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Hypoglycemia - Low Blood Sugar

Hypoglycemia (Low Blood Sugar) is a medical term referring to a pathologic state produced and usually defined by a lower than normal amount of sugar (glucose) in the blood. The term hypoglycemia literally means "low blood sugar". Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia). Derangements of function can range from vaguely "feeling bad" to coma and (rarely) death. Low blood sugar can arise from many conditions, and can occur at any age.

Endocrinologists (specialists in disorders of blood glucose metabolism) typically consider the following criteria (referred to as Whipple's triad) as confirming a diagnosis of hypoglycemia (low blood sugar):

  • Measurably low level of blood glucose
  • Presence of symptoms or problems at the time of the low glucose
  • Reversal or improvement of symptoms or problems when the glucose is restored to normal

symptoms of hypoglycemia - low blood sugar symptoms

Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.

Adrenergic Manifestations of low blood sugar symptoms

  • Shakiness, anxiety, nervousness, tremor
  • Palpitations, tachycardia
  • Sweating, feeling of warmth
  • Pallor, coldness, clamminess
  • Dilated pupils

Glucagon Manifestations of hypoglycemia symptoms

  • Hunger, borborygmus
  • Nausea, vomiting, abdominal discomfort

Neuroglycopenic Manifestations of hypoglycemia symptoms

  • Abnormal mentation, impaired judgement
  • Nonspecific dysphoria, anxiety, moodiness, depression, crying, fear of dying
  • Negativism, irritability, belligerence, combativeness, rage
  • Personality change, emotional lability
  • Fatigue, weakness, apathy, lethargy, daydreaming, sleep
  • Confusion, amnesia, dizziness, delirium
  • Staring, "glassy" look, blurred vision, double vision
  • Automatic behavior
  • Difficulty speaking, slurred speech
  • Ataxia, incoordination, sometimes mistaken for "drunkenness"
  • Focal or general motor deficit, paralysis, hemiparesis
  • Paresthesias, headache
  • Stupor, coma, abnormal breathing
  • Generalized or focal seizures

Not all of the above manifestations occur in every case of hypoglycemia. There is no consistent order to the appearance of the symptoms. Specific manifestations vary by age and by the severity of the hypoglycemia. In young children vomiting often accompanies morning hypoglycemia with ketosis. In older children and adults, moderately severe hypoglycemia can resemble mania, mental illness, drug intoxication, or drunkenness. In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise. The symptoms of a single person do tend to be similar from episode to episode.

In newborns, hypoglycemia can produce irritability, jitters, myoclonic jerks, cyanosis, respiratory distress, apneic episodes, sweating, hypothermia, somnolence, hypotonia, refusal to feed, and seizures or "spells". Hypoglycemia can resemble asphyxia, hypocalcemia, sepsis, or heart failure.

In both young and old patients, the brain may habituate to low glucose levels, with a reduction of noticeable symptoms despite neuroglycopenic impairment. In insulin-dependent diabetic patients this phenomenon is termed hypoglycemia unawareness and is a significant clinical problem when improved glycemic control is attempted. Another aspect of this phenomenon occurs in type I glycogenosis, when chronic hypoglycemia before diagnosis may be better tolerated than acute hypoglycemia after treatment is underway.

In the large majority of cases, hypoglycemia severe enough to cause seizures or unconsciousness can be reversed without obvious harm to the brain. Cases of death or permanent neurologic damage occurring with a single episode have usually involved prolonged, untreated unconsciousness, interference with breathing, severe concurrent disease, or some other type of vulnerability. Nevertheless, brain damage or death has occasionally resulted from severe hypoglycemia.

Posted by Staff at May 23, 2005 8:14 PM

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Comments Archive

Iam a mother of a five year old girl who recently was diagnosed with Ketoacidosis Hypoglycemia. A relatively unknown metabolic disorder misunderstood by most doctors even. She was first diagnosed with this condition in Nov of this year when She came down with a flu. The next morning I had trouble waking her and she was quite confused and disoriented. I dropped my older children off at school and was proceeding on to the local Childrens Hospital as she just was not acting normal at all. Half way there she would not wake up at all and was totally unresponsive. When we reached the ER They started doing blood tests immediatly. She was having alot of trouble maintaining her blood pressure so she was immediatly put on monitors and watched very closley as we waited for her blood results. When we did get them back they were very alarming. She had extremely low blood sugar the acid in her blood was extremely high and the ketones were well over 4. They immediatly admitted us to the ICU as she wasent able to maintain her blood pressures and was in a low blood sugar coma.

The Metabolics specialist firtst thoughts were that she had a condition called Addisons disease. Which thank god it diddnt turn out to be. They later came to a diagnosis of Ketoacidosis Hypoglycemia with glucos synthaise disorder as well. We just had another scare with her and just released from the hospital two days ago. I am still terrified and dont understand this diagnosis that well if anyone could help me that would be great. Her team of doctors that follow her are some of the best in Canada but I just dont understand alot of it still. If anyone can help I would really appreciate it. Also if anyone elses child suffers from the same thing please feel free to email me. From what I was told by her speacialists he is only treating 5 people in Alberta Canada with this

Chantale Sauve

Posted by: Chantale Sauve at June 16, 2005 8:00 PM

We posted a new article about ketoacidosis at:

Posted by: Staff at June 17, 2005 7:10 PM

if One had to chose care among 2 kids in triage. which would be choosen first. The 6 year old with a bp of 65/57 or a diabetic 8 or 9 year old with blood sugar of 180

Posted by: georgia rooks at June 24, 2005 4:58 PM

I am the sister of Otis Jackson Hughes Jr. He passed away on July 4th 2005. He had type1 diabetes and was seeing a regular Doctor for this, he was 42 years old and got into some trouble and went to Prison for probation violation, he was there 72 days. They changed his insulin from Lantis and regular insulin to NPH and regular insulin, they did not allow him to check his sugar but twice a day and they cut the amounts of regular insulin injections he had been recieving. His glucose levels dropped as low as 27 and they would do nothing to help him. He was unconcious at one point and it took them over an hour to get a gsurd in there to help him. I know my brother had done something wrong but he did not deserve to die. I have walked the last mile with my brother now I am walking the first mile for him. Prison is a death sentence to some people with health problems and it should not happen that way.

Posted by: Odessia Hufstetler at July 28, 2005 9:09 PM

I will like to contact Ms. Chantale Sauve.


Posted by: Evelyn Morales at April 4, 2006 10:15 PM