Consult by instant messaging with a Hypoglycaemia

Hypoglycaemia: glucose levels, fasting, who to consult?

Hypoglycaemia is an abnormal drop in blood glucose levels. Most often, hypoglycaemia is caused by medications used to control diabetes. Less common causes include the use of other medications, the presence of a serious illness, an allergic reaction to carbohydrates, a pancreatic tumour, organ failure, or complications from weight-loss surgery. A drop in blood sugar causes several symptoms, such as excessive sweating, hunger, general fatigue (asthenia), tremors, muscle weakness or difficulty thinking clearly. In cases of severe hypoglycaemia, symptoms can include seizures, confusion and coma. Treatment relies on giving sugar and reducing certain medications, when they are responsible for the drop in blood sugar.

What causes hypoglycaemia?

Hypoglycaemia is generally caused by 3 factors:
   • Medications;
   • Fasting;
   • A reaction to food.
The main medications implicated in hypoglycaemia are those used to treat diabetes: taking insulin in particular, but also other medications such as sulfonylureas or oral hypoglycaemic agents. All of these medications work by lowering blood sugar. Diabetics who develop chronic kidney failure or who reduce their food intake are more frequently affected by hypoglycaemia. In practice, taking an antidiabetic medication can lower blood sugar excessively when the patient does not eat enough or after intense physical exertion. Finally, other medications, such as pentamidine, used to treat certain forms of pneumonia (occurring mainly in the context of AIDS), can cause hypoglycaemia. Quinine, used to relieve muscle cramps, can also cause an abnormal drop in glucose levels. There is also hypoglycaemia linked to fasting. People who may be affected often have conditions or illnesses that hinder the body's ability to maintain an adequate blood sugar level. In these people, prolonged fasting can cause hypoglycaemia. In addition, in people who drink a lot of alcohol without eating, glucose production can remain blocked in the liver. Certain illnesses can also prevent the liver from storing and producing an adequate amount of glucose:
   • Viral hepatitis;
   • Digestive disorders;
   • Cirrhosis;
   • Cancer;
   • Chronic kidney failure;
   • Heart failure;
   • Septicaemia (sepsis).
Lastly, hypoglycaemia can be reactive to a meal containing too many carbohydrates, although this type of reaction is rare. In some cases, bariatric surgery (gastric bypass, for example) aimed at weight loss can also cause an abnormal drop in glucose levels.

Symptoms of hypoglycaemia

The symptoms of hypoglycaemia depend on whether it is mild or severe:
   • In mild hypoglycaemia: hunger, nervousness, sweating, fainting, tremors, palpitations;
   • In severe hypoglycaemia: fatigue, dizziness, headaches, weakness, confusion, inability to concentrate, speech difficulties, seizures, blurred vision, coma.
Symptoms of hypoglycaemia generally begin when blood glucose levels fall below 50 mg/dl (3.3 mmol/l). Some patients may nonetheless feel symptoms at levels slightly above this threshold, particularly when the drop in blood sugar is rapid. Others develop no symptoms even when their blood sugar level is much lower. The body's first response to a drop in blood sugar is to release adrenaline from the adrenal glands. This hormone stimulates the release of glucose stored by the body. However, adrenaline also causes symptoms similar to those of a panic attack. In severe hypoglycaemia, the supply of glucose to the brain is reduced, causing significant fatigue (asthenia), dizziness, weakness, difficulty concentrating, headaches, difficulty speaking, seizures or even coma. In cases of prolonged and profound hypoglycaemia, brain damage can be irreversible. In addition, symptoms can appear suddenly or gradually. They can develop rapidly within minutes, from a mild feeling of unwellness to a panic attack or severe confusion. In some people with an insulinoma, a digestive disorder, hypoglycaemia can occur after the overnight fast, early in the morning. This is even more likely in cases of physical activity before breakfast, which uses up the body's glucose reserves.

What to do in case of hypoglycaemia?

Treatments for hypoglycaemia include:
   • Consuming sugar, to restore blood glucose levels to normal;
   • Adjusting medication doses;
   • Eating several small meals throughout the day;
   • In case of a tumour, surgical removal.
The immediate treatment for hypoglycaemia is therefore consuming sugar. This can be in any form: glucose tablets, sweets, a sugary drink, etc. People prone to frequent hypoglycaemic episodes, particularly diabetics, may for example keep a few pieces of glucose on them; these have the advantage of working quickly. It is also possible to consume sugar directly, in addition to a food containing carbohydrates (a biscuit, bread, etc.). In cases of severe hypoglycaemia, when it is not possible to give sugar orally, it is sometimes necessary to quickly administer glucose intravenously in order to avoid the risk of brain damage. A medication also exists to stimulate the release of a large amount of glucose by the liver: this is glucagon, which can be administered via a nasal inhaler or by injection. Finally, it is also possible to treat the cause of hypoglycaemia directly. When it is due to a medication, the dose must be adjusted or the medication replaced. In the case of an insulinoma, however, treatment is surgical.

Understanding and treating the causes of hypoglycaemia with an online doctor

Most of the time, hypoglycaemia is caused by medications used to treat diabetes. Hypoglycaemia or low blood sugar can cause various symptoms, including central nervous system dysfunction. Generally speaking, hypoglycaemia is common among diabetics taking anti-hyperglycaemic medication or insulin. When hypoglycaemia is not related to insulin treatment (insulin therapy), another cause should be looked for, such as a medication or a metabolic disorder. Finally, when diagnosis requires further examination, a blood test should be carried out during symptoms of hypoglycaemia or during a 72-hour fast. Most of the time, treatment for hypoglycaemia consists of giving sugar and treating an underlying disorder or condition. In any case, it is not normal to experience frequent episodes of hypoglycaemia. If in doubt, you can consult a general practitioner during an online consultation, to help prevent hypoglycaemia and identify an underlying disorder. Take care of your health, especially if you are diabetic.