Hypoglycemia

     Hypoglycemia is characterized by a drop in blood glucose to a level where first it causes nervous system symptoms (sweating, palpitations, hunger, trembling, and anxiety), then begins to affect the brain (causing confusion, hallucinations, blurred vision, and sometimes even coma and death). An actual diagnosis of hypoglycemia requires satisfying the "Whipple triad." These three criteria include:

• Documented low glucose levels (less than 40 mg/dL (2.2 mmol/L) often tested along with insulin levels and sometimes with C-Peptide levels)
• Symptoms of hypoglycemia
• Reversal of the symptoms when blood glucose levels are returned to normal.

Types of hypoglycemia:

1. Primary hypoglycemia (fasting hypoglycemia): is caused by various disease in various organs such as:
   • Pancreatic diseases as tumors of β cell of pancreas causing increases insulin secretion.
   • Adrenocortical diseases secreting decreased amount of adrenaline as tumors and that cause decreased glycocogenolysis and gluconeogenesis.
   • Hepatic diseases as tumors and glycogen storage diseases that cause decreased glycocogenolysis and gluconeogenesis.

   2- Reactive hypoglycemia (postprandial hypoglycemia) is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). It is thought to represent a consequence of excessive insulin release triggered by the carbohydrate meal.

There are different kinds of reactive hypoglycemia:

1) Alimentary Hypoglycemia; it occurs in about 15% of people who have had stomach surgery)

2) Pre-diabetes

3) Hormonal Hypoglycemia (due to lack of some hormones; i.e., hypothyroidism) and increased dose of insulin during treatment of DM.

4) Helicobacter pylori-induced gastritis (some reports suggest this bacteria may contribute to the occurrence of reactive hypoglycemia)

5) Congenital enzyme deficiencies (hereditary fructose intolerance due to inhibition of phosphyrlase enzyme that leads to inhibition of glycogenolysis; galactosemia, and leucine sensitivity of childhood that stimulate secretion of insulin.

6) Idiopathic reactive hypoglycemia

7) Late Hypoglycemia: Occult Diabetes; characterized by a delay in early insulin release from pancreatic β cells, resulting in initial exaggeration of hyperglycemia during a glucose tolerance test.

 8) Alcoholic intoxication results in large increase in NADH and diversion of gluconeogenesis intermediates (pyruvate and oxaloacetate) which can cause hypoglycemia.

Treatment of hypoglycemia:

• Eat small meals and snacks about every 3 hours.
• Exercise regularly, eat a variety of foods, including meat, poultry, fish, or non-meat sources of protein, foods such as whole-grain bread, fruits, vegetables, and dairy products.
• Avoid intake of foods high in sugar, especially on an empty stomach, avoid alcohol, caffeine, and highly starchy foods such as white rice, potatoes and corn.

Glycosuria:

It is the presence of glucose in urine

Causes of glycosuria:

1. DM
2. Diabetogenic hormones
3. Renal: due to low renal threshold
4. Gestational glycosuria due to low renal threshold