Hypoglycemia

[1] Hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death.

[2] The three conditions are the following: The biggest difference in blood glucose levels between the adult and pediatric population occurs in newborns during the first 48 hours of life.

[8] As a result, there has been difficulty in developing guidelines on interpretation and treatment of low blood glucose in neonates aged less than 48 hours.

[8] Following a data review, the Pediatric Endocrine Society concluded that neonates aged less than 48 hours begin to respond to hypoglycemia at serum glucose levels of 55–65 mg/dL (3.0–3.6 mmol/L).

[5] It is important to quickly obtain a blood glucose measurement in someone presenting with symptoms of hypoglycemia to properly identify the hypoglycemic episode.

[3] When blood sugar levels fall to the low-normal range, the first line of defense against hypoglycemia is decreasing insulin release by the pancreas.

[3][17] Once blood glucose levels fall out of the normal range, additional protective mechanisms work to prevent hypoglycemia.

[3][18] If increased glucagon does not raise blood sugar levels to normal, the adrenal glands release epinephrine.

[3][17] After hypoglycemia has been prolonged, cortisol and growth hormone are released to continue gluconeogenesis and glycogenolysis, while also preventing the use of glucose by other organs.

[3][17] In a state of hypoglycemia, the brain also signals a sense of hunger and drives the person to eat, in an attempt to increase glucose.

[20][21] Neuroglycopenic symptoms are caused by low glucose in the brain, and can result in tiredness, confusion, difficulty with speech, seizures, and loss of consciousness.

[3] Adrenergic symptoms are caused by the body's reaction to low glucose in the brain, and can result in fast heart rate, sweating, nervousness, and hunger.

[3][2][23] Other medications with very low quality evidence include the antibiotics levofloxacin and trimethoprim-sulfamethoxazole, progesterone blocker mifepristone, anti-arrhythmic disopyramide, anti-coagulant heparin, and chemotherapeutic mercaptopurine.

[3] Glycogen stores are then unable to be repleted due to the lack of food intake, all compounded the inhibition of glucose production by alcohol.

[3] Children with primary adrenal failure, also called Addison's disease, may experience hypoglycemia after long periods of fasting.

[3] Addison's disease is associated with chronically low levels of the stress hormone cortisol, which leads to decreased glucose production.

[3] Hypopituitarism, leading to decreased growth hormone, is another cause of hypoglycemia in children, particularly with long periods of fasting or increased exercise.

[3] Briefly, inborn errors of metabolism are a group of rare genetic disorders that are associated with the improper breakdown or storage of proteins, carbohydrates, or fatty acids.

[3] Normal regulatory mechanisms are not in place, which prevent insulin levels from falling during states of low blood glucose.

[8] In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dL (3.9–5.5 mmol/L), similar to adults, with hypoglycemia being far less common.

[3][2] Identifying Whipple's triad in a patient helps to avoid unnecessary diagnostic testing and decreases healthcare costs.

[5] If an individual recognizes the symptoms of hypoglycemia coming on, blood sugar should promptly be measured, and a sugary food or drink should be consumed.

[35] After correcting blood glucose levels, people may consume a full meal within one hour to replenish glycogen stores.

[1] It is important for these people to receive training on how to recognize hypoglycemia, what foods to help the hypoglycemic eat, how to administer injectable or intra-nasal glucagon, and how to use a glucose meter.

[3] Upon recognizing the signs and symptoms of hypoglycemia in a diabetic, a blood sugar level should first be measured using a glucose meter.

[3][2] If the person is conscious and able to swallow, the family, friend, or co-worker can help the hypoglycemic consume 10–20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L).

[2][3][17] In the United States, glucacon kits are available by prescription for diabetic patients to carry in case of an episode of severe hypoglycemia.

[1][3][2] In those with diabetes treated by insulin, glinides, or sulfonylurea, the prevention of hypoglycemia has a large focus on patient education and medication adjustments.

[3][2] Post-gastric bypass hypoglycemia can be prevented by eating smaller, more frequent meals, avoiding sugar-filled foods, as well as medical treatment with an alpha-glucosidase inhibitor, diazoxide, or octreotide.

The term means 'low blood sugar' from Greek ὑπογλυκαιμία, from ὑπο- hypo- 'under' + γλυκύς glykys 'sweet' + αἷμᾰ haima 'blood'.

A glucagon kit used to treat severe hypoglycemia
An insulin pump used to deliver appropriate levels of insulin