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Hypoglycemia, which occurs independently of any exogenous insulin therapy, is a very rare clinical event and is characterized by low plasma levels of glucose, stimulation of the sympathetic nervous system and CNS disorders. Many medications and diseases can lead to hypoglycaemia. Blood tests at the time of the occurrence of symptoms or during a 72-hour sobriety phase necessary for the diagnosis. The therapy consists of a glucose load in combination with the elimination of the underlying disease.
The most common symptomatic hypoglycemia is a complication of drug treatment of DM. Oral antihyperglycemic agents or insulin may be involved.
Hypoglycemia, which occurs independently of any exogenous insulin therapy, is a very rare clinical event and is characterized by low plasma levels of glucose, stimulation of the sympathetic nervous system and CNS disorders. Many medications and diseases can lead to hypoglycaemia. Blood tests at the time of the occurrence of symptoms or during a 72-hour sobriety phase necessary for the diagnosis. The therapy consists of a glucose load in combination with the elimination of the underlying disease. The most common symptomatic hypoglycemia is a complication of drug treatment of DM. Oral antihyperglycemic agents or insulin may be involved. Symptomatic hypoglycemia, which occurs regardless of the treatment of DM, is comparatively rare, because the body has a variety counterregulative mechanisms by which low blood glucose values ??can be compensated. Glucagon and epinephrine levels increase in response to acute hypoglycemia and the first stage in the counter-regulatory cascade seem. in the acute phase cortisol and growth hormone levels rise too, and are important to the recovery in prolonged hypoglycemia. The threshold for the secretion of these hormones is normally above the hypoglycemic for triggering symptoms. Etiology The causes of physiological hypoglycaemia can such be classified follows: drug induced or drug-induced insulin-dependent causes are exogenous insulin administration, insulin secretagogues or insulin-secreting tumor (insulinoma) insulin mediated by fasting reactive (postprandial) or or non-insulin-mediated. A helpful, applied in practice classification is based on the clinical fact that the hypoglycemia occurs in healthy or sick people appearing to be. Within these categories, the causes of hypoglycemia in drug-associated and other causes can be divided. Pseudohypoglykämie occurs if the further processing of the blood takes place delayed in untreated test tube and cells, such as. (Especially if they are as increases in leukemia or polycythemia), consume as erythrocytes and leukocytes glucose. A hypoglycaemia factitia is a real hypoglycemia, which is caused by a non-therapeutic use of sulfonylureas or insulin. Symptoms and complaints The sudden rise of the autonomous activity in response to low blood glucose levels caused sweating, nausea, a feeling of warmth, anxiety, tremors, palpitations and possibly hunger and paresthesia. Insufficient cerebral glucose intake causes headache, blurred vision or double vision, confusion, speech problems, seizures and coma. Under controlled conditions, autonomic symptoms at glucose levels less than or equal to 60 mg / dl show (3.3 mmol / l), while CNS symptoms until at values ??less than or equal to 50 mg / dl occur (2.8 mmol / l). Symptoms that may indicate hypoglycemia Most people with glucose levels in the range of these limits are far more common than the hypoglycemia itself. Show no symptoms, and most people with symptoms that may indicate hypoglycemia, have normal glucose levels. Diagnostic blood sugar levels correlated with clinical findings in response to administration of dextrose (or other sugar) Sometimes fasting blood glucose (72 h) Sometimes insulin, C-peptide and Proinsulinwerte In principle, the diagnosis requires confirmation that low blood glucose levels (<50 mg / dl [<2.8 mmol / l]) at the time of occurrence of the symptoms were present, and that the symptoms of a Dextrosegabe reacted. If there is the onset of symptoms the possibility of blood, the blood sugar should be determined immediately. When blood sugar is normal, hypoglycaemia may be excluded and further investigations in this direction are unnecessary. When blood glucose is pathologically low, can be distinguished in the serum from the same test tube between an insulin-dependent or non-insulin dependent and between a Hypoglycaemia factitia and a physiological hypoglycemia using the measurement of insulin, C-peptide and proinsulin. After that, the need for further tests done. Insulin growth factor-2 (IGF-2) levels can contribute to the identification of non-islet cell tumors, the IGF-2 secrete contribute. However, this is an unusual cause of hypoglycaemia. In practice, however, it is rare that the onset of symptoms that may indicate hypoglycemia, it is possible for blood collection. Home glucose meters are unreliable in terms of quantification of hypoglycemia, and there is no clear glycated HbA1c limit value that allows a long-existing hypoglycemia can be distinguished from normoglycemia. So the decision for further investigations depending on the likelihood of actually a disorder that causes hypoglycemia, to track down. To estimate the probability of clinical impression and the existence of other diseases of the patient are used. A fasting blood glucose control over 72 hours under controlled conditions is the standard diagnostics. Patients drink only calorie, caffeine-free drinks, and the blood glucose values ??are at the beginning, whenever symptoms and every 4-6 hours or every 1-2 h when glucose levels below 60 mg / dl (3.3 mmol / l) fall is determined. Insulin, C-peptide and proinsulin in serum should be determined upon the occurrence of hypoglycemia, in order to distinguish an endogenous from an exogenous (spurious) hypoglycemia. The fasting period will be canceled after 72 hours if the patient has shown no symptoms and glucose levels in the normal range were; the break sooner if glucose levels drop below ? 45 mg / dl (2.5 mmol / l) in the presence of hypoglycemic symptoms. The measurements at the end of the fasting period, also include values ??for ?-hydroxybutyric acid (which should be low in insulinomas) Serumsulfonylharnstoff to identify a drug-associated hypoglycemia, and plasma glucose after the i.v. Administration of glucagon to see the characteristic with insulinomas increase. In terms of sensitivity, specificity and the predictive value to detect hypoglycemia using that protocol, there is no data. There is no definitive lower limit of glucose, which clearly defines a pathological hypoglycemia during a 72 hours lasting fasting period. Normal women tend to lower fasting blood glucose levels than men and may have blood sugar levels that are to have (1.7 mmol / l), with no symptoms as low as 30 mg / dl. in the period of 72 hours if no hypoglycemia has occurred, the patient for 30 minutes to weigh heavily physically. If again no hypoglycemia, insulinoma is largely excluded, and further investigation is not necessary. Treatment Oral administration of sugar or i.v. Sometimes dextrose parenteral glucagon The immediate treatment of a secured hypoglycemia is the administration of glucose. Patients who are able to eat and drink should drink juice, sugar water or a glucose solution or eat candy, glucose tablets and other foods as soon as symptoms appear. Infants and small children should be a 10% dextrose at a dose of 2 to 5 ml / kg i.v. be administered as a bolus. Adults and older children who can not eat or drink, can 0.5 (<20 kg) or 1 mg (? 20 kg) glucagon s.c. or i.m. or 50% dextrose at a dose of 50-100 ml i.v. are given. A continuous infusion of 5-10% dextrose can follow. The efficiency of glucagon depends on the size of the hepatic glycogen stores. Glucagon has in patients who have been fasting for a prolonged period or who were hypoglycemic already for some time, only a small effect on blood glucose levels. Hypoglycemia underlying disease must also be treated. Islet cell tumors and non-islet cell tumors have localized the first thing and then removed by enucleation or partial pancreatectomy. Within 10 years, about 6% show a recurrence. Diazoxide and octreotide can be used to control the symptoms while the patient waits for the operation if the patient refuses surgery or is inoperable. Inselzellhypertrophie is often a diagnosis of exclusion, when the suspicion of an islet cell tumor has not been confirmed. Medications that can cause hypoglycemia, including alcohol must be avoided. The treatment of inherited and endocrine disorders, kidney, heart and liver failure and sepsis and shock are discussed elsewhere. Summary of hypoglycemia is a low plasma glucose levels (<50 mg / dl [<2.8 mmol / l]) plus. Concurrent hypoglycemic symptoms that respond to a Dextrosegabe. Most of the hypoglycemia is caused by drugs used to treat DM (including unauthorized use); Insulin-secreting tumors are rare causes. If the etiology is unclear, a fast test 72-h can be carried out with a measurement of plasma glucose at regular intervals and whenever symptoms occur. Serum insulin, C-peptide and proinsulin should be determined upon the occurrence of hypoglycemia, in order to distinguish an endogenous from an exogenous (spurious) hypoglycemia.