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Friday, January 13, 2012

Hypoglycemia: Will The Real Hypoglycemia Please Stand Up

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Hypoglycemia Will the Real Hypoglycemia Please Stand Up


Three individuals, all located in different jobs on a certain day, begin to experience symptoms of varying amounts of dizziness, shakiness, hunger, and headache, among other things. All three individuals recognize these symptoms, having experienced them in the past at one time or another. In addition, all three treat the symptoms, as experience has taught them, by quickly eating a food rich in carbohydrates. Symptoms in all three, in a short amount of time, begin to alleviate.


Although all three individuals have just experienced classic symptoms of hypoglycemia, only one may actually be suffering from it.


This paper will attempt to educate the reader in exactly what hypoglycemia is, how to treat it, and how it relates to diabetes. In so doing, the hope is that the reader will be able to recognize hypoglycemia and how to treat it, as well as treat the symptoms of hypoglycemia that may be caused by some other condition.


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What Is Hypoglycemia?


The human body requires blood glucose levels to be between 70mg/dl and 110mg/dl (md/dl means milligrams of glucose in 100 milliliters of blood). Blood sugar below 70mg/dl is Hypoglycemia, a condition that occurs when blood does not contain enough glucose for the body’s cells. The nerve and brain cells require a continuous supply of glucose and are severely affected by having too little. The pancreatic hormones insulin and glucagons maintain blood sugar in this narrow range (Norman Endocrine Surgery Clinic, 00).


Insulin and Glucose


Hormones from the pancreas called insulin regulate the body’s use of sugar and other foods. When food is eaten and absorbed into the bloodstream, the pancreas increases the secretion of insulin. Insulin moves nutrients from the bloodstream to target cells located in the liver, muscle, and fat tissues. Protein molecules known as insulin receptors bind the insulin and activate the receptors which speed up the entry and use of nutrients (World Book, 00). Glucose, produced by the digestion of carbohydrates is then used to provide energy for the body or converted into glycogen. When blood glucose begins to fall, stored glycogen is broken down and used to provide needed glucose (NDIC, 00).


Some symptoms of hypoglycemia are hunger, headache, nervousness, and perspiration. Because these symptoms are so common for many ailments, people are often misdiagnosed with hypoglycemia (Sizer & Whitney, 00). The most common symptoms of hypoglycemia are nervous or shakiness, dizziness, sleepiness, confusion, and difficulty speaking. People who do suffer from hypoglycemia also experience confusion, amnesia, poor coordination, and slurred speech. In severe or advanced cases, loss of consciousness and convulsions may occur, and extremely rare cases may result in death or brain damage (NDIC, 00).


Causes of Hypoglycemia


Hypoglycemia often occurs in people who are taking medicine for diabetes, as these people have too little insulin. Because a diabetic’s blood contains too much sugar they take insulin to lower it. Hypoglycemia may occur if the dose is too large and this can result in loss of consciousness unless treated immediately. Most people with diabetes know well how to spot the early signs of a hypoglycemic reaction and how to treat it, usually by consuming a carbohydrate (NDIC, 00).


Aside from diabetes, there are traditionally two cases of hypoglycemia, organic and functional (World Book, 00). Organic hypoglycemia is the more severe form and is the result of a physical abnormality such as liver disease. Since the liver stores glycogen and converts it to glucose before releasing it into the blood as needed, a diseased liver may fail to release the proper amounts. Tumors in the pancreas can also cause organic hypoglycemia, because the tumors may cause the pancreas to release too much insulin. This can be effectively treated by having the tumors removed (World Book, 00).


Reactive hypoglycemia is the major form of functional hypoglycemia, an exaggeration of the body’s normal reaction to eating (World Book, 00). Few causes of reactive hypoglycemia are certain. Because of the rapid way in which food passes into the small intestine gastric surgery may be one cause. Some rare enzyme deficiencies such as fructose intolerance may also be a cause of reactive hypoglycemia (NDIC, 00) .


Along with the medicines used to treat diabetes, salicylates, sulfa drugs, pentamidine, and quinine may cause a hypoglycemic reaction. If using these medications causes a drop in blood glucose a doctor can prescribe a change in dosage or stop them all together. Alcohol is another cause of hypoglycemia because the way the body breaks down alcohol interferes with the liver doing its job of raising blood glucose (NDIC, 00). This is one more way that excessive drinking can be fatal.


Diagnosis


For many years doctors relied on the oral glucose tolerance test (OGTT) to diagnosis hypoglycemia. Unfortunately that test was not reliable, and could actually trigger hypoglycemic symptoms. Doctors today perform a more thorough exam that includes checking blood sugar at the time the person is having the hypoglycemic symptoms. A doctor will also consider what medications are being taken, the patients medical history, and the severity of the symptoms (Milton, 00). Laboratory tests to measure insulin production can also be performed.


Hypoglycemia is actually quite rare, and research suggests that some people are just more sensitive to the body’s normal release of the hormone epinephrine after a meal.


Medication Side Effects


Hypoglycemia is not a disease by its self; it is a condition that is the result of low blood sugar levels. One disease that can cause hypoglycemia is diabetes. When the blood glucose begins to fall, glucagon signals the liver to break down glycogen and release glucose. This causes the blood glucose levels to go back up to normal levels. In a person with diabetes, this glucagons response to hypoglycemia may be impaired, thus making it difficult for the glucose levels to return to a normal range (NDIC, 00).


Hypoglycemia occurs in people who use insulin to lower the blood sugar. The reason for the insulin is to help lower high blood sugar levels; either insulin or oral drugs can do depending on the type of diabetes this. Hypoglycemia can occur several different ways, taking too much medication, missing or postponing a meal, eating too little food for the amount of insulin taken, exercising too much, drinking too much alcohol, or any combination of these factors (Web MD, 00).


Treating Diabetes Related Hypoglycemia


People with type 1 diabetes are more susceptible to insulin reactions that can cause loss of consciousness. Some people with long-standing insulin dependent diabetes can develop a condition known as hypoglycemia unawareness. This is when they would have some difficulty recognizing the symptoms of low blood sugar. A physician may prescribe an injectable form of the hormone glucagons. This injection can quickly lower the symptoms of low blood sugar by releasing a burst of glucose into the blood.


In order to reduce episodes of hypoglycemia, the blood sugar levels should frequently be monitored. The person should also learn how to recognize symptoms of low blood sugar and the situations that may trigger it. Hypoglycemia can be treated quickly by eating or drinking something with sugar in it such as candy, juice, or non-diet soda.


Children with Diabetes and Hypoglycemia


Children with hypoglycemia from diabetes will need a great deal of attention from their parents and teachers and other adults that may spend large amounts of time with such a child. They will need assistance with maintaining and monitoring their diet, checking blood sugar levels, taking insulin, and handling high and low blood sugar levels (Web MD, 00).


It’s also recommended that the child participate in the care of diabetes to the level that is appropriate for the age of the child. The idea is that by the time the child is an adult, it will all be routine.


Health Plan and Exercise


Maintaining a healthy lifestyle that includes regular exercise and a healthy diet will help deter the onset of hypoglycemia. However, for those that are diagnosed with this disease responding to the symptoms immediately will be key in moderating the symptoms and lowering the chances of the disease worsening. Sizer & Whitney suggest that structuring a high protein and well balanced diet, as well as scheduling meals is extremely important in treating the symptoms of Hypoglycemia.


Prevention


It is helpful to avoid drinking excessive amounts of alcoholic beverages, which can cause hypoglycemia, and can ultimately be fatal. When the body has to concentrate on breaking down alcohol, this can interfere with the livers efforts to raise blood glucose.


Some suggestions on ways to prevent the onset of hypoglycemia are avoiding too many carbohydrates in meals, eating frequent small meals and snacks throughout the day, choosing healthy snacks over junk food, and following a regular exercise plan.


Treatment Medication


Treatment will vary slightly depending on individual’s age, what stage the disease is at, a person’s tolerance level, and overall health. In severe cases a person can lose consciousness, so it is advisable that people diagnosed with this disease wear a medical id bracelet. Friends and family should be taught how to administer a glucagon injection. People with diabetes are especially susceptible to this disease. It is important that they recognize warning symptoms. It is necessary to eat something with sugar in it immediately (NDIC, 00). “Children who have hyperinsulinism may require treatment with medications to decrease the production of insulin the body. In more serious cases, the child may have to undergo surgery to remove the pancreas.” (Lucile Packard Childrens Hospital, 00).


It is important that if an individual is diagnosed with the hypoglycemia that he or she knows how to administer his or her prescribed medication correctly. If he believes that his blood glucose is low, he should not wait. It should be checked and treated it immediately. Easy meals should be prepared in advance to keep close by at all times, since it is necessary to eat and allow 15 minutes prior to checking blood glucose levels. “Suggested foods to help raise blood glucose levels quickly are 4 ounces of fruit juice, 4 ounces non-diet soda, 8 ounces of milk, 5-6 pieces of hard candy, or 1- teaspoons of sugar or honey.” (NDIC, 00). She will need to ensure that her blood glucose level is between 70 to 110 mg/dL first thing in the morning and 70 to 140 after meals. For those that have diabetes the levels are different between 0 to 10 before meals, less than 180 an hour after meals (NDIC, 00).


“To produce even mild hypoglycemia and its symptoms in normal, healthy people requires extreme measures � administering drugs that overwhelm the body’s glucose-controlling hormones, insulin and glucagon.” (Sizer & Whitney, 00). Side effects from some medicines can cause the onset of hypoglycemia, so it is important to be aware of this when taking prescription drugs. The follow list includes some of the medicines that can cause a person’s blood glucose to drop salicylates, sulfa medicines that treat infections, pentamidine that treat pneumonia, or quinine that treats malaria.


Treatment Health Plan and Exercise


Individuals with hypoglycemia should follow a healthy diet established by a qualified dietitian or nutritionist (NDIC, 00). When enduring a more strenuous activity than normal one should talk to specialist about how to increase the diet accordingly. For example, if hiking, it may be necessary to eat before beginning.


It is essential that those suffering from this disease eat a variety of foods. “Some suggested foods include meat, poultry, fish, or non-meat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products.” (NDIC, 00). The suggested recommendations of the FDA food pyramid can be useful to plan an appropriate diet.


It is also important to eat a diet high in fiber. “Fiber helps the body slow the absorption of nutrients and cholesterol absorption, bind bile for excretion, enhance bacterial fermentation in the colon, and increase stool weight.” (Sizer & Whitney, 00). Sizer & Whitney describe major food sources to increase soluble fiber intake include barley, fruits, legumes, oats, oat bran, rye, seeds, and vegetables. They go on to explain that insoluble fiber can be found in brown rice, fruits, legumes, seeds, vegetables, wheat bran, and whole grains.


Another useful tool to help limit the negative effects of hypoglycemia is to use the glycemic index of popular foods, from the book The Basics of Human Nutrition, as a guide for monitoring and limiting sugar intake. This chart divides food into low, medium, and high levels of glucose to help individuals monitor the types of food they eat based on the amount of sugar in the food.


Research


Ongoing research continues to make new advances in preventing and treating this disease. “The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) was established by Congress in 150 as one of the National Institutes of Health under the U.S. Department of Health and Human Services. The NIDDK conducts and supports research in diabetes, glucose metabolism, and related conditions.” (NDIC, 00).


Summary and Conclusion


In some individuals, hypoglycemia can be a very dangerous condition. In others, the condition may simply be an annoyance. For both, however, the symptoms and condition are very treatable and manageable with diet, exercise, and for diabetes sufferers, and chronic hypoglycemic sufferers, medication.


Though the condition is relatively rare, a true diagnosis requires the attention of a physician, who can measure the blood sugar level, a necessary step in the diagnosis. As this paper demonstrates, there is much that is involved with what goes on in the bodies of those who suffer from the condition.


Giving proper attention to hypoglycemia and diabetes can prevent a possible serious medical condition or episode, and can help those who suffer from them lead more healthy and productive lives. References


Lucile Packard Childrens Hospital (00). Diabetes & Other Endocrine and Metabolic Disorders. Retrieved August 6, 00 from the World Wide Web http//www.lpch.org/DiseaseHealthInfo/HealthLibrary/diabetes/hypo.html


Milton, L. (00). Diagnosis of Hypoglycemia. Retrieved August 5, 00 from the World Wide Web http//www.english.uga.edu/cdesmet/class/engl480/work/projects/milton/diagnosis.html


NDIC (00). Hypoglycemia. Retrieved August 5, 00 from the World Wide Web http//diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/index.htm


Norman Endocrine Surgery Clinic (00). Normal Regulation of Blood Glucose. Retrieved August 5, 00 from the World Wide Web http//www.endocrineweb.com/insulin.html


Sizer, F., Whitney, E. (00). Nutrition Concepts and Controversies. Belmont, CA Wadsworth/Thomas Learning.


Web MD (00). Children Living With the Disease . Retrieved August 8, 00 from the World Wide Web http//my.webmd.com/content/healthwise/1/70


Web MD (00). Hypoglycemia (Low Blood Sugar). Retrieved August 8, 00 from the World Wide Web http//my.webmd.com/content/healthwise/154/845.htm?lastselectedguid={5FE84E0-BC77-4056-A1C-5171CA48}


World Book (00). World Book Online. Retrieved August 5, 00 from the World Wide Web http//www.worldbookonline.com/wbol/wbAuth/jsp/wbArticle.jsp?/na/ar/co/ar7780.htm


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