HYPOGLYCEMIA-MMj Treatment
What is hypoglycemia?
Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.
After a meal, glucose is absorbed into the bloodstream and carried to the body’s cells. Insulin, a hormone made by the pancreas, helps the cells use glucose for energy. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use glycogen for energy between meals. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy.
When blood glucose begins to fall, glucagon—another hormone made by the pancreas—signals the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a normal level. In some people with diabetes, this glucagon response to hypoglycemia is impaired and other hormones such as epinephrine, also called adrenaline, may raise the blood glucose level.
Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. If left untreated, hypoglycemia can get worse and cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death.
In adults and children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. Hypoglycemia can also result, however, from other medications or diseases, hormone or enzyme deficiencies, or tumors.
What are the symptoms of hypoglycemia?
Hypoglycemia causes symptoms such as
- hunger
- shakiness
- nervousness
- sweating
- dizziness or light-headedness
- sleepiness
- confusion
- difficulty speaking
- anxiety
- weakness
Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include
- crying out or having nightmares
- finding pajamas or sheets damp from perspiration
- feeling tired, irritable, or confused after waking up
What causes hypoglycemia in people with diabetes?
Diabetes Medications
Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medications—pills—that increase insulin production, such as
- chlorpropamide (Diabinese)
- glimepiride (Amaryl)
- glipizide (Glucotrol, Glucotrol XL)
- glyburide (DiaBeta, Glynase, Micronase)
- nateglinide (Starlix)
- repaglinide (Prandin)
- sitagliptin (Januvia)
- tolazamide
- tolbutamide
Certain combination pills can also cause hypoglycemia, including
- glipizide + metformin (Metaglip)
- glyburide + metformin (Glucovance)
- pioglitazone + glimepiride (Duetact)
- rosiglitazone + glimepiride (Avandaryl)
- sitagliptin + metformin (Janumet)
Other types of diabetes pills, when taken alone, do not cause hypoglycemia. Examples of these medications are
- acarbose (Precose)
- metformin (Glucophage)
- miglitol (Glyset)
- pioglitazone (Actos)
- rosiglitazone (Avandia)
In addition, use of the following injectable medications can cause hypoglycemia:
- Pramlintide (Symlin), which is used along with insulin
- Exenatide (Byetta), which can cause hypoglycemia when used in combination with chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, and tolbutamide
Other Causes of Hypoglycemia
In people on insulin or pills that increase insulin production, low blood glucose can be due to
- meals or snacks that are too small, delayed, or skipped
- increased physical activity
- alcoholic beverages
How can hypoglycemia be prevented?
Diabetes treatment plans are designed to match the dose and timing of medication to a person’s usual schedule of meals and activities. Mismatches could result in hypoglycemia. For example, taking a dose of insulin—or other medication that increases insulin levels—but then skipping a meal could result in hypoglycemia.
To help prevent hypoglycemia, people with diabetes should always consider the following:
- Their diabetes medications. A health care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take medications. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine.
- Their meal plan. A registered dietitian can help design a meal plan that fits one’s personal preferences and lifestyle. Following one’s meal plan is important for managing diabetes. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks.
- Their daily activity. To help prevent hypoglycemia caused by physical activity, health care providers may advise
- checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL)
- adjusting medication before physical activity
- checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed
- checking blood glucose periodically after physical activity
People who take diabetes medications should ask their doctor or health care provider
- whether their diabetes medications could cause hypoglycemia
- when they should take their diabetes medications
- how much medication they should take
- whether they should keep taking their diabetes medications when they are sick
- whether they should adjust their medications before physical activity
- whether they should adjust their medications if they skip a meal
How is hypoglycemia treated?
Signs and symptoms of hypoglycemia vary from person to person. People with diabetes should get to know their signs and symptoms and describe them to their friends and family so they can help if needed.
People who experience hypoglycemia several times in a week should call their health care provider. They may need a change in their treatment plan: less medication or a different medication, a new schedule for insulin or medication, a different meal plan, or a new physical activity plan.
Prompt Treatment for Hypoglycemia
When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose:
- 3 or 4 glucose tablets
- 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate
- 1/2 cup, or 4 ounces, of any fruit juice
- 1/2 cup, or 4 ounces, of a regular—not diet—soft drink
- 1 cup, or 8 ounces, of milk
- 5 or 6 pieces of hard candy
- 1 tablespoon of sugar or honey
Recommended amounts may be less for small children. The child’s doctor can advise about the right amount to give a child.
The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it’s still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above.
Hypoglycemia in People Who Do Not Have Diabetes
Two types of hypoglycemia can occur in people who do not have diabetes:
- Reactive hypoglycemia, also called postprandial hypoglycemia, occurs within 4 hours after meals.
- Fasting hypoglycemia, also called postabsorptive hypoglycemia, is often related to an underlying disease.
Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia. Symptoms may include hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness.
To find the cause of a patient’s hypoglycemia, the doctor will use laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body’s use of energy.
Reactive Hypoglycemia
Diagnosis
To diagnose reactive hypoglycemia, the doctor may
- ask about signs and symptoms
- test blood glucose while the patient is having symptoms by taking a blood sample from the arm and sending it to a laboratory for analysis
- check to see whether the symptoms ease after the patient’s blood glucose returns to 70 mg/dL or above after eating or drinking
A blood glucose level below 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis. The oral glucose tolerance test is no longer used to diagnose reactive hypoglycemia because experts now know the test can actually trigger hypoglycemic symptoms.
Causes and Treatment
The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body’s normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia.
A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric—or stomach—surgery can cause reactive hypoglycemia because of the rapid passage of food into the small intestine. Rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, also may cause reactive hypoglycemia.
To relieve reactive hypoglycemia, some health professionals recommend:
- eating small meals and snacks about every 3 hours
- being physically active
- eating a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products
- eating foods high in fiber
- avoiding or limiting foods high in sugar, especially on an empty stomach
The doctor can refer patients to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet to treat reactive hypoglycemia.
Fasting Hypoglycemia
Diagnosis
Fasting hypoglycemia is diagnosed from a blood sample that shows a blood glucose level below 50 mg/dL after an overnight fast, between meals, or after physical activity.
Causes and Treatment
Causes of fasting hypoglycemia include certain medications, alcoholic beverages, critical illnesses, hormonal deficiencies, some kinds of tumors, and certain conditions occurring in infancy and childhood.
Medications. Medications, including some used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include:
- salicylates, including aspirin, when taken in large doses
- sulfa medications, which are used to treat bacterial infections
- pentamidine, which treats a serious kind of pneumonia
- quinine, which is used to treat malaria
If using any of these medications causes a person’s blood glucose level to fall, the doctor may advise stopping the medication or changing the dose.
Alcoholic beverages. Drinking alcoholic beverages, especially binge drinking, can cause hypoglycemia. The body’s breakdown of alcohol interferes with the liver’s efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be serious and even fatal.
Critical illnesses. Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. Sepsis, which is an overwhelming infection, and starvation are other causes of hypoglycemia. In these cases, treating the illness or other underlying cause will correct the hypoglycemia.
Hormonal deficiencies. Hormonal deficiencies may cause hypoglycemia in very young children, but rarely in adults. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and treatment. Hormone replacement therapy may be advised.
Tumors. Insulinomas are insulin-producing tumors in the pancreas. Insulinomas can cause hypoglycemia by raising insulin levels too high in relation to the blood glucose level. These tumors are rare and do not normally spread to other parts of the body. Laboratory tests can pinpoint the exact cause. Treatment involves both short-term steps to correct the hypoglycemia and medical or surgical measures to remove the tumor.
The most common forms of hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Hypoglycemia is treated by restoring the blood glucose level to normal by the ingestion or administration of dextrose or carbohydrate foods. In some circumstances it is treated by 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 much of the pancreas.
The level of blood glucose low enough to define hypoglycemia may be different for different people, in different circumstances, and for different purposes Most healthy adults maintain fasting glucose levels above 4.0 mmol/L. Hypoglycemia is less common in non-diabetic persons.
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. When hypoglycemia occurs repeatedly, a record or "diary" of the spells over several months, noting the circumstances of each spell (time of day, relation to last meal, nature of last meal, response to carbohydrate, and so forth) may be useful in recognizing the nature and cause of the hypoglycemia.
An especially important aspect is whether the patient is seriously ill with another problem. Severe disease of nearly all major organ systems can cause hypoglycemia as a secondary problem.
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Hypoglycemia-- Symptom Treatments:
A. Medical marijuana (cannabinoids) stabilize blood sugar
B. Marijuana does not block the body’s response to hypoglycemia
C. Marijuana relieves stress
D. Marijuana relieves anxiety
E. Marijuana is an appetite stimulant
F. Marijuana relieves nausea
G. Marijuana relieves stomach pains
Eat a varied diet: five to six small portion meals everyday.
Hypoglycemic Diet Menu Strategy
Very low blood sugar condition can be worsened if one eats candy, chocolate, sweets, desserts, or drinks alcoholic drinks (containing far more sugar).
White sugar, coffee, tea, cola drinks (made up of caffeine) and smoking (nicotine) significantly influence adrenaline secretion and blood sugar levels. So these really should be strictly prevented in hypoglycemia.
Study reviews say that nine out of ten overweight persons have reactive hypoglycemia.
Weight problems must be treated using the assist of diet plan and increased physical exercise. Some ailments can trigger hypoglycemia after which, it becomes necessary to treat the underlying trigger if you would like to recover rapidly.
Hypoglycemic diet plan menu will need to consist of meals that contain complex carbohydrates like cereal, entire grain bread, soft pretzel, bagels, whole grain crackers or perhaps a protein bar.
A low carb diet made up of meat, eggs, dairy items, (not the over-processed items), peanut butter (with out canola oil), reduced carb veggies and fruits, decaffeinated coffee, light tea, herbal teas, and reduced carb fruit juices are recommended as part of the hypoglycemic diet.
It is possible to also refer to a high fiber meals checklist. Fruits include fiber, so it truly is much better to consume fruits rather than drink fruit juices.
Sample Hypoglycemic Diet Menu:
Breakfast:
Cornflakes ¾ cup with skim milk one cup
Entire wheat toast 1 slice with butter (1 tsp and sugar-free jam 1 tsp)
Orange 1 medium
Decaffeinated coffee ¾ cup/cream/sugar substitute(stevia)
Early morning Snack:
1 medium apple
Lunch:
Cooked carrot 1/2 cup
Italian salad dressing one tbsp
1 avocado or banana
Seeds and nuts ¼ cup
1 hamburger with lean meat and lettuce, tomato, etc. (with bun)
Afternoon Snack:
Skim milk 1 cup with whole wheat crackers 3
piece of cheddar cheese
Dinner:
Fruits like strawberries, grapes
Green beans ½ cup with baked medium potato ½ cup
Dinner roll one (whole grain)
Baked chicken breast two oz
Eat an old fashion balanced diet to maintain good health for life!
References:
Hypoglycemic Forum: www.ehealthforum.com/health/mmj
www.Hypoglycemia.org
www.druglibrary.org
www.medicinenet.com
www.mcsocal.com/blog
www.healthcaremagioc.com
Dr. Brinn
