endocrine and metabolic disorders
Hypoglycemia
Symptoms and Signs of Hypoglycemia
The surge in autonomic activity in response to low plasma glucose causes sweating, nausea, warmth, anxiety, tremulousness, palpitations, and possibly hunger and paresthesias. Insufficient glucose supply to the brain causes headache, blurred or double vision, confusion, agitation, seizures, and coma. In older patients, hypoglycemia may cause stroke-like symptoms of aphasia or hemiparesis and is more likely to precipitate stroke, myocardial infarction, and sudden death. Patients with diabetes mellitus, especially patients with type 1 diabetes, type 2 diabetes of long duration or patients with frequent hypoglycemia may be unaware of hypoglycemic episodes because they no longer experience autonomic symptoms (hypoglycemia unawareness) ( Symptoms and signs references ). In research studies under controlled conditions, autonomic symptoms begin at or beneath a plasma glucose level of about 60 mg/dL (3.3 mmol/L), whereas central nervous system symptoms occur at or below a glucose level of about 50 mg/dL (2.8 mmol/L) ( Symptoms and signs references ). . In contrast, people with glucose levels at these thresholds may have no symptoms, while people with symptoms suggestive of hypoglycemia can have normal glucose concentrations. 1.Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients.World J Diabetes2015;6(7):912-926. doi:10.4239/wjd.v6.i7.912 2.Cryer PE. Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia unawareness.Endocrinol Metab Clin North Am1999;28(3):495-vi. doi:10.1016/s0889-8529(05)70084-0 