EMERGENCIES ALL SHOULD KNOW:HYPOGLYCEMIA(LOW SUGAR LEVEL)

HYPOGLYCEMIA(LOW SUGAR LEVEL)
                                           

Hypoglycemia is a condition where there is abnormally low blood sugar (glucose) in blood.The problems arise from inadequate supply of glucose to the brain,resulting in giddiness,siezures,un-consciousness ,brain damage occasionally death.

                                         

Hypoglycemia occurs most commonly in diabetics on either insulin or oral hypoglycemia drugs.The Hypoglycemia is less common in non-diabetic persons, but can occur at any age. 

 The other causes include  excessive insulin produced in the body as in insulinoma,inborn errors of metabolism,some medications,poisons,alcohol,hormone deficiencies, prolonged starvation, alterations of metabolism associated with infection, and organ failure.

                                    

It is often self-diagnosed in experienced diabetics and self-medicated orally by the ingestion of balanced meals.Hypoglycemia is treated by restoring the blood glucose level to normal by the ingestion or administration of dextrose or carbohydrate foods.  In more severe circumstances, it is treated by i.v glucose,injection or infusion of glucagon. Recurrent hypoglycemia may be prevented by reversing or removing the underlying cause, by increasing the frequency of meals, with medications like diazoxide, octreotide, or glucocorticoids, or by surgical removal of part  of  pancreas.

The level of blood glucose low enough to define hypoglycemia may be different for different people, in different circumstances, and for different purposes, and occasionally has been a matter of controversy. Most healthy adults maintain fasting glucose levels above 4.0 mmol/l (72 mg/dl), and develop symptoms of hypoglycemia when the glucose falls below 4 mmol/L. It can sometimes be difficult to determine whether a person's symptoms are due to hypoglycemia. Criteria referred to as whipples triad are used to determine a diagnosis of hypoglycemia:

1. Symptoms known to be caused by hypoglycemia
2. Low glucose at the time the symptoms occur
3. Reversal or improvement of symptoms or problems when the glucose is restored to normal.

                                           

1. Blood glucose levels  usually are venous plasma or serum levels measured by standard, automated glucose oxidase methods used in labs. 

1.  The whole blood glucose levels measured by finger prick methods  using glucometer are about 10%-15% lower than venous plasma levels.
2. The delay that occurs when blood is drawn at a satellite site and transported to a central laboratory hours later for routine processing is also another common cause of falsely low glucose levels.
3. Children's blood sugar levels are often slightly lower than adults'. Overnight fasting glucose levels are below 70 mg/dL (3.9 mM) in 5% of healthy adults, but up to 5% of children can be below 60 mg/dL (3.3 mM) in the morning fasting state.

                                        

1.  Hormonal defence mechanisms like adrenaline,glucagon are normally activated as it drops below a threshold level (about 55 mg/dL (3.0 mM) for most people), producing the typical hypoglycemic symptoms of shakiness.
2. In newborns, hypoglycemia can produce irritability, jitters, jerks,,cyanosis, respiratory distress, apneic episodes, sweating, hypothermia, somnolence,  refusal to feed, and seizures or "spells.
3. Hypoglycemic symptoms can also occur when one is sleeping. Examples of symptoms during sleep can include damp bed sheets or clothes from perspiration. Having nightmares or the act of crying out can be a sign of hypoglycemia. Once the individual is awake they may feel tired, irritable, or confused and these may be signs of hypoglycemia as well.
4.                              
5. In nearly all cases, hypoglycemia that is severe enough to cause seizures or unconsciousness can be reversed without obvious harm to the brain.
6. The circumstances of hypoglycemia provide most of the clues to diagnosis. Circumstances include the age of the patient, time of day, time since last meal, previous episodes, nutritional status, physical and mental development, drugs or toxins (especially insulin or other diabetes drugs), diseases of other organ systems, family history, and response to treatment. It may take longer to recover from severe hypoglycemia with unconsciousness or seizure even after restoration of normal blood glucose.
7. The risk of further episodes of diabetic hypoglycemia can often (but not always) be reduced by lowering the dose of insulin or other medications, or by more meticulous attention to blood sugar balance during unusual hours, higher levels of exercise, or decreasing alcohol intake.

                                         

1. Treatment of some forms of hypoglycemia, such as in diabetes, involves immediately raising the blood sugar to normal through the ingestion of carbohydrates
2. It can be taken as food or drink if the person is conscious and able to swallow. This amount of carbohydrate is contained in about 3–4 ounces (100–120 ml) of orange, apple, or grape juice although fruit juices. the "rule of 15" – consuming 15 grams of carbohydrate followed by a 15 minute wait, repeated if glucose remains low . in-hospital personnel can establish IV access and give intravenous dextrose, concentrations varying depending on age (infants are given 2 ml/kg dextrose 10%, children are given dextrose 25%, and adults are given dextrose 50%).

                                            

Prevention of hypoglycemia is better way than treating it.Keep A WATCH ON YOUR DIET AND INSULIN.
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ACUTE PAIN ABDOMEN

HAEMETEMESIS

THROMBOSED,PAINFUL PILES

ACUTE TUBULAR NECROSIS

PARAPHIMOSIS

TESTICULAR TORSION

TRAUMA

RENAL COLIC

PRIAPISM

ACUTE URINE RETENSION

SEVERE PALLOR

ABSCESS

ANIMAL BITES

POISONING

BURNS

SEIZURES

PARALYTIC STROKE

ANY PREGNANCY RELATED EVENT

SUDDEN LOSS OR IMPAIRMENT OF VISION

SUDDEN HEAD ACHE AND VOMITING

HIGH GRADE FEVER

NON-RESPONSIVENESS

VIOLENT BEHAVIOUR

SUDDEN CALF PAIN

SEVERE BREATHLESSNESS