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Continuous
HYPOGLYCEMIA
supply of glucose is necessafy for the normal
functioning of brain and for the brain to derive energy. In a
normal personn hypoglycemia is
prevented mainly by the com-
bined action of two hormones insulin and glucagon.
1. Insulin lowers blood
glucose.
2. Glucagon
raises blood glucose by stimulating hepatic
glycogenolysis and gluconeogenesis.
Epinephrine promotes glycogenolysis and inhibits secretion
of insulin. The combined effect of glucagon and epinephrine
along with diminished release of insulin is important in comba-
ting hypoglycemia.
Hypoglycemia is traditionally classified as;
1

1) Post prandial hypoglycemia

2) Fasting hypoglycemia
1) Post prandial hypoglycemia is the hypoglycemia follow-
ing a meal. It is also called reactive hypoglycemia. The most
common cause is alimentary hyperinsulinism caused by exagger
ated insulin release following a meal. This can occur in patients
who have undergone gastrectomy, gastrojejunostomy or vagotomy.
In all these conditions, the hypoglycemia is due to rapid gastric
emptying with quick absorption of glucose. This is followed by
increased secretion of insulin leading to hypoglycemia. However,
 the blood glucose level returns to normal even if the patient
is not fed.

2) Fasting hypoglycemia occurs during fasting

The main causes are:
1. Inadequate intake of food
2. Underproduction of glucose, as occurring in states of
hormone deficiency like,
a) Hypopituitarism
b) Adrenal deficiency
c) Glucagon deficiency
3) Hypoglycemia due to other causes are:

1) Pancreatic islet cells diseases, eg, tumors of Pancreas.

2) Glycogen storage diseases due to enzyme defect.

3) Galactosemia due to enzyme defect.
4) Transient postnatal hypoglycemia in infants of diabetic

mother.
Alcohol intoxication: Alcohol ingestion can induce hypo-
glycemia in a person, after a period of fasting sufficient enough
to deplete liver glycogen, as in the following conditions.

1) After administration of antidiabetic drugs like sulpho-

nylureas and insulin.

2) After strenuous exercise.

The reactions leading to hypoglycemia in alcohol intoxica

tion are explained as follows:-

Alcohol acts by (1) inhibiting hepatic gluconeogenesis and

(2) depleting liver glycogen stores.
Oxidation of ethanol produces excess of NADH (reducing
equivalents). The quantity of NADH produced is so high that it
exceeds the capacity of the liver to handle and the excess NADH
block the conversion of lactate to glucose, resulting in hypo-
glycemia and accumulation of lactate in blood. This leads to
lacticacidosis. The hypoglycemia may lead to irreversible damage
to the central nervous
system.
 Symptoms of hypoglycemia decline in
arise with rapid decline
blood glucose level to less than 50 mg %.
The symptoms in hypoglycemia are due in part, to release
of epinephrine and to lack of supply of glucose to brain which
leads to impaired functioning of the brain.

1. Symptoms due to release of epinephrine are, sweating

trembling, hunger, nausea and vomiting
2.Symptoms due lack of supply of glucose to brain and
to
decreased utilisation of oxygen by the brain are headache, rest
lessness, visual disturbances and difficulty with speech. Symptoms
in more pronounced hypoglycemia are convulsions, prolonged
sleep, loss of consciousness and coma. Transient hypoglycemia
causes cerebral dysfunction. Severe and prolonged hypoglycemia
causes brain cell damage.

Hypoglycemia during pregnancy and newborn

Hypoglycemia may occur during pregnancy because the
glucose consumption by the foetus increases and is drawn from
the mother's nutrition.
The risk of developing hypoglycemia, both maternal and
foetal, is more during nights and when the interval between
meals is prolonged.
Newborn particularly premature have a
greater suscepti-
bility to hypoglycemia because they have larger brain / body
weight ratio and the brain utilises greater amount of glucose
than the rest of the body.

Neonates have limited capacity tor ketogenesis and forma-

tion of free fatty acids. Ketone bodies and free
fatty
acids are
important fuels for formation of glucose by the brain.
ment of this function in neonates leads to
Impair-
hypoglycemia.