Hypoglycemic syndrome is associated with an imbalance of glucose in the human body. It can occur not only in patients with diabetes mellitus, but also in he althy people. Especially often this phenomenon occurs after heavy 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 occur. This syndrome is associated primarily with diabetes mellitus, with complications in the process of sugar-lowering therapy.
In a he althy person, the level of glucose is maintained at a constant level (with slight deviations) with the help of glycoregulatory 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 international classificationdiseases ICD-10 hypoglycemic syndrome belongs to the 4th class of pathologies associated with diseases of the endocrine system and metabolic disorders.
Reasons
In the pathogenesis of the development of hypoglycemia, 2 large groups of factors are distinguished:
- Physiological. The syndrome is observed in he althy people after fasting and disappears on its own 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:
- Intrinsic factors - adrenal insufficiency; tumors that develop 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, increased sensitivity 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 andaglycogenosis, 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, insufficient intake of carbohydrates with food; insulin overdose in the treatment of diabetes mellitus; increased insulin sensitivity, long-term treatment with sugar-lowering drugs.
Drugs that cause hypoglycemia
From drugs, this condition can provoke the use of such drugs:
- sulfonylureas;
- salicylates ("Aspirin", "Askofen", sodium salicylate, "Asfen", "Alka-Seltzer", "Citramon" and others);
- insulin and hypoglycemic drugs;
- antidepressants;
- sulfanilamide antibiotics ("Streptocid", "Sulfazin", "Sulfasalazine", "Sulfadimethoxin", "Ftalazol" and others);
- antihistamines (to eliminate allergic reactions);
- lithium preparations ("Mikalit", "Litarex", "Sedalite", "Priadel", "Litonite", GHB and others);
- beta-blockers ("Atenolol", "Betaxolol", "Bisoprolol", "Medroxalol" and others);
- NSAIDs.
Reactive Fasting Hypoglycemia
One type 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 insulin production) or 4-5 hours later (late stage). In the latter case, late hypoglycemia may signal the development of the initial stage of type 2 diabetes mellitus. In such patients, within 1-2 hours after eating, the glucose concentration exceeds the normal value, and then falls below the acceptable limit.
Late hypoglycemia is also observed in people who drink spirits along with beer or juices. The main causes of hypoglycemia are the following inherited metabolic disorders:
- enzyme production in the liver;
- oxidation of fatty acids;
- carnitine metabolism;
- synthesis of ketone bodies.
Hypoglycemic syndrome after eating in such cases has been observed since childhood, reactions from the nervous system predominate. Attacks do not depend on the type of food, and the use of sweets alleviates 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.
Specialists believe that the accelerated evacuation of food from the stomach into the small intestine causes increased production of insulin in the pancreas, which leads to the development of this condition.
Post-surgical hypoglycemia
Hypoglycemic syndrome after surgery is observed in patients after surgery onorgans of the gastrointestinal tract. At risk are those patients who underwent the following surgical interventions:
- Resection of part of the stomach or intestines.
- Crossing the vagus nerve to reduce the production of hydrochloric acid in the stomach.
- Dissection of the pylorus followed by closure of the defect.
- Connecting the jejunum to the hole made in the stomach.
Hypoglycemic syndrome after gastric resection 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 level of glucose in the blood of the umbilical cord of the child 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, because due to the activity of the liver, the process of splitting glycogen to glucose is activated. In medical studies, it is noted that if the child did not receive food during the first day of life, then hypoglycemia develops in almost half of all newborns.
Many pathological processes and risk factors can disrupt the normal adaptation mechanism and cause hypoglycemic syndrome in children:
- presence of diabetes mellitus and hypertension in the future mother, her use of narcotic drugs, certain drugs (fluoroquinolones, quinine, beta-blockers, antiepileptic drugs);
- prematurity;
- oxygen starvation;
- hypothermia;
- mother's multiple pregnancy;
- blood diseases (polycythemia and others);
- infectious diseases;
- nervous system damage;
- hormone deficiency;
- introduction of "Indomethacin" (with an open ductus arteriosus) and Heparin;
- pathologies associated with impaired production of amino acids and other diseases.
An unfavorable factor is also the fact that during childbirth women do not receive nutrition and they are often injected with glucose intravenously. 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 susceptible to this condition than adults, as they have a higher brain-to-body mass ratio. It is glucose that provides half of the entire energy requirement of the child (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 may have a long-term character and subsequently be expressed in the form of mental retardation and visual impairment in the child.
According to ICD-10, hypoglycemic syndrome in newborns belongs to the P-70 group. It can also develop in he althy children if their birth weight is less than 2.5 kg, since they have reduced glycogen stores and the enzymatic system is still underdeveloped. risk factoris malnutrition of the pregnant mother (starvation). The daily requirement of glucose for babies is about 7 g.
Signs
Symptoms of hypoglycemic syndrome are:
- excruciating hunger;
- abdominal pain, nausea, vomiting;
- general weakness;
- trembling limbs;
- sweating;
- feeling hot, red or pale in the face;
- strong heartbeat, tachycardia, drop in blood pressure.
From the side of the central nervous system, the following symptoms are noted:
- dizziness;
- drowsy;
- burning sensation, goosebumps;
- headache;
- blackout eyes;
- visual impairment (doubling of objects);
- mental retardation;
- convulsions;
- amnesia;
- loss of consciousness, coma.
The degree of manifestation of these symptoms can be different - from mild, in which the attack lasts a few minutes and the patient's general condition is satisfactory, to severe, when patients completely lose their ability to work. For those people who have insulinoma, the only complaint may be frequent sudden blackouts between meals, at night, or after exercise.
Symptoms in newborns and infants
Newborns do not have specific signs of hypoglycemia. Many manifestations may coincide with other pathologies. Therefore, the only reliable diagnostic criterionis the level of glucose in the blood. Affected newborns may experience the following:
- visual disturbances - circular movements of the eyeballs, their high frequency fluctuations;
- weak piercing cry;
- limb tremor, lethargy or hyperexcitability;
- weakness, frequent regurgitation, refusal to eat;
- excessive sweating;
- pallor of the skin.
Hypoglycemic coma
At the last stage of the hypoglycemic syndrome comes coma (loss of consciousness, impaired respiratory function and heartbeat). The reason for this is a severe deficiency of glucose in the nerve cells of the brain, which leads to their swelling and damage to the cell membranes.
The hallmarks of this condition are:
- acute onset;
- excessive perspiration on the skin;
- no acetone breath odor;
- motor activity, convulsions.
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, psychosis, mental retardation.
Diagnosis
Identification of hypoglycemic syndrome is performed according to the scheme below.
Severe neuropsychiatric disorders often lead to patients being misdiagnosed. This is observed in 75% of patients with insulinoma who are mistakenly treated for epilepsy, vegetovascular dystonia, neurasthenia.
Patients with hypoglycemic syndrome, as well as patients with diabetes, require regular self-monitoring with glucometers.
Treatment
Treatment of the syndrome depends 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).
Severe hypoglycemia requires hospitalization to prevent complications. In the hospital, a 40% glucose solution is administered intravenously. 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 treatments are also used:
- "Hydrocortisone" (in case of ineffectiveness of previous medicines);
- glucose solution with cocarboxylase, insulin, potassium preparations (to improve metabolism);
- ascorbic acid solution;
- solution of magnesium sulfate, "Mannitol" (to prevent cerebral edema);
- oxygen therapy;
- donor blood transfusion.
Afterto recover 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 insulinoma, the most radical treatment is surgical removal of the tumor.
To prevent this condition, patients are recommended diet therapy and fractional meals (at least 5-6 meals a day). Patients are also prescribed physiotherapy (electrotherapy, hydrotherapy).
