Hypoglycemia in simple terms can be described as blood sugar/glucose level dropping below the normal amount required by the human body. It can be a symptom of many other diseases and manifest clinically when the body and the brain cannot function as properly due to the lack of energy supplied by glucose. Brain is especially sensitive to the blood glucose levels, as glucose is the only source of energy brain can utilize; other tissues of the body can use glucose as well as other substances to make energy when required.
The main source of blood glucose is diet, especially carbohydrates. After ingestion of food it will be digested to simple molecules like glucose, amino acids and fatty acids, these are then absorbed from the intestine to blood stream and carried to all tissues in the body where glucose acts as the primary source of energy. Insulin is the hormone which is responsible for metabolism of glucose and it is made by pancreas. When the blood level of glucose exceeds the amount body needs, the surplus of glucose will be stored as glycogen in liver and muscles. Excess glucose also can be converted to fat and stored in fatty tissue as well.
When blood glucose level falls below normal levels (80 – 100mg/dl or 4.4 – 5.5 mmol/l), the pancreas secretes glucagon hormone, which sends signals to glycogen stores to mobilize and break down into glucose to maintain blood glucose. But these stores have a limited capacity and can maintain blood glucose only for few hours. When they are exhausted blood glucose levels begin to fall again, and when it falls below 40mg/dl (2.5mmol/l) person will experience symptoms of hypoglycemia indicating need of an external energy supply. If this warning is not addressed blood glucose will further fall depriving brain cells of energy leading to permanent damage and cell death.
Both fasting as well as excess insulin can cause blood glucose to drop to dangerous levels. As the number of diabetics on insulin as well as insulin secreting medication is quite high, incidence of hypoglycemia is common and can be encountered in day to day life. Therefore, recognizing and proper first aid management can save a life of a person and is an essential part of any first aid training course.
Symptoms of hypoglycemia-
• Light headache
• If severe, collapse and loss of consciousness
Causes of hypoglycemia-
• Over medication with oral hypoglycemic agents or/ and insulin in a patient with diabetes.
• Alcohol consumption.
• Missed meals/ fasting.
• Severe infections.
• Adrenal insufficiency (Addison’s disease/crisis)
• Kidney failure
• Liver failure
• Congenital hyper-insulinism (excess secretion of insulin)
• Infants with diabetic mothers
• Insulinoma – insulin secreting tumor
First aid Management
1. The whole purpose of management of hypoglycemia is rising up the level of blood glucose. It can be achieved by giving oral or parental sugar/ glucose, but as a first aid measure focus on supplying via oral route.
2. First reassure the patient and make him/her lie or sit on a comfortable position and a posture.
3. Give high sugar containing cup of fruit juice or 3 to 4 teaspoons of sugar/glucose dissolved in water.
4. Then give more substantial foods like sandwich, pastry, cake etc.
5. If the patient is unconscious follow the guidelines of basic life support. And call emergency services as soon as possible.
6. If a non-diabetic patient experiences recurrent episodes of hypoglycemia, medical intervention is required to find out the cause for hypoglycemia.
7. If the patient is known diabetic, he may have glucometer with him/her, check and monitor blood glucose levels to get idea about the prognosis and need for further management.
8. For diabetic patient on oral hypoglycemic agents and on insulin needs to follow following basic principles to prevent hypoglycemic episodes and treat such event.
- o Get idea about the early warning signs such as hunger, sweating, shakiness, faintishness.
- o Keep some sweets whenever you go out. Like toffee, chocolate, sweet tablets, pack of glucose.
- o Do not miss your regular meals.
- o Inform family members/work mates how to recognize hypoglycemic episode and what to be done.
- o Prevent psychological stresses.
- o Contact your doctor for adequate follow up and optimize blood glucose levels.
- o Always carry a MedicAlert™ bracelet or an information card regarding your condition.
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