe symptoms can include impaired vision, confusion, seizures, and unconsciousness. [web.archive.org]

    Symptoms If blood sugar levels become too low, hypoglycemia signs and symptoms can include: Looking pale Shakiness Sweating Headache Hunger or nausea An irregular or fast heartbeat Fatigue Irritability or anxiety Difficulty concentrating Dizziness or [mayoclinic.org]

    Signs include hunger shakiness dizziness confusion difficulty speaking feeling anxious or weak in people with diabetes, hypoglycemia is often a side effect of diabetes medicines. Eating or drinking something with carbohydrates can help. [icd9data.com]

  • Headache

    If you have a cluster headache, sinus headache, migraine headache or any other type of headache you may want to consult a doctor. Long Lasting Relief Always have Vanquish ® on hand to provide effective, yet gentle headache relief. view product info ❯ [vanquishheadacherelief.com]

    We have found that some patients who are viewed as receiving sufficient doses of glucocorticoids occasionally exhibit morning headache or morning discomfort, which may be caused by unrecognized nocturnal hypoglycemia. [ncbi.nlm.nih.gov]

    Severe slump symptoms include a profound and intense desire to sleep, muscle fatigue, sweating, the shakes, headaches, changes in vision, or any combination of these symptoms. [thebalance.com]

    It’s normal to feel fatigue, weakness, or have a headache periodically, especially if someone has had a stressful day or too little sleep. [rchsd.org]

  • Irritability

    An infant presented with short history of jaundice and irritability, examination showed soft hepatomegaly. [ncbi.nlm.nih.gov]

    […] abnormal behavior lightheadedness unsteady movement inability to concentrate personality changes headache restlessness depressed mood tingling in the hands, feet, lips, or tongue irritability abnormal behavior lightheadedness unsteady movement inability [glucagenhypokit.com]

    You may feel suddenly overwhelmed, frustrated, angry, anxious, or irritated, or in some cases, irrational. [healthcentral.com]

    Irritability, nervousness. Unsteadiness. Nightmares, bad dreams, restless sleep. You might pass out if your hypoglycemia is not treated. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. [my.clevelandclinic.org]

    Symptoms Early warning signs and symptoms Early signs and symptoms of diabetic hypoglycemia include: Shakiness Dizziness Sweating Hunger Irritability or moodiness Anxiety or nervousness Headache Nighttime symptoms Diabetic hypoglycemia can also occur [mayoclinic.org]

Workup

This case highlights the importance of an appropriate workup that can lead to avoidance of unnecessary testing in such patients. [ncbi.nlm.nih.gov]

Perform diagnostic workup based on the leading differential diagnosis and whether the patient has diabetes or not. If the Whipple triad is not confirmed, no further workup is indicated. [amboss.com]

Some patients may present with typical symptoms of neuroglycopenia like slurred speech, confusion, and, rarely, seizures and coma, in which case further workup is required. [emedicine.com]

Urine

  • Ketonuria

    […] seizures, and hypertonia; the intermediate and intermittent forms present in childhood or later with acute episodes of ataxia and vomiting Applies To Disturbances of metabolism of leucine, isoleucine, and valine Hypervalinemia Intermittent branched-chain ketonuria [icd9data.com]

Serum

  • Glucose Decreased

    In a 24-week continuous glucose monitoring (CGM) substudy, postprandial glucose decreased ( P ≤ 0.009) and CGM demonstrated up to 3 h more time in the target range of 3.9-10.0 mmol/L with sotagliflozin. [ncbi.nlm.nih.gov]

    Low blood sugar is a condition that occurs when the body's blood sugar (glucose) decreases and is too low. Blood sugar below 70 mg/dL (3.9 mmol/L) is considered low. Blood sugar at or below this level can be harmful. [nlm.nih.gov]

    The fast is terminated at 72 hours if the patient has experienced no symptoms and glucose remains normal, sooner if glucose decreases to ≤ 45 mg/dL (≤ 2.5 mmol/L) in the presence of hypoglycemic symptoms. [merckmanuals.com]

  • Glucagon Increased

    Insulin levels were not different among sessions, whereas glucagon increased with MDG administration ( P < 0.001). [ncbi.nlm.nih.gov]

    Glucagon increases the amount of glucose in the blood by breaking down stored glucose (starch, called glycogen) and releasing it from the liver into the bloodstream. [emedicinehealth.com]

Treatment

Hypoglycemia is often related to diabetes treatment. But other drugs and a variety of conditions — many rare — can cause low blood sugar in people who don't have diabetes. Hypoglycemia needs immediate treatment. [mayoclinic.org]

While dietary restriction alone did not result in sufficient glucose control in this patient with autoimmune hypoglycemia, treatment with hydrothermally modified slow release corn starch led to stable euglycemia. [ncbi.nlm.nih.gov]

You have diabetes and hypoglycemia isn't responding to treatment. Initial treatment of hypoglycemia is drinking juice or regular soft drinks, eating candy or taking glucose tablets. [mayoclinic.com]

Treatment of hypoglycemia consists of correcting the glucose deficiency and directing further treatment to the underlying cause. [3, 4, 5, 6, 7, 8] Consultation is guided generally by determination of the underlying cause of hypoglycemia. [emedicine.com]

Prognosis

Insulin-like growth factor 2 is overexpressed in various cancers, and is associated with a poor prognosis. Also, it is known that insulin-like growth factor 2 is an etiology of non-islet cell tumor hypoglycemia. [ncbi.nlm.nih.gov]

In ill, hospitalized patients, spontaneous hypoglycemia that is not caused by drugs portends a poor prognosis and can occur when poor nutrition is combined with advanced organ failure (especially liver, kidney, or heart failure) and/or sepsis. [merckmanuals.com]

Etiology

Clinical hypoglycemia has diverse etiologies. [icd9data.com]

Although hyperinsulinism is the predominant inherited cause of hypoglycemia in the newborn period, inborn errors of metabolism are the primary etiologies after 1 month of age. [ncbi.nlm.nih.gov]

Epidemiology

Few studies have examined the epidemiology of hypoglycemia in a community-based population. RESEARCH DESIGN AND METHODS: We included 1,206 Atherosclerosis Risk in Communities (ARIC) Study participants with diagnosed diabetes (baseline: 1996-1998). [ncbi.nlm.nih.gov]

Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med 1991;90:450–9. Davis EA, Keating B, Byrne GC, et al. [guidelines.diabetes.ca]

Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000 ; 283 : 2008 -12. ↵ Noto H, Goto A, Tsujimoto T, Noda M. [doi.org]

Epidemiology Hypoglycaemia is uncommon in people without diabetes [ 2 ]. Aetiology [ 2, 4 ] Alcohol is the most common non-iatrogenic (non-physician) cause of hypoglycaemia in adults. [patient.info]

Data from various epidemiological studies are shown in Tables 1 and 2. Epidemiological data from interventional trials The U.K. [care.diabetesjournals.org]

Pathophysiology

Causes/Pathophysiology : Currently idiopathic. [pedclerk.bsd.uchicago.edu]

Physiology and pathophysiology To understand the signs and symptoms of hypoglycemia, one must comprehend some basic normal physiology and pathophysiology. The primary energy fuel for cells is glucose. [ems1.com]

[…] information 1 Department of Internal Diseases, Diabetology, and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland. [email protected] 2 Department of Pathophysiology [ncbi.nlm.nih.gov]

In this article, the author has described the definition, physiology, pathophysiology, clinical features, imaging abnormalities, and management of hypoglycemia. [medlink.com]

Thursday October 06, 2016 Many patients with diabetes often do not completely grasp the consequences of hypoglycemia and hyperglycemia on vascular health, and health care providers should not assume that a patient has been well educated on the pathophysiology [contemporaryclinic.pharmacytimes.com]

Prevention

Current approaches to prevent exercise-induced hypoglycemia include reduction in insulin dose or ingestion of carbohydrates, but these strategies may still result in hypoglycemia or hyperglycemia. [ncbi.nlm.nih.gov]

Prevention In the short term, confusion or fainting can cause a fall or an accident. Over the long term, repeated hypoglycemia can have serious health consequences. [diabete.qc.ca]

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