David Mamet

A hypoglycemia is a too low Glycémie; it is when the rate of Glucose (Sucre) in the Sang is lower than the normal, not making it possible more the Métabolisme to normally be held.

For an adult human being, a hypoglycemia is a glycemia lower than 0,8 G/L.

The opposite of a hypoglycemia is a Hyperglycémie.

Causes

  • Taken alcohol: cause most frequent.

  • the Fast: the food was insufficient, digestion did not bring sugar sufficient, and the body did not react yet to release its reserves; it can be a question of specific, but such a nutritional problem (too severe mode, context of Anorexie, denutrition of varied causes…) ;
  • effort: the operation of the muscles consumed glucose available in blood, and the body did not release its reserves yet (it is the “pang of hunger” of the sportsman), always temporary at the healthy subject;
  • the catch of Drug: certain drugs produce a hypoglycemia; it is in particular the case drugs antidiabetic, like the Insuline and the oral anti-diabetics at the subjects diabetic S. Of other drugs can be in question: Aspirine, anti-inflammatory drugs not stéroïdiens, Béta-blocking S noncardio-selective, Quinidine.
More rarely, hypoglycemia can be revealing:
  • of a pathology endocrinienne: hyper secretion of Insulin within the framework for example of a Insulinôme, tumor secreting of the IGF1;
  • of antecedents of gastrectomie452 (ablation of the stomach), generally after gastric cancer.

Diagnosis

A subject reached of hypoglycemia can feel whole or part of the Symptôme S following:

  • feeling of hunger
  • tremors
  • sweats
  • swarmings in the ends (Paraesthesia), numbness of the members
  • eye troubles
  • Giddiness S
  • tiredness (Asthenia)
    • cardiac
  • nauseas, vomiting
  • palpitations
  • Paleness, Cyanosite
  • headaches (Cephalgia S)
  • turbid behavioral: confusion, difficult word, excitation, irritation…
  • turbid of vigilance: somnolence, convulsions, even Coma

Within the framework of the First aid, it is not possible to distinguish it Malayan hypoglycemic from another Malaise: any faintness or coma must make evoke the hypoglycemia, which when it deep and is prolonged can result in death.

Within the medical framework , the measurement of the Glycémie belongs to the basic assessment of any faintness and must be made in particular with the immediate waning of this last.

Physiological reaction

Initially, the body reacts to the fall of the glycemia by a discharge of Adrénaline (adrenergic answer hormonal, endogenous secretion of Catécholamine by the Glandes suprarenals), which causes

  • a cardiac acceleration (from where palpitations),
  • a rise in the blood Pressure (Vasoconstriction),
  • and a dilation of the Bronche S (Broncodilatation, to facilitate the Respiration)
to compensate for the state of weakness. The body also releases from the reserves of glucose to make go up the glycemia; in particular, there is a Sécrétion Glucagon by the Pancréas, a hormone causing on the one hand the release of glucose starting from hepatic glycogen (Glycogénolyse), and on the other hand the degradation of the triglycerides (greases) stored in the adipocytes (and secondarily in the liver) by a process of Lipolyse. Whereas the fatty-acids thus released are used as energy substrate with the cells, the glycerol is collected by the liver and convert in glucose (Néoglucogenèse).

The adrenergic answer consumes energy, it can in itself worsen hypoglycemia, in particular in the insulinodépendant diabetic.

The glycogenèse making go up the glycemia, that involves an insulin release (except at the patient insulinodépendant diabetic) which can in its turn cause new a faintness if the person did not take of sugar. One can thus have an alternation normal pang of hunger-state.

Hypoglycemia reactivates (post-prandiale)

Hypoglycemia according to the meals, with tiredness, confusion and other symptoms of hypoglycemia.

Treatment

The resucrage by oral way (at a conscious subject: sugar or fruit juice, more the bread or cookies) or intravenous (in the event of coma: aqueous solution glucose to 30%) is the essential and sufficient treatment of hypoglycemia. In the second time, one will have to seek the cause of hypoglycemia (assessment of the medicamentous catches, blood alcohol content, etc)

Preventive medication

For a person without particular problem: it is advisable to adapt its mode to its physical-activity, to avoid “jumping a meal”, and in particular to insist on the Petit-déjeuner. That also formed part of the education of the sportsman: slow sugar consumption several hours before providing an effort, to have with provision of fast sugars during the effort. It is necessary also well to lunch before going to give its blood (contrary to the blood test for analysis which it is done with jeun).

In the treated diabetic:

  • to learn how to recognize on oneself the signs of hypoglycemias; to have always sugars of fast absorption on oneself;
  • to rehabilitate the medicamentous treatment of the diabetic with the attending physician;
  • to split the meals and to make a collation if need be;
  • to privilege sugars of slow absorption

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