Hypoglycemic syndrome is associated with imbalance of glucose in the human body. It can occur not only in patients with diabetes mellitus, but also in healthy people. Especially often this phenomenon occurs after great physical exertion and prolonged fasting, as well as in pregnant women.
Description
Hypoglycemic syndrome is a condition characterized by a blood glucose level of <2.75 mmol / L. In this case, various disorders of the autonomic nervous system arise. This syndrome is primarily associated with diabetes mellitus, with complications in the process of sugar-lowering therapy.
In a healthy person, the glucose level is maintained at a constant level (with slight deviations) with the help of glyco-regulating hormones. If its content is in the range of 2.75-3.5 mmol / l, then the symptoms of hypoglycemic syndrome may be minimal or completely absent. The drop in concentration is associated with a violation between the influx of glucose into the blood and its consumption by various tissues.
According to the international classification of diseases ICD-10, hypoglycemic syndrome belongs to the 4th class of pathologies associated with diseases of the endocrine system and metabolic disorders.
Causes
In the pathogenesis of the development of hypoglycemia, 2 large groups of factors are distinguished:
- Physiological. The syndrome is observed in healthy people after fasting and independently disappears after eating.
- Pathological. This category is due to pathologies of the endocrine system and other organs.
In modern medicine, there are more than 50 types of hypoglycemia. Pathological causes of hypoglycemic syndrome are:
- Internal factors - adrenal insufficiency; tumors developing in the endocrine cells of the pancreas; extreme exhaustion of the body, prolonged fever; large malignant neoplasms in the liver and adrenal cortex; infectious toxic shock; insulin-producing tumors (insulinomas); autoimmune insulin syndrome (in the absence of diabetes mellitus); malignant blood diseases (leukemia, lymphoma, myeloma); conditions associated with excessive production of insulin (postoperative complication after removal of part of the stomach, the initial stage of diabetes mellitus, hypersensitivity to leucine in children); liver pathology (cirrhosis, toxic lesions); pituitary insufficiency, decreased production of growth hormone and cortisol; the presence of antibodies to insulin receptors; congenital metabolic disorders in the liver (glycogenosis and aglycogenosis, aldolase enzyme deficiency, galactosemia).
- External factors - alcohol consumption (as a result, the intake of glucose from the liver decreases); taking certain medications (listed below); malnutrition, inadequate intake of carbohydrates with food; an overdose of insulin in the treatment of diabetes; increased sensitivity to insulin, prolonged treatment with sugar-lowering drugs.
Hypoglycemia medications
From drugs, this condition can provoke the intake of such funds:
- sulfonylurea preparations;
- salicylates ("Aspirin", "Askofen", sodium salicylate, "Asfen", "Alka-Seltzer", "Citramon" and others);
- insulin and hypoglycemic drugs;
- antidepressants;
- sulfonamide antibiotics (Streptocid, Sulfazine, Sulfasalazine, Sulfadimethoxine, Phthalazole and others);
- antihistamines (to eliminate allergic reactions);
- lithium preparations ("Micalit", "Litarex", "Sedalite", "Priadel", "Litonit", GHB and others);
- beta-blockers ("Atenolol", "Betaxolol", "Bisoprolol", "Medroxalol" and others);
- NSAIDs.
Reactive fasting hypoglycemia
One of the varieties of hypoglycemia is late dumping syndrome. Hypoglycemic syndrome develops after 2-3 hours after eating (early stage, rapid absorption of glucose in the intestine with excessive production of insulin) or after 4-5 hours (late stage). In the latter case, late hypoglycemia can signal the development of the initial stage of type 2 diabetes. In such patients, within 1-2 hours after eating food, the glucose concentration exceeds the normal value, and then falls below the permissible limit.
Late hypoglycemia is also observed in people who drink hard liquors with beer or juices. The main causes of hypoglycemia are the following hereditary metabolic disorders:
- production of enzymes in the liver;
- fatty acid oxidation;
- carnitine metabolism;
- synthesis of ketone bodies.
Hypoglycemic syndrome after eating in such cases has been observed since childhood, reactions from the nervous system prevail. Attacks do not depend on the type of food, and the use of sweets eases the patient's condition. The mechanism of development of such hypoglycemia is not well understood. Often there is a glycemic syndrome after training or other types of physical activity in combination with an untimely meal.
Experts believe that the accelerated evacuation of food from the stomach to the small intestine causes increased insulin production in the pancreas, which leads to the development of this condition.
Post-surgical hypoglycemia
Hypoglycemic syndrome in surgery is observed in patients after operations on the organs of the gastrointestinal tract. At risk are those patients who underwent the following surgical interventions:
- Resection of a part of the stomach or intestines.
- Crossing the vagus nerve in order to reduce the production of hydrochloric acid in the stomach.
- Dissection of the pylorus with subsequent suturing of the defect.
- A junction of the jejunum with an opening made in the stomach.
Hypoglycemic syndrome after resection of the stomach may occur 1.5-2 hours after eating. This phenomenon is associated with a violation of the reservoir function of this organ and the rapid penetration of glucose into the small intestine.
Newborn babies
Immediately after birth, the glucose level in the blood of the baby’s umbilical cord is in the range of 60-80% of the concentration in the mother’s blood. After 1-2 hours, the level of this substance decreases. After 2-3 hours, it begins to stabilize, as due to the activity of the liver, the process of glycogen breakdown to glucose is activated. In medical studies, it is noted that if the child did not receive nutrition during the first days of life, then almost half of all newborns develop hypoglycemia.
Many pathological processes and risk factors can disrupt the normal mechanism of adaptation and cause hypoglycemic syndrome in children:
- the presence of diabetes mellitus and hypertension in the expectant mother, her use of drugs, certain drugs (fluoroquinolones, quinine, beta-blockers, antiepileptic drugs);
- prematurity;
- oxygen starvation;
- hypothermia;
- multiple pregnancy in the mother;
- blood diseases (polycythemia and others);
- infectious diseases;
- lesions of the nervous system;
- hormone deficiency;
- the introduction of "Indomethacin" (with open ductus arteriosus) and Heparin;
- pathologies associated with impaired production of amino acids and other diseases.
An unfavorable factor is also that during childbirth women do not receive nutrition and are often injected with glucose. The greatest risk of hypoglycemia is recorded in the first 24 hours after birth, but in some children up to 3 days.
Newborns are more prone to this condition than adults, since they have a greater ratio of brain mass to body mass. Half of the child’s total energy needs are provided by glucose (the rest is mainly amino acids and lactic acid). Brain cells consume a significant amount of glucose. The danger of this condition lies in the fact that even a short-term “starvation” of the brain leads to damage to its cells. These consequences can be of a distant nature and are expressed subsequently in the form of a lag in mental development and visual impairment in a child.
According to ICD-10, hypoglycemic syndrome in newborns belongs to the P-70 group. It can also develop in healthy children if their birth weight is less than 2.5 kg, since they have reduced glycogen stores and the enzymatic system is still underdeveloped. A risk factor is malnutrition of a pregnant mother (starvation). The daily glucose requirement for babies is about 7 g.
Signs
Symptoms of hypoglycemic syndrome are:
- excruciating hunger;
- abdominal pain, nausea, vomiting;
- general weakness;
- trembling in the limbs;
- sweating
- sensation of heat, redness or pallor of the face;
- palpitations, tachycardia, drop in blood pressure.
From the side of the central nervous system, the following symptoms are noted:
- dizziness;
- drowsiness;
- burning sensation, creeping creeps;
- headache;
- darkening in the eyes;
- visual impairment (bifurcation of objects);
- mental retardation;
- convulsions;
- amnesia;
- loss of consciousness, coma.
The degree of manifestation of these signs can be different - from mild, in which the attack lasts several minutes and the general condition of the patient is satisfactory, to severe, when patients completely lose their working capacity. For people who have insulin, the only complaint may be frequent sudden loss of consciousness between meals, at night or after exercise.
Symptoms in newborns and infants
In newborns there are no specific signs of hypoglycemic syndrome. Many manifestations may coincide with other pathologies. Therefore, the only reliable diagnostic criterion is the level of glucose in the blood. In sick newborns, the following phenomena can be noted:
- visual disturbances - circular movements of the eyeballs, their high-frequency fluctuations;
- weak piercing scream;
- tremor of limbs, lethargy or increased irritability;
- weakness, frequent spitting up, refusal to eat;
- excessive sweating;
- pallor of the skin.
Hypoglycemic coma
At the last stage of hypoglycemic syndrome, coma occurs (loss of consciousness, impaired respiratory function and palpitations). The reason for this is severe glucose deficiency in the nerve cells of the brain, which leads to their edema and damage to the cell membranes.
Distinctive features of this condition are:
- acute onset;
- profuse sweat on the skin;
- lack of acetone breath;
- physical activity, cramps.
Hypoglycemic coma can lead to irreversible pathological changes in the central nervous system, to cerebral edema. If glucose deficiency persists for a long time, then death occurs. Frequent episodes of severe hypoglycemia later manifest as personality changes, memory loss, psychoses, and mental retardation.
Diagnostics
Identification of hypoglycemic syndrome is carried out according to the scheme below.
Severe neuropsychiatric disorders often lead to the fact that patients are diagnosed incorrectly. This is observed in 75% of patients with insulinoma who are mistakenly given therapy for epilepsy, vegetovascular dystonia, and neurasthenia.
Patients with hypoglycemic syndrome, as well as patients with diabetes mellitus, require regular self-monitoring with the help of glucometers.
Treatment
The tactics for treating the syndrome depend on its stage (severity). In mild cases, it is enough to take a small amount of food consisting of easily digestible carbohydrates (tea with sugar, syrup or compote based on sweet fruits, sweets, chocolate, jam).
In severe hypoglycemia, hospitalization is required to prevent complications. A 40% glucose solution is administered intravenously in a hospital. Treatment of hypoglycemic coma is carried out in the intensive care unit. If the glucose solution does not help, then adrenaline or glucagon is used, after which the patient regains consciousness within 15-20 minutes. Other drugs and treatment methods are also used:
- "Hydrocortisone" (in case of failure of previous drugs);
- glucose solution with cocarboxylase, insulin, potassium preparations (to improve metabolism);
- ascorbic acid solution;
- a solution of magnesium sulfate, "Mannitol" (to prevent cerebral edema);
- oxygen therapy;
- blood transfusion.
After removing from a coma, the patient is prescribed drugs that improve blood microcirculation and metabolic processes in the body:
- glutamic acid;
- Aminalon;
- Cavinton
- "Cerebrolysin" and others.
In the case of the presence of insulinoma, the most radical treatment is surgical - removal of the tumor.
To prevent this condition, patients are recommended diet therapy and fractional nutrition (at least 5-6 meals per day). Physiotherapeutic treatment is also prescribed to patients (electrotherapy, hydroprocedures).