Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon.
Symptoms and effects can be mild, moderate or severe, depending on how low the glucose falls and a variety of other factors.
In a counter-intuitive manifestation, hypoglycemia can trigger a Somogyi effect, resulting in a rebounding high blood sugar or hyperglycemia.
Hypoglycemia is a true medical emergency, which requires prompt recognition and treatment to prevent organ and brain damage.
Composition of the treatment should be considered, as fruit juice is typically higher in fructose which takes the body longer to metabolize than simple dextrose alone.
Dextrose 25% and 50% are heavily necrotic due to their hyperosmolarity, and should only be given through a patent IV line – any infiltration can cause massive tissue necrosis.
[citation needed] Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the liver, causing glycogenolysis and release of glucose into the blood.
It comes in a glucagon emergency rescue kit which includes tiny vials containing 1 mg, which is a standard adult dose.
Glucagon works if given subcutaneously, but absorption and recovery are faster if it is injected deep into a muscle (usually the middle of the outside of the thigh).
In the United States, caregivers for patients with Type 1 diabetes are instructed to have an unexpired glucagon emergency kit on hand at all times.
[6] A number of companies are developing glucagon injection devices with the goal of simplifying administration for caregivers and patients during severe hypoglycemic events.
Especially in people with long-standing type 1 diabetes and those who attempt to maintain glucose levels which are closer to normal, hypoglycemic unawareness is common.
The following factors contribute to hypoglycemic unawareness: During hypoglycemia, the body normally releases epinephrine (more commonly known as adrenaline) and related substances.
This serves two purposes: The β-effect of epinephrine is responsible for the palpitations and tremors, giving the patient warning that hypoglycemia is present.
If a person has frequent episodes of hypoglycemia (even mild ones), the brain becomes "used to" the low glucose and no longer signals for epinephrine to be released during such times.
Since repeated hypoglycemia is common in people with diabetes who strive to keep their glucose levels near normal, the incidence of hypoglycemic unawareness becomes more prevalent in patients who follow 'intensive treatment' protocols.
The most common treatment for this condition is to liberalize the patient's target glucose levels, in an attempt to decrease the frequency of hypoglycemic episodes.