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Hypoglycemia in type 1 and type 2 diabetes mellitus


Hypoglycemia is a condition in which there is a decrease in blood sugar. It can progress, leading to brain damage and human death. Most often, seizures occur in patients with type 2 diabetes. To avoid such health problems, you need to know the main causes and initial manifestations of the disorder.

Description of hypoglycemia in type 2 diabetes

Diabetes mellitus is a common disease that can be accompanied by severe and life-threatening complications. It manifests itself in acute or chronic form. One of the options for its complication is hypoglycemia. This condition is characterized by a sharp decrease in blood glucose. The attack develops very quickly, usually within half an hour. Its precursors are the following conditions: hyperhidrosis, hunger, weakness. In some cases, they do not appear, and a person immediately loses consciousness.

It is believed that only patients with type 2 diabetes can suffer from hypoglycemia. However, it is incorrect. Symptoms of the disorder sometimes occur in completely healthy people. For example, a decrease in blood glucose is observed with intense physical exertion or with a diet.

Type 2 diabetes is non-insulin dependent. Therefore, at the initial stages of development, hypoglycemia is easily eliminated by simple physical exertion, diet. In some cases, it is necessary to take medicines whose action is aimed at lowering glucose values. On the other hand, the process associated with decompensation over time provokes a reduction, and then a final cessation of insulin production. Therefore, replacement therapy becomes a vital necessity.

Main reasons

Hypoglycemia in type 2 diabetes occurs due to excessive levels of insulin in the body. The amount of this hormone is produced a little more than is required for the full absorption of glucose.

In the treatment of diabetes, the patient is often prescribed drugs whose pharmacological action is aimed at stimulating the production of insulin. These are safe and highly effective medicines. On the other hand, they can cause hypoglycemia against the background of diabetes. The thing is that with constant "artificial" stimulation, a gradual depletion of the elements responsible for the production of insulin occurs.

Among the main causes of the development of the disorder, doctors distinguish the following:

  1. The use of sulfonylureas in the initial stage of diabetes. When the patient complies with the nutritional plan proposed by the doctor, the body processes glucose better. If, under these conditions, you do not stop taking the medication, the sugar level will continue to decline. Therefore, competent therapy implies either a complete abolition, or a reduction in the dosage of sugar-lowering drugs.
  2. Lack of diet. Taking medications that reduce the amount of glucose in the blood requires a mandatory dietary adjustment. If you eat poorly or skip meals, diabetes will progress.
  3. Excessive physical activity, before which or immediately after it, the patient does not have the opportunity to take glucose.
  4. Alcohol abuse.
  5. Sugar-lowering drugs are excreted by the kidneys. Their incorrect operation can provoke an increase in the concentration of active substances.
  6. Some drugs enhance the effects of sulfonylureas. Therefore, the independent selection of medicines is unacceptable. They can only be prescribed by a doctor, taking into account the interaction of medicines.

Hypoglycemia can cause concomitant ailments that develop against the background of diabetes. For example, damage to the structures of the brain and central nervous system contributes to the violation of a full metabolism.

Consider the causes of hypoglycemia

The main cause of hypoglycemia is an excess of insulin relative to the intake of carbohydrates in the body. This leads to:

  1. Excessive administration of insulin to patients. Often patients with diabetes, just starting insulin therapy, incorrectly calculate the required dose, which leads to a drop in blood glucose. The second common mistake is the introduction of the previous dose of insulin while reducing the amount of food eaten.
  2. Improper intake of sugar-lowering drugs. Sugar-lowering drugs affect the body in two ways. Some improve the absorption of glucose by body tissues, without causing it to decrease (for example, metformin). Others cause an increase in insulin production, therefore, with an overdose, hypoglycemia develops (for example, glibenclamide).

Often, such hypoglycemia occurs in the elderly. They forget if they took the drug, and when it was, they take an extra dose, causing hypoglycemia. In addition, often elderly people have concomitant chronic diseases that slow down the absorption and distribution of the drug in the body, because of which its dose should be reduced.

There are patients who believe that they themselves can adjust the dose of the drug, forgetting that it is impossible to do this without a doctor.

  1. Excessive exercise increases tissue absorption of glucose. This must be considered when administering insulin.
  2. Violation of the technique of administering insulin. For the introduction of various types of insulin, there are parts of the body. For example, insulin injected under the skin of the abdomen is absorbed within 5-15 minutes, and under the skin of the thigh within a few hours. It is also necessary to monitor the serviceability of syringes, syringe pens, glucometers.
  3. Chronic diseases Cardiac, renal, and liver failure violate the mechanisms of action of sugar-lowering drugs and insulin.
  4. Alcohol intoxication leads to severe hypoglycemia. Alcohol blocks the release of glucose from the liver.
  5. 1 trimester pregnancy and lactation.

Symptoms of hypoglycemia

Symptoms of an attack of hypoglycemia in diabetes mellitus appear and grow very quickly. With a lack of glucose, starvation of the brain begins. To activate the defenses, the adrenal glands release a large amount of adrenaline, causing a rapid pulse, sweating, trembling in the body, nausea, dilated pupils, and hunger.

If adrenaline fails to activate glucose production from glycogen stores in the liver, symptoms of brain starvation join. Weakness, blurred vision, dizziness, fear of death, headache appear. There may be aggression, speech impairment, memory loss, in severe cases - convulsions and coma. Often patients in a state of hypoglycemia are mistaken for drunk.

Symptoms of hypoglycemia

In patients with long-term diabetes mellitus, the mechanism of adrenaline release in response to hypoglycemia is disrupted. As a result, such people do not feel its symptoms, often guessing their condition already at the moment of loss of consciousness.

People surrounding a patient suffering from this disease know that unusual behavior, a change in aggression and inadequate inhibition behavior are symptoms that indicate the need for medical intervention. To do this, others must be trained in the rules of first aid.

With hypoglycemia, the patient's skin is wet, muscles are tense, cramps are possible, there is no smell of acetone from the mouth. With a sharp increase in blood glucose, there is also no intense smell of acetone from the mouth, but the patient is relaxed, the skin is dry and pale.

If a glucometer is located next to the patient, you must immediately determine the level of glucose in the blood. It will be the main criterion for first aid, it must also be reported to the ambulance arrived.

How to provide first aid for hypoglycemia?

Every patient with diabetes who receives insulin or drugs that increase the production of insulin by the pancreas should be aware of possible hypoglycemia and be able to provide first aid at the initial stages.

You should always have a glucometer with you, as well as a simple carbohydrate in sufficient quantities. It can be glucose tablets sold in a pharmacy, or sugar cubes, sweet juice or a carbonated drink. Honey in this situation is not the best option, because it does not contain glucose, but fructose, which does not turn into glucose in the liver very quickly.

For stopping mild hypoglycemia 200 ml of juice or 4–5 pieces of refined sugar will suffice. Feeling fast enough will improve. Remember that after mild hypoglycemia, you must also use a longer carbohydrate, which will maintain the level of glucose in the blood in the future. It could be a piece of bread.

If hypoglycemia is accompanied by loss of consciousness, in no case should you put a person in the mouth with food or drink it. The patient should be laid on his side, if there is a cramp, then remove the dentures and make sure that he does not bite his tongue (do not put metal objects like a spoon in your mouth like an ordinary handkerchief.).

If you know that the patient has a kit for first aid for hypoglycemia, use it.

The kit is a syringe with liquid and a vial of 1 mg glucagon. It is necessary to introduce the fluid from the syringe into the vial, dissolve the powder contained in it and inject the resulting solution into the muscle along the front surface of the thigh. After 10 minutes, the patient should feel better, consciousness will be restored. After this, it is necessary to feed the patient food containing carbohydrates.

If there is no first aid kit, or glucagon injection did not help, you should call an ambulance team. Upon her arrival, do not forget to inform about the events held.

The ambulance will begin to inject a 40% glucose solution until consciousness returns. If this turns out to be ineffective, the patient is hospitalized in the intensive care unit.

What is the danger of hypoglycemia?

Hypoglycemia can lead to the following consequences:

  • With frequent recurrence of hypoglycemia, the brain is affected. The patient begins to decline memory, headaches, dizziness appear. Paralysis and strokes are possible.
  • The vessels and nerves are affected. Since hypoglycemia is usually followed by an increase in blood glucose, such jumps adversely affect the state of blood vessels and nerves. Over time, this leads to the development of neuropathy, damage to the kidneys, eyes and legs.
  • In the case of severe hypoglycemia, a coma develops - a condition accompanied by loss of consciousness, respiratory failure, cardiac activity and loss of brain function, which can lead to death.

Causes of hypoglycemia

Hypoglycemia (translated from ancient Greek as “not quite sweet blood”) is a temporary pathological condition of the body in which the level of sugar (glucose) in the blood is low (for patients with diabetes - below 3.3-3.5 mmol / l) . If blood sugar does not return to normal in time, an epileptic seizure, convulsions, loss of consciousness and, finally, severe hypoglycemic coma and death can occur.

The onset of hypoglycemia may also have other causes unrelated to low blood sugar in diabetics. Its appearance can be promoted by: improper nutrition with the abuse of unrefined carbohydrates with a deficiency of fiber and vitamins in food, unusually high physical activity, various diseases, mainly of the endocrine system, hormonal deficiency, alcohol abuse, etc.

The mechanism of formation of blood sugar following. As a result of the intake of carbohydrate-containing products, glucose enters the body, which enters the bloodstream and spreads throughout all cells of the body. In response to glucose intake, the pancreas produces insulin, a hormone that helps cells use glucose as an energy source. In a healthy person, insulin is secreted exactly as much as is necessary for processing the received glucose.

In patients with type 1 diabetes mellitus, the pancreas cannot secrete the right amount of insulin, so they are forced to inject insulin from the outside. The main task of a diabetic is to enter the correct dose of insulin, exactly as much as is necessary for the absorption of glucose received in the body (diabetics consider glucose in bread units - XE).

If more insulin is injected than necessary, then an imbalance occurs in the body - as a result, the liver begins to break down the glycogen reserves contained in it and release glucose into the blood, helping the body cope with the increased level of insulin. If there is enough glycogen in the liver, then hypoglycemia may not occur (or pass almost imperceptibly). In diabetics, as a rule, glycogen stores in the liver are much lower than in healthy people, so the risk of developing hypoglycemia is much higher.

So, the main causes of hypoglycemia are as follows:

  • improper dose of insulin (delivered more than required)
  • skipping meals
  • high physical activity, as a result of which blood sugar decreased,
  • alcohol intake. Strong drinks, especially vodka, temporarily lower blood sugar,
  • taking medications that, when interacting with insulin, further lower blood sugar. For example, some oral hypoglycemic drugs (tablets) can increase the concentration of insulin in the blood. These include Diabines, Prandin, Starlix, DiaBeta, Glinaz, Yanuvia and others.

Symptoms and manifestations of hypoglycemia

Hypoglycemia usually develops suddenly, but in the first 5-10 minutes it is usually mild and quickly eliminated by taking sweets. If glucose does not enter the body, then severe hypoglycemic coma may occur within 20-30 minutes.

There are many symptoms of hypoglycemia and they all manifest individually. The main primary symptoms:

  • general weakness
  • hunger,
  • nausea, vomiting,
  • arrhythmia (tachycardia),
  • sweating (with very low sugar,

Many diabetics, as a rule, are able to recognize the first symptoms of hypoglycemia - this comes with experience. Patients with a short history of diabetes should observe their feelings during hypoglycemia in order to learn how to determine this condition by its first signs.

Hypoglycemia in a dream is rather dangerous. It can be accompanied by nightmares, the patient, as a rule, wakes up on a sheet wet from sweat. Hypoglycemia can pass without awakening the patient, then in the morning he may feel tired, broken and irritable.

How to cure hypoglycemia and quickly increase blood sugar?

In the case of mild hypoglycemia (2.7-3.3 mmol / l), it is necessary to quickly eat something sweet (15-20 g of simple carbohydrate are enough):

  • drink 150 grams of sweet fruit juice,
  • drink warm tea with 1-2 tablespoons of sugar or honey,
  • eat 5-6 cloves of dried apricots or prunes or a banana,
  • eat a few slices of chocolate or candy.

In short, you need to eat any product that contains simple carbohydrates. A sandwich of whole-grain bread or porridge will not work here, since they are complex carbohydrates and are absorbed for a long time in the intestines.

Please note that with hypoglycemia you do not need to immediately eat a lot of sweets (even taking into account the fact that hypoglycemia is often accompanied by severe hunger). Excessive intake of carbohydrates will not only bring sugar back to normal, but will quickly increase it above the required level, in addition it will create a strong jump in glucose in the body, which is very harmful for small vessels.

If the patient is hospitalized, the hypoglycemic coma is usually stopped by the intravenous administration of a 40% glucose solution - this method is more affordable than glucagon injection and also contributes to a quick return to consciousness.

Clinical picture

Symptoms of hypoglycemia in type 2 diabetes can vary depending on the severity of the pathological process. Every person who has already had a disease should be able to recognize them in a timely manner. In the absence of medical care, paralysis of the systems of internal organs can occur.

How to prevent hypoglycemia?

To prevent an attack of hypoglycemia, every diabetic must observe a number of important rules:

- know your dose of insulin, well understand the principles of insulin action and know by heart how to stop hypoglycemia,

- comply with the daily routine, the schedule of insulin injections and food intake,

- constantly monitor blood sugar levels. Modern endocrinologists recommend measuring sugar before meals 4-5 times a day, as well as at bedtime and on an empty stomach,

- make adjustments to the dose of insulin before physical activity - in this case, the dose of insulin should be reduced or, at the same dose, it is necessary to take more carbohydrates,

- control the use of alcohol. Strong alcohol (such as vodka), especially if taken on an empty stomach, lowers blood sugar. Beer sugar boosts. It is recommended for patients with diabetes to minimize the amount of alcohol, but if nevertheless its intake is inevitable, then it should be consumed simultaneously with food or snacks.

Symptoms of "mild" hypoglycemia

Signs of hypoglycemia begin to manifest in a mild form. При этом больной может жаловаться на гипергидроз и тремор конечностей. У некоторых отмечается тахикардия, бледность кожных покровов.This clinical picture is a consequence of the delayed production of pancreatic hormone.

Nutritional deficiency in the central nervous system is accompanied by other signs:

  • irritability,
  • headache,
  • lability of mood
  • visual impairment
  • weakness in the lower limbs,
  • a sharp hunger
  • impotence.

The body constantly needs glucose as one of the sources of energy. It is necessary for the full functioning of the main systems of internal organs. Therefore, the human body reacts quite sharply to a decrease in glucose indicators to the level of 3.3 mmol / l or more.

As you know, sugar stores in the liver in the form of glycogen. For this substance to successfully transform into glucose, the use of contrainsular hormones is required. They are represented by cortisol, adrenaline and glucagon. Hypoglycemic attacks in diabetes are always accompanied by irritability, fear and pallor of the skin. For such symptoms, a sharp release of adrenaline into the blood is responsible. It is also the main cause of hyperhidrosis. Lack of energy in the cells leads to impaired visual function and increased appetite.

Consequences and complications of hypoglycemia

As noted above, every diabetic is faced with hypoglycemia. If it occurs more than twice a week - you need to contact your endocrinologist to adjust the dose of insulin, it is possible that you are putting a large dose somewhere.

Frequent attacks of hypoglycemia negatively affect small vessels - especially the eyes and legs, this can trigger the rapid development of angiopathy.

People who often experience severe hypoglycemic conditions are usually prone to cardiovascular complications and brain damage.

Severe form of pathology

If during the next hypoglycemic attack the body does not receive the necessary portion of glucose, its level drops to the level of 1.7 mmol / L. This is a critical condition, also called coma. In this case, various changes can occur in the patient’s body, and some of them provoke a fatal outcome:

  • loss of consciousness,
  • cramps
  • stroke,
  • increased aggressiveness
  • impaired coordination of movements.

Some patients manage in time to determine a sharp drop in blood sugar and take a pill. Others suddenly lose consciousness, as a result of which they may receive additional injuries. Therefore, patients with diabetes, prone to hypoglycemia, are strictly forbidden to drive vehicles or engage in work on which the life of strangers depends.

Cases of dull symptoms

In some cases, signs of hypoglycemia in type 2 diabetes mellitus can be extremely mild. This is a blunting of symptoms, which usually happens under the influence of the following factors:

  • chronic form of diabetes,
  • frequent bouts of addictive hypoglycemia,
  • consistently low glucose values.

At risk are elderly patients and people taking beta-blockers - drugs to normalize blood pressure and prevent heart attacks.

In some patients, the opposite situation may occur, when the sugar levels are restored, and signs of hypoglycemia persist. This violation is due to a sharp release of adrenaline into the blood amid intensive work of the adrenal glands. To adjust the indicators and stop unpleasant symptoms, you need to consult a profile doctor.

Urgent Care

When a patient with hypoglycemia with type 2 diabetes cannot control his condition, outside help is required. Usually during an attack, his body becomes lethargic and inhibited. A person himself in such a period is not able to eat something sweet or take a pill. Therefore, to stop the attack, it is better to use special gels with glucose, which are applied to the surface of the gums. If the patient is capable of swallowing, he can be given sweet tea or fruit juice.

When the patient lost consciousness on the background of an attack, it should be extremely carefully turned on one side. Insert a wooden stick or any other object into your mouth. This way you can avoid biting your tongue. After this, it is necessary to call a team of medical workers and make an injection of glucose intravenously.

Methods to eliminate exacerbation

There is no specific treatment for hypoglycemia in type 2 diabetes. To stop attacks, modern medicine suggests using the following methods:

  • take 3-4 glucose pills,
  • eat candy
  • a meal rich in simple carbohydrates.

If after 15 minutes no visible improvement is observed, you need to repeat the selected solution. When it is also ineffective, it is recommended to seek medical help.

Recommendations of specialists

According to doctors, in the case of competent and timely therapy for type 2 diabetes, the likelihood of hypoglycemia attacks is negligible. Also, the risk of developing pathology is reduced if the patient uses insulin by the low-dose method.

When the initial symptoms of an attack appear, you should immediately measure blood glucose. This can be done independently with the help of a modern apparatus - a glucometer. Perhaps he will not show the full clinical picture, but he will be able to "warn" of the impending danger. In the case of a drop in sugar indicators of about 0.6 mmol / l compared with the usual results, you need to take measures that were described a little higher.

The consequences of pathology

Not all patients with type 2 diabetes mellitus feel an attack every time. In such cases, changes in behavior are noticed by friends or relatives. Alarms include poor coordination and mood swings. The patient loses consciousness of what is happening around. He cannot answer elementary questions.

When such signs appear in a loved one, you need to call a doctor and try to help him. In case of inaction, a hypoglycemic coma may begin. In this case, the patient faints, convulsions are not excluded. First of all, the brain suffers from a lack of energy. Improper exit from a coma is usually accompanied by a new jump in sugar, which again affects the state of health.


Hypoglycemia in type 2 diabetes is not a dangerous condition if attacks occur early. To this end, doctors recommend:

  • constantly monitor blood glucose,
  • stick to a diet designed for patients with diabetes,
  • try to correctly enter physical activity and snacks into the regime of the day.

Close relatives and friends should be informed about the existing disease, how hypoglycemia manifests itself in type 2 diabetes. They should know how to help if another attack or coma is approaching.