Treatment and prevention Management of hypoglycemia involves immediately raising the blood sugar to
normal, determining the cause, and taking measures to hopefully prevent future
episodes.
Reversing acute hypoglycemia
The blood glucose can be raised to normal within minutes by taking (or
receiving) 10-20 grams of
carbohydrate. 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
contain a higher proportion of fructose which is more slowly metabolized than
pure dextrose, alternatively, about 4-5 ounces (120-150 ml) of regular
(non-diet) soda may also work, as will about one slice of bread, about 4
crackers, or about 1 serving of most starchy foods.
tarch is
quickly digested to glucose (unless the person is taking
carbose),
but adding fat or protein retards digestion. Symptoms should begin to improve
within 5 minutes, though full recovery may take 10-20 minutes. Overfeeding does
not speed recovery and if the person has diabetes will simply produce
hyperglycemia afterwards.
If a person is suffering such severe effects of hypoglycemia that they cannot
(due to combativeness) or should not (due to seizures or unconsciousness) be
given anything by mouth, medical personal such as EMTs and Paramedics, or
in-hospital personel can establish an IV and give intravenous Dextrose,
concentrations varying depending on age (Infants are given 2cc/kg Dextrose 10%,
Children Dextrose 25%, and Adults Dextrose 50%). Care must be taken in giving
these solutions because they can be very necrotic if the IV is infiltrated. If
an IV cannot be established, the patient can be given 1 to 2 milligrams of
Glucagon in an
intramuscular injection. More treatment information can be found in the
article
diabetic hypoglycemia.
One situation where starch may be less effective than glucose or sucrose is
when a person is taking acarbose. Since acarbose and other
alpha-glucosidase inhibitors prevents starch and other sugars from being
broken down into
monosaccharides that can be absorbed by the body, patients taking these
medications should consume monosaccharide-containing foods such as glucose
tablets, honey, or juice to reverse hypoglycemia.
Prevention
The most effective means of preventing further episodes of hypoglycemia
depends on the cause.
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 alcohol intake.
Many of the inborn errors of metabolism require avoidance or shortening of
fasting intervals, or extra carbohydrates. For the more severe disorders, such
as type 1 glycogen storage disease, this may be supplied in the form of
ornstarch
every few hours or by continuous gastric infusion.
Several treatments are used for hyperinsulinemic hypoglycemia, depending on
the exact form and severity. Some forms of congenital hyperinsulinism respond to
iazoxide
or
octreotide. Surgical removal of the overactive part of the pancreas is
curative with minimal risk when hyperinsulinism is focal or due to a benign
insulin-producing tumor of the pancreas. When congenital hyperinsulinism is
diffuse and refractory to medications, near-total pancreatectomy may be the
treatment of last resort, but in this condition is less consistently effective
and fraught with more complications.
Hypoglycemia due to hormone deficiencies such as hypopituitarism or adrenal
insufficiency usually ceases when the appropriate hormone is replaced.
Hypoglycemia due to dumping syndrome and other post-surgical conditions is
best dealt with by altering diet. Including fat and protein with carbohydrates
may slow digestion and reduce early insulin secretion. Some forms of this
respond to treatment with a
glucosidase inhibitor, which slows
tarch
digestion.
Reactive hypoglycemia with demonstrably low blood glucose levels is most
often a predictable nuisance which can be avoided by consuming fat and protein
with carbohydrates, by adding morning or afternoon snacks, and reducing alcohol
intake.
Idiopathic postprandial syndrome without demonstrably low glucose levels at
the time of symptoms can be more of a management challenge. Many people find
improvement by changing eating patterns (smaller meals, avoiding excessive
sugar, mixed meals rather than carbohydrates by themselves), reducing intake of
stimulants such as
affeine,
or by making lifestyle changes to reduce stress. See the following section of
this article.
Hypoglycemia as American folk medicine Hypoglycemia is also a term of contemporary American
folk medicine which refers to a recurrent state of symptoms of altered mood
and subjective cognitive efficiency, sometimes accompanied by
drenergic
symptoms, but not necessarily by measured low blood
glucose. Symptoms are primarily those of altered mood, behavior, and mental
efficiency. This condition is usually treated by dietary changes which range
from simple to elaborate. Advising people on management of this condition is a
significant "sub-industry" of
alternative medicine. More information about this form of "hypoglycemia",
with far more elaborate dietary recommendations, is available on the internet
and in health food stores. Most of these websites and books describe a
conflation of reactive hypoglycemia and idiopathic postprandial syndrome but do
not recognize a distinction. The value of most of their recommendations is
unproven from a controlled, empirical scientific perspective.
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