Hypoglycemic states:
Hypoglycaemia is condition we have low glucose concentration than normal in blood. Noemal glucose around 5mmol/L. this cause by regulation disorder by decrease income of glucose and gluconeogenesis , increase glucose disposal through exercise and hyperinsulinism
It can be :
- Fasting hypoglycaemia
- Insulinoma
- Postprandial hypoglycaemia especially after stomach resections.
What is etiology for hypoglycaemia:
- Nutrition disorders
· This is because of severe fasting and mental anorexia. This cause decrease in substrate offer causing glycogen production and decrease gluconeogenesis.
2 2. Conditions based on decrease glucose production
· Shortage of contra regulatory hormones which are hypothyroidism, renal cortex insufficiency, glucagon defcit and hypothyreosis.
· Serious liver disease cause decrease amount of glycogen and gluconeogenesis
· Alcohol excess in undernourished people or after exercise causing inhibition of gluconeogenesis because substrate for glucose formation is use to metabolise alcohol.
· Enzymopathies.Lack of certain enzyme to synthesis glucose
3. Increase glucose disposal by hyperinsulinemia.
· This can be congenital insulinemia, infant diabetic mothers(due to insulin hypersecretion as a response to hyperglycemia.
· Can also cause by dumping syndrome, where food we eat by pass from stomach to small intestine rapidly causing our intestine cannot digest what we eat.
· Overdose of insulin in diabetic patients.
· Therapy with sulphonylurea derivates. Cause increase insulin secretion.
· Insulinoma, which is tumour of B cells.
Clinical picture:
Hypoglycaemia occur when glucose level below 3.3mmol/L, serious below 2.5mmol/L
1 Adrenergic reaction activation:
· Excessive sweating
· Trembling
· Tachycardia
2 Brain hypoglycaemia
· Fatigue
· Mental confusion, cognitive disorders
· Irritability up to seizure, aggresivity, slurred speech
· Unconsciousness
Therapy:
60ml og 40% glucose oral or intavenous
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