Hypoglycemia is really terrible, and it can be fatal if it is serious!!! Don’t take it lightly anymore!

On a working day that seemed no different from any other, my colleague got up, washed, went out, and took the subway as usual. Unexpectedly, as soon as he got off the subway, his eyes suddenly went dark, his legs couldn't stop weakening, he wanted to fall down, and his body was instantly soaked in cold sweat...

If you have had similar experiences, you can probably guess that she has hypoglycemia.

Hypoglycemia is a moment that many people may have experienced, especially many women.

Some netizens also shared their own "embarrassing moments of hypoglycemia":

The picture comes from the Internet

Although it seems a little funny in the "social death" reading, many people don't pay much attention to their hypoglycemia, but in fact, hypoglycemia is really dangerous!!!

What is hypoglycemia?

What are the dangers of hypoglycemia?

Hypoglycemia, as the name suggests, refers to the concentration of blood sugar in the body falling below the normal lower limit, which is generally believed to be 3.9mmol/L. For normal people, if the blood sugar level is lower than 2.8mmol/L, corresponding hypoglycemia symptoms will occur. [1]

Sugar is the body’s energy source. Hypoglycemia represents a lack of energy in the body, which may lead to damage to important organs such as the brain and heart, such as cognitive dysfunction, cerebellar ataxia, and sudden cardiac death [4].

The clinical manifestations of hypoglycemia can be divided into two categories: autonomic nervous system excitement symptoms and neural glucose deficiency symptoms.

Symptoms of autonomic nervous system excitement include hunger, fatigue, sweating, increased heart rate, tremor, anxiety, increased systolic blood pressure, paresthesia, etc. Neurological glucose deficiency symptoms are caused by the depletion of glucose in the central nervous system neurons. Symptoms include convulsions, changes in consciousness, abnormal mental behavior, drowsiness and confusion in mild cases, and coma in severe cases. If hypoglycemia is severe and persistent, it can lead to death.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

Who is prone to hypoglycemia?

Hypoglycemia mainly occurs in patients with diabetes. Hypoglycemia in patients without diabetes is rare. Other rare causes include insulinoma, acute alcohol poisoning, critical illnesses such as liver/kidney failure, certain medications, etc. [2]. If you do not eat enough for a long time, or exercise on an empty stomach in the morning, you are also at risk of hypoglycemia.

In other words, if you have frequent hypoglycemia, it may be a precursor to diabetes or other diseases. It is recommended to go to the hospital for examination in time.

For patients with type 1 diabetes and type 2 diabetes who need to use insulin, hypoglycemia is an inevitable complication and a major obstacle to maintaining stable blood sugar levels. Repeated hypoglycemia will lead to hyperglycemia, which increases the risk of diabetic complications, ultimately reducing the patient's quality of life and leading to increased medical expenses [3].

What is more noteworthy is that some patients experience asymptomatic hypoglycemia.

For patients with type 1 diabetes, the incidence of asymptomatic hypoglycemia is positively correlated with the risk of severe hypoglycemia[5].

Asymptomatic may sound mild, but for some hypoglycemic patients, being asymptomatic is actually a serious symptom. This means that their sympathetic adrenal response is damaged due to long-term and repeated hypoglycemia, and they are unable to show symptoms early. In the end, symptoms may only appear when cognition is affected, which means that the hypoglycemia level has reached severe levels [6]. This means that the opportunity for early treatment is lost.

Studies have found that after 25 years of treatment, the prevalence of this phenomenon reaches 50% in patients with type 1 diabetes and is approximately 10% in patients with type 2 diabetes [6].

From reference [6]

Therefore, in order to detect hypoglycemia in time, patients at risk of hypoglycemia should monitor their blood sugar regularly. Once hypoglycemia is detected, it should be taken seriously and treated as soon as possible, especially for patients with type 1 diabetes.

What should I do if I experience hypoglycemia?

If you have hypoglycemia, if you are conscious and can eat on your own, you can supplement carbohydrates (sugar) on your own. Here I would like to remind you to avoid eating too much sugar. You can avoid recovering from hypoglycemia and then having hyperglycemia again.

If the patient is already in a coma or unable to eat on his own, he must be corrected by intravenous infusion or intramuscular injection of glucagon.

After alleviating hypoglycemia, it is necessary to further investigate the possible causes of hypoglycemia and correct various risk factors. For example, for patients who experience unaware hypoglycemia, the blood sugar control target should be relaxed to strictly avoid hypoglycemia again.

How to prevent hypoglycemia in daily life?

1. First of all, we must carry out standardized treatment of the primary disease and control common causes, such as diabetes, renal insufficiency, and liver insufficiency.

2. Avoid overly strict blood sugar management, and the elderly should be cautious in using intensive treatment (i.e., short-term additional use of insulin). [7] The "Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly in China (2021 Edition)" also proposed a "de-intensive treatment strategy" to promote the refined management of diabetes in the elderly.

3. Avoid drinking alcohol, as alcohol can also affect blood sugar metabolism.

4. Avoid excessive exercise. By monitoring blood sugar before and after physical exercise, you can take early measures to prevent hypoglycemia.

5. Patients at risk of hypoglycemia should prepare glucose or carbohydrate-containing foods for themselves under the guidance of a doctor and always keep them at hand.

6. Carry a diabetes emergency card with you at all times. In case you experience hypoglycemia and are unable to save yourself, it will be convenient for passers-by to come to your rescue and buy time for rescue.

7. If your child is at risk of hypoglycemia, parents should carry candy with them. When the child shows symptoms of hypoglycemia, let the child take the candy to supplement the sugar. After 15 minutes of supplementation, check the blood sugar level again to see if it has recovered. If the child wants to exercise, the blood sugar level should also be tested before and after exercise to avoid hypoglycemia. Another very important point is to synchronize the child's situation with the teacher and the school.

References

[1] Lin Maowei, Yu Dan. A new interpretation of the consensus of ADA and ENDO on hypoglycemia and diabetes. China Health Industry, 2013(16):143-144.

[2]BritoPC,LopesV,AntunesE,etal.HypoglycemiainaNon-diabeticPatientandtheSideEffectsofDiazoxideUse.Cureus.2023;15(3):e36804.

[3] Chinese Society of Endocrinology. Expert consensus on the management of hypoglycemia in Chinese diabetic patients. Chinese Journal of Endocrinology and Metabolism, 2012, 28(8): 619-623.

[4]KalraS,MukherjeeJJ,VenkataramanS,etal.Hypoglycemia:Theneglectedcomplication.IndianJEndocrinolMetab.2013;17(5):819-834.

[5]HenriksenMM,AndersenHU,ThorsteinssonB,etal.HypoglycemicExposureandRiskofAsymptomaticHypoglycemiainType1DiabetesAssessedbyContinuousGlucoseMonitoring.JClinEndocrinolMetab.2018;103(6):2329-2335.

[6]NakhlehA,ShehadehN.Hypoglycemiaindiabetes:Anupdateonpathophysiology,treatment,andprevention.WorldJDiabetes.2021;12(12):2036-2049.

[7] YunJS,KoSH.RiskFactorsandAdverseOutcomesofSevereHypoglycemiainType2DiabetesMellitus.DiabetesMetabJ.2016;40(6):423-432.

[8] National Geriatrics Center, Chinese Medical Association Geriatrics Branch, Chinese Geriatrics Association Diabetes Professional Committee. Chinese Geriatric Diabetes Diagnosis and Treatment Guidelines (2021 Edition). Chinese Journal of Diabetes, 2021, 13(1): 14-46.

Author: Jiang Yongyuan, Master of Internal Medicine, Third Military Medical University

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association