Materiały źródłowe

• #1 Hypoglycemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534841/

  Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. […] The body has inherent counter-regulatory mechanisms to prevent hypoglycemic episodes. These counter-regulatory mechanisms include an interplay of hormones and neural signals to regulate endogenous insulin release, increase hepatic glucose output, and alter peripheral glucose utilization. […] A decrease in insulin production as a response to low serum glucose isn’t the body’s first line of defense against hypoglycemia. For endogenous glucose production to take place, particularly hepatic glycogenolysis, low insulin levels are necessary. […] The previously mentioned counter-regulatory mechanisms may occasionally fail to resolve the hypoglycemia. At this point, further counter-regulatory measures are employed, such as growth hormone and cortisol.

• #1 Hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypoglycemia

  Glucose is the main source of energy for the brain, and a number of mechanisms are in place to prevent hypoglycemia and protect energy supply to the brain. […] The body can adjust insulin production and release, adjust glucose production by the liver, and adjust glucose use by the body. […] When blood sugar levels fall to the low-normal range, the first line of defense against hypoglycemia is decreasing insulin release by the pancreas. […] This drop in insulin allows the liver to increase glycogenolysis. […] Glycogenolysis is the process of glycogen breakdown that results in the production of glucose. […] Decreased insulin also allows for increased gluconeogenesis in the liver and kidneys. […] Gluconeogenesis is the process of glucose production from non-carbohydrate sources, supplied from muscles and fat.

• #1 Hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypoglycemia

  Once blood glucose levels fall out of the normal range, additional protective mechanisms work to prevent hypoglycemia. […] The pancreas is signaled to release glucagon, a hormone that increases glucose production by the liver and kidneys, and increases muscle and fat breakdown to supply gluconeogenesis. […] If increased glucagon does not raise blood sugar levels to normal, the adrenal glands release epinephrine. […] Epinephrine works to also increase gluconeogenesis and glycogenolysis, while also decreasing the use of glucose by organs, protecting the brain’s glucose supply. […] After hypoglycemia has been prolonged, cortisol and growth hormone are released to continue gluconeogenesis and glycogenolysis, while also preventing the use of glucose by other organs. […] The effects of cortisol and growth hormone are far less effective than epinephrine. […] In a state of hypoglycemia, the brain also signals a sense of hunger and drives the person to eat, in an attempt to increase glucose.

• #1 Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/122122-overview

  Hypoglycemic symptoms are related to sympathetic activation and brain dysfunction secondary to decreased levels of glucose. Stimulation of the sympathoadrenal nervous system leads to sweating, palpitations, tremulousness, anxiety, and hunger. […] Reduction in cerebral glucose availability (ie, neuroglycopenia) can manifest as confusion, difficulty with concentration, irritability, hallucinations, focal impairments (eg, hemiplegia), and, eventually, coma and death. […] The adrenergic symptoms often precede the neuroglycopenic symptoms and, thus, provide an early warning system for the patient. […] Studies have shown that the primary stimulus for the release of catecholamines is the absolute level of plasma glucose; the rate of decrease of glucose is less important. […] However, it is important to note that a patient with repeated hypoglycemia can have almost no symptoms (hypoglycemic unawareness).

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. […] Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia. […] The above defense mechanisms are often impaired in patients with diabetes and significant beta-cell failure who lack an initial response to a drop in insulin. This leads to a delay in the secretion of glucose from the liver during hypoglycemia. […] It is believed that the impaired sympathoadrenal response is secondary to repeated episodes of hypoglycemia that reduce the autonomic response to other hypoglycemic events. […] The presumed mechanisms of hypoglycemia unawareness are summarized in Figure 2. […] Hypoglycemia causes physical and psychological morbidity in diabetic patients.

• #1 Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e001194

  In people without diabetes, hypoglycemia is rare since endogenous insulin secretion is inhibited as glucose levels fall below normal. Individuals with diabetes, treated with insulin, sulfonylureas or other insulin secretagogues, are at increased hypoglycemic risk because glucose levels will continue to fall until either insulin boluses or the effect of oral medication are cleared. […] With increased duration of diabetes, in both T1D and advanced T2D, progressive loss of cells prevents paracrine cross-talk between the and cells leading to impaired glucagon release during hypoglycemia. This increases vulnerability to hypoglycemia. Thus, duration of T1D and, in T2D, the duration of insulin treatment are important predictors of hypoglycemic risk. […] In summary, these pathophysiological changes, which both diminish symptomatic responses as well as reduce the ability of the body to resist the glucose-lowering effect of insulin, explain why individuals with T1D or long-standing T2D both are vulnerable to hypoglycemia during treatment.

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  The current classification of hypoglycemic episodes in diabetes includes three levels corresponding to the severity of hypoglycemia. […] Symptoms of hypoglycemia include autonomic symptoms and neuroglycopenic symptoms. […] Risk factors for hypoglycemia can be from therapeutic hyperinsulinemia or failure of defense mechanisms from a drop in plasma glucose concentration. […] Impairment in counter-regulatory responses to hypoglycemia. […] The above defense mechanisms are often impaired in patients with diabetes and significant beta-cell failure who lack an initial response to a drop in insulin. […] It is believed that the impaired sympathoadrenal response is secondary to repeated episodes of hypoglycemia that reduce the autonomic response to other hypoglycemic events. […] Hypoglycemia causes physical and psychological morbidity in diabetic patients.

• #1 Mechanisms of hypoglycemia unawareness and implications in diabetic patients

  https://www.wjgnet.com/1948-9358/full/v6/i7/912.htm

  Hypoglycemia unawareness (HU) is defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms. […] Though the aetiology of HU is multifactorial, possible mechanisms include chronic exposure to low blood glucose, antecedent hypoglycaemia, recurrent severe hypoglycaemia and the failure of counter-regulatory hormones. […] Presently, the major risk factors for the development of HU are duration of the disease and improved metabolic control. […] The severity of HU was associated with longer diabetes duration and with a history of frequent low glycemic levels, whereas aging and the blood glucose decreasing rate using professional continuous glucose monitoring systems (CGMS), which falls from near blood glucose level, were risk of severe HU. […] Aberrant glucose counter-regulation (as a result of a failure in the reduction of insulin production and an increase in glucagon release), and HU (as the result of an attenuated increase in sympathoadrenal activity) are the components of hypoglycemia-associated autonomic failure (HAAF) in diabetics patients.

• #1 Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications

  https://www.mdpi.com/2227-9059/12/2/391

  Hypoglycemia unawareness describes a condition in which autonomic and neuroglycopenic symptoms of hypoglycemia decrease and hence are hardly perceivable. […] The pathophysiological mechanisms are manifold, but mainly concern altered brain glucose sensing, cerebral adaptations, and an impaired hormonal counterregulation with an attenuated release of glucagon, epinephrine, growth hormone, and other hormones, as well as impaired autonomous and neuroglycopenic symptoms. […] The impaired hormonal counterregulatory response to recurrent hypoglycemia can lead to a vicious cycle of frequent and poorly recognized hypoglycemic episodes. […] There is a shift in glycemic threshold to trigger hormonal counterregulation, resulting in hypoglycemia-associated autonomic failure and leading to the clinical syndrome of hypoglycemia unawareness.

• #1 Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications

  https://www.mdpi.com/2227-9059/12/2/391

  It is suggested that hypoglycemia unawareness syndrome is mainly induced by recent antecedent hypoglycemic episodes causing defective glucose counterregulation. […] The absence of symptoms of hypoglycemia reflects the attenuation of the sympathoadrenal response. […] Hypoglycemia unawareness syndrome is commonly observed in individuals with recurrent hypoglycemic episodes disrupting the normal release of counterregulatory hormones, such as glucagon, growth hormone (GH), and epinephrine. […] The blunted hormonal response leads to impaired glucose counterregulation and reduced awareness of hypoglycemia. […] Recurrent hypoglycemic episodes can trigger adaptive responses within the central nervous system. […] Over time, the brain adapts to the lower glucose levels, resetting the threshold for glucose sensing to lower values.

• #1 Mechanisms of hypoglycemia unawareness and implications in diabetic patients

  https://www.wjgnet.com/1948-9358/full/v6/i7/912.htm

  HAAF is most often caused by recent/recurrent iatrogenic hypoglycemia, and indeed HAAF is maintained by recurrent hypoglycemia. […] Previous hypoglycemia leads to a blunted catecholamine response to a following episode of hypoglycemia. […] Hypoglycemia is associated with an elevation in systemic corticosteroids, and this has been proposed to feedback to the hypothalamus contributing to HAAF. […] Preclinical and clinical studies with opioids demonstrated a rise in endogenous opioids during hypoglycemia. […] Although it is well established that recurrent hypoglycemia leads to HU, the mechanism responsible for this are unknown. […] Several studies have identified specific brain regions that exhibit decrease glucose uptake. […] It has been hypothesized that recurrent hypoglycemia leads to HU through an alteration in the glucose transport or metabolism.

• #1 Hypoglycemia and the Central Nervous System | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/hypoglycemia-and-the-central-nervous-system/

  Enhanced glucose metabolism is another potential mechanism. With more efficient glucose metabolism, the brain could maintain energy levels despite lower blood-glucose concentrations. […] Increased glucokinase activity has been hypothesized to play a major role. […] Increased glycogen content following hypoglycemia (termed glycogen supercompensation) may also contribute to HAAF. […] Both animal and human studies have shown glycogen levels to increase above basal levels following hypoglycemia. […] Alterations on potassium channel (KATP) activity and on the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) have been implicated in the pathogenesis of HAAF. […] Taken together, many mechanisms may contribute to HAAF.

• #1 Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hypoglycemia-low-blood-glucose-in-people-with-diabetes-beyond-the-basics

  Hypoglycemia is the medical term for low blood glucose (blood sugar). People with type 1 diabetes who take insulin to manage their blood glucose levels are at risk for getting hypoglycemia. People with type 2 diabetes who take insulin and/or certain other medications (eg, sulfonylureas, meglitinides) can also develop hypoglycemia, although this is generally less common. The frequency of hypoglycemia among people with longstanding type 2 diabetes increases over time, as the body eventually stops making enough insulin. […] Low blood glucose can happen if you: […] Take too much insulin […] Take too much of oral diabetes medications that cause your body to release more insulin (eg, sulfonylureas, meglitinides) […] Do not eat enough food […] Exercise vigorously without eating a snack or decreasing your insulin dose beforehand

• #1 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  Hypoglycemia happens when the level of sugar (glucose) in your blood drops below the range thats healthy for you. Its also called low blood sugar or low blood glucose. Hypoglycemia is common in people with diabetes, especially Type 1 diabetes. […] Low blood sugar often happens due to excess insulin whether your body naturally makes too much or you inject too much synthetic insulin. Other hormonal and metabolic issues can also lead to low blood sugar. […] Hypoglycemia happens when your blood sugar drops below a healthy range. Several factors can contribute to this for people with diabetes. Hypoglycemia can develop if things like food, exercise and diabetes medications are out of balance. […] Common situations that can lead to hypoglycemia for people with diabetes include: Taking too much insulin, the wrong insulin or injecting it into your muscle instead of in your fat tissue.

• #1 Causes and How to Prevent Hypoglycemia (Low Blood Glucose) | American Diabetes Association

  https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose/causes-prevention

  Hypoglycemia (or low blood glucose) is common for people with type 1 diabetes. It also can occur in people with type 2 diabetes taking insulin or certain diabetes medications. […] The average person with type 1 diabetes has low blood glucose levels up to twice a week, and thats only counting episodes with symptoms. If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher. […] Too much insulin or certain diabetes medications is a common cause of low blood glucose. Miscalculating for how many carbs you’ve eating can lead to giving too much insulin, resulting in a low. But there are a few other ways insulin can cause hypoglycemia. […] Physical activity and exercise can lower your blood glucose. Also, more intense physical activity or exercise than usual can make your body more sensitive to insulin and lower your blood glucose levels after you’re done.

• #1 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  However, certain conditions and situations can lead to fasting hypoglycemia in people without diabetes, including: Excessive alcohol consumption: Alcohol prevents your body from forming new glucose cells (gluconeogenesis). […] Adrenal insufficiency causes lower-than-normal cortisol levels. As cortisol (a hormone) helps regulate your blood sugar by increasing it, having low levels of cortisol can lead to hypoglycemia episodes. […] Non-islet cell tumor hypoglycemia (NICTH): This is a rare but serious syndrome in which a tumor releases excess insulin-like growth factor 2 (IGF-2). This is a hormone that has similar effects as insulin. Excess IGF-2 causes hypoglycemia. […] An insulinoma is a rare tumor in your pancreas that produces excess insulin. It leads to hypoglycemia episodes most commonly in the early morning.

• #1 Hypoglycaemia (low blood sugar) – causes, signs, symptoms and management | healthdirect

  https://www.healthdirect.gov.au/hypoglycaemia-low-blood-sugar

  Hypoglycaemia (hypo) is when you have too little glucose (sugar) in your blood. A blood glucose level lower than 4 mmol/L is considered hypoglycaemia. […] Hypoglycaemia is most common in people with diabetes who take insulin or some oral diabetes medicines. […] If you have diabetes, hypoglycaemia can happen if there is a mismatch between factors that lower your blood glucose levels (for example, insulin or exercise) and factors that increase it (for example, food). […] Situations where this might happen include: taking too much insulin or too much of your glucose lowering medicine, being more active or exercising more than usual, delaying or missing a meal or snack, or not eating enough carbohydrates, drinking alcohol, especially without eating, vomiting or diarrhoea, breastfeeding. […] Sometimes, there is no clear reason for why you have hypoglycaemia.

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Hypoglycemia is defined as a condition where plasma glucose concentration is low, which may expose patients to possible harm. This is common amongst persons who have type 1 diabetes, with an annual incidence of severe hypoglycemia ranging from 3.3% to 13.5%. […] While patients treated with insulin or insulin secretagogues (sulfonylureas and meglitinides) are generally at higher risk, severe hypoglycemia is less common in patients with type 2 diabetes. […] Historically, lowering the glycemic targets in diabetes in order to prevent microvascular and macrovascular complications has led to greater risk of hypoglycemia. […] In patients with diabetes, it is not easy to determine a specific plasma glucose concentration that is diagnostic of hypoglycemia, because the threshold for the appearance of hypoglycemia symptoms varies among patients.

• #1 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  Reactive hypoglycemia happens when you experience low blood sugar after a meal. It typically occurs about two to four hours after a meal. […] Researchers dont yet know the exact cause. But they think it happens due to a sudden spike and then fall in blood sugar after eating certain foods, especially simple carbohydrate foods like white rice, potatoes, white bread, cake and pastries. […] Bariatric surgery can also result in reactive hypoglycemia. After certain types of bariatric surgery, such as gastric bypass surgery, your body absorbs sugars very quickly, which stimulates excess insulin production. This can then cause hypoglycemia. […] For the majority of people without diabetes, not eating food for a long time (fasting) doesnt lead to hypoglycemia. This is because your body uses hormones and stored glucose to manage your blood sugar.

• #1 Reactive hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Reactive_hypoglycemia

  Reactive hypoglycemia, postprandial hypoglycemia, or sugar crash is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours after a high carbohydrate meal in people with and without diabetes. […] The condition is related to homeostatic systems used by the body to control the blood sugar level. […] The alleged mechanism for the feeling of a crash is correlated with an abnormally rapid rise in blood glucose after eating. This normally leads to insulin secretion (known as an insulin spike), which in turn initiates rapid glucose uptake by tissues, either storing it as glycogen or fat, or using it for energy production. The consequent fall in blood glucose is indicated as the reason for the „sugar crash”. […] Another cause might be hysteresis effect of insulin action, i.e., the effect of insulin is still prominent even if both plasma glucose and insulin levels were already low, causing a plasma glucose level eventually much lower than the baseline level.

• #1 Hypoglycemia Without Diabetes: What Does It Mean?

  https://www.healthline.com/health/hypoglycemia-without-diabetes

  Although rare, a tumor of the pancreas can cause the body to make too much insulin or an insulin-like substance, resulting in hypoglycemia. Hormone deficiencies can also cause hypoglycemia because hormones control blood sugar levels. […] Several factors can cause hypoglycemia, even if you don’t have diabetes. Causes of hypoglycemia without diabetes include drinking alcohol, taking certain medications, kidney problems, problems with your adrenal or pituitary gland, pancreatic tumors, severe infections, liver disease, immune system producing antibodies, or anorexia nervosa. […] Hypoglycemia without diabetes can occur in both children and adults. […] A doctor needs to identify the cause of your hypoglycemia to determine the right treatment for you. […] Unmanaged hypoglycemia can cause long-term health problems. Your body needs glucose to function. Without the right level of glucose, your body will have difficulty performing its normal functions.

• #1 Hypoglycemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia

  Insulinoma is a rare neuroendocrine tumor of insulin-producing beta cells. It typically causes fasting hypoglycemia although postprandial hypoglycemia can also occur. […] Hypoglycemia that occurs after bariatric surgery is a hyperinsulinemic hypoglycemia that develops sometimes years after bariatric (especially roux-en-Y gastric bypass) surgery. […] NIPHS is a rare condition in which patients have hyperinsulinemic hypoglycemia with negative localizing imaging studies and no history of bariatric surgery. […] Insulin autoimmune hypoglycemia is a condition that most often occurs in patients with other autoimmune conditions such as systemic lupus erythematosus. […] Non-insulin-mediated causes include adrenal insufficiency and use of medications other than insulin or a sulfonylurea. […] Non-islet cell tumor hypoglycemia is a rare condition caused by production of large amounts of aberrant forms of insulin-like growth factor 2 (IGF-2) by a tumor.

• #1 Hypoglycemia in Children | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypoglycemia-children

  Other causes of hypoglycemia in children include deficiency of growth hormone and/or cortisol, and genetic defects in the liver affecting its ability to release glucose. […] Hypoglycemia can also be a consequence of surgeries that alter the gastrointestinal track, such as surgery to prevent reflux known as fundoplication. […] This form of hypoglycemia is known as postprandial hypoglycemia or late dumping syndrome. […] In addition, hypoglycemia may also occur as a result of accidental or intentional ingestions, taking certain medications or consuming alcohol.

• #1 Hypoglycemia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_pathophysiology

  Epinephrine response to hypoglycemia becomes suppressed in many patients. This happens when blood glucose level falls between 65-70 mmHg. A suppressed epinephrine response causes defective glucose counter-regulation and hypoglycemia unawareness occurs. […] The pathophysiology of hypoglycemia mainly relies on the failure of physiological defense mechanisms and hormones such as insulin, glucagon and epinephrine to correct hypoglycemia. […] Insulinoma is a rare benign pancreatic neuroendocrine tumor that arises from islet cells. It is thought that insulinoma is mediated by a mutation in mTOR/P70S6K signaling pathway. […] The progression to hypoglycemia is actually because of decreased glucose synthesis rather than increased use due to the direct effect of insulin on the liver. […] Non-islet-cell tumors are large tumors of mesenchymal or epithelial cell types originate from the pancreas. NICTH appears to be increased glucose utilization and inhibition of glucose release from the liver. This happens as a result of tumor production of incompletely processed IGF-2. […] The net result is continued glucose utilization by skeletal muscle and inhibition of glucose release, glycogenolysis, and gluconeogenesis in the liver.

• #1 Hypoglycemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia

  Factitious hypoglycemia is true hypoglycemia induced by nontherapeutic administration of sulfonylureas or insulin. […] To differentiate between insulin-mediated and non-insulin-mediated hypoglycemia and to determine the etiology of hypoglycemia, a 48- or 72-hour fast may be required. […] A prolonged fast can trigger hypoglycemia in a person who has a history of fasting hypoglycemia. […] The efficacy of glucagon depends on the size of hepatic glycogen stores; glucagon has little effect on plasma glucose in patients who have been fasting or who are hypoglycemic for long periods. […] Hyperglycemia may follow hypoglycemia either because too much sugar was ingested or because hypoglycemia caused a surge in counter-regulatory hormones (glucagon, epinephrine, cortisol, growth hormone).

• #1 Somogyi Effect: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11443-somogyi-effect

  The Somogyi (so-MOH-gyee) effect happens when a low blood sugar (hypoglycemia) episode overnight leads to high blood sugar (hyperglycemia) in the morning due to a surge of hormones. It can affect people with diabetes who take insulin. […] The theory of the Somogyi effect states that if your blood sugar drops too low in the middle of the night while you’re sleeping due to injected insulin, your body will release hormones in an attempt to rescue you from the low blood sugar. […] These hormones include: Adrenaline, Corticosteroids, Growth hormone, Glucagon. […] They increase your blood sugar by triggering your liver to release stored glucose in larger amounts than usual. This glucose release increases your blood sugar (glucose). If you have diabetes, your pancreas doesn’t produce any or enough insulin to correct the increase. This means your blood sugar remains high. […] If you don’t have diabetes, your body naturally regulates your blood sugar to keep it in range. This is why the Somogyi effect doesn’t affect people who don’t have diabetes.

• #1 Hypoglycemia and Brain: The Effect of Energy Loss on Neurons | IntechOpen

  https://www.intechopen.com/chapters/81593

  Neuronal death occurs after a period of approximately 15 minutes of inactivity. Repeated episodes of hypoglycemia cause irreversible damage, causing the irreversible cognitive deficit, which correlates to various brain structures, the most sensitive to the damage being the cortex, hippocampus and striatum. […] Excitotoxicity refers to the ability of some amino acids (glutamate) to cause neurodegeneration secondary to prolonged stimulation of postsynaptic receptors. […] The mechanism of damage is as follows: extracellular concentrations of glutamate are regulated by reuptake into the synaptic space by specific transporters located in astrocytes and neurons. […] The production of ROS by NOS and NOX induces DNA damage and consequent activation of PARP-1, which consumes the NAD+ which is required for glucose oxidation through the glycolytic pathway, as well as activating programmed cell death pathways such as calpain.

• #1 Hypoglycemia and Brain: The Effect of Energy Loss on Neurons | IntechOpen

  https://www.intechopen.com/chapters/81593

  Apoptosis is a type of cell death that depends on energy and various cellular functions in which the membrane retains its integrity. […] The physician must be able to identify the clinical signs of hypoglycemia since the first organ to suffer the consequences is the brain, and we must avoid unfavorable outcomes, such as neuronal damage and death (neuroglycopenia). […] When the arterial glucose supply is interrupted and the protective mechanisms are overcome, the previously described alterations occur at the level of ionic gradients, neurotransmitter release and reuptake, and oxidative stress, culminating in mitochondrial and cellular dysfunction. […] There are usually very effective endogenous mechanisms to prevent neuroglycopenia. […] A very particular characteristic of the brain is the high consumption of glucose and oxygen, with a high tolerance to periods of transient deficit of these substrates, however, when glucose decreases below 20 mg/dl, there is a cessation of brain electrical activity (hypoglycemic coma). […] Glucose is the main fuel for the appropriate functioning of the central nervous system. […] We emphasize that neurons and astrocytes interact to form common metabolic cooperation generating a neuroprotective effect to avoid hypoglycemic coma or a major brain injury that leads to cellular death.

• #1

  https://link.springer.com/article/10.1007/s00125-020-05369-0

  This review also highlights how hypoglycaemia, as an oxidative stressor, may also exacerbate chronic hyperglycaemia-induced increases in oxidative stress and inflammation, leading to damage to vulnerable brain regions (and other end organs) and accelerating cognitive decline. […] It is proposed that prior glycaemic control, hypoglycaemia and the degree of rebound hyperglycaemia interact synergistically to accelerate oxidative stress and inflammation, which may explain why increased glycaemic variability is now increasingly considered a risk factor for the complications of diabetes. […] We also recognise that, in response to recurrent hypoglycaemia, these specialised glucose-sensing cells adapt, leading (through mechanisms still not entirely worked out) to a clinical syndrome called impaired awareness of hypoglycaemia.

• #1 Hypoglycemia and the Central Nervous System | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/hypoglycemia-and-the-central-nervous-system/

  Hypoglycemia is not limited to patients with type 1 diabetes, but frequently occurs in patients with type 2 diabetes as well. As the rate-limiting step for insulin therapy in diabetes, hypoglycemia precludes the maintenance of long-term euglycemia and the long-term benefits associated with tight glucose control. […] Recognizing the impact of hypoglycemia and the development of novel therapies aimed at reducing iatrogenic hypoglycemia are all vital to improve blood sugar management and improve the lives of people with diabetes. […] The exact mechanisms for the shift in the glycemic threshold are not fully understood, but clinical and basic science research has begun to discover critical adaptations within the CNS that contribute to HAAF. Several possibilities have been investigated, including increased brain glucose transport, enhanced glucose metabolism, glycogen supercompensation, and altered neuronal activity. […] Although some studies have shown that glucose transport to the brain may be increased after prolonged hypoglycemia, studies investigating individuals with HAAF and patients with type 1 diabetes found no change in global blood-brain glucose transport after antecedent hypoglycemia.

• #1 Low Blood Glucose (Hypoglycemia) | ADA

  https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose

  Low blood glucose is when your levels fall below 70 mg/dL […] It’s important to treat low blood glucose levels as soon as possible, as they can quickly become dangerous […] Severe low blood glucose is an emergency and will require help from others to treat it […] Low blood glucose, sometimes just called a low, is when your blood glucose levels have fallen low enough that you need to take action to bring them back to your target range. This is usually when your blood glucose is less than 70 mg/dL […] When low blood glucose isn’t treated and you need someone to help you treat it, it’s considered severe hypoglycemia. […] During a severe hypoglycemia incident, you may lose consciousness or be unable to eat or drink on your own. In these events, you will need specialized treatment called glucagon.

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8696639/

  In systematic follow-up of patients over 18 years from the DCCT/EDIC, no significant reduction in long-term cognitive function was demonstrated in patients with type 1 diabetes. […] Concern about hypoglycemia is a barrier to diabetes treatment and control, while patients experiencing recurrent episodes of hypoglycemia are also at risk of depression and anxiety. […] In a meta-analysis of more than 900000 patients, a 2-fold increase in the risk of cardiovascular morbidity was observed amongst patients with type 2 diabetes and severe hypoglycemia. […] In more severe cases, hypoglycemia is liable to cause mortality, responsible for 4%-10% of mortality in patients with type 1 diabetes. […] Hypoglycemia in diabetes is associated with increased morbidity and constitutes a barrier to glycemic control.

• #1 Mechanisms of hypoglycemia unawareness and implications in diabetic patients

  https://www.wjgnet.com/1948-9358/full/v6/i7/912.htm

  Neuronal communication relies on the release of classical neurotransmitters, such as Gamma-Aminobutyric Acid (GABA), a potent inhibitory neurotransmitter. […] The psychological consequences of HU include subsequent fear to hypoglycemia, and secondary poor treatment compliance, increased anxiety and decreased levels of satisfaction and happiness.

• #1 Hypoglycemic and pregnant: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/321734

  When someone is pregnant, they may experience hypoglycemia, or low blood sugar, due to changes in how their body regulates and metabolizes glucose. […] People with diabetes are especially vulnerable to hypoglycemia when pregnant, particularly those with type 1 diabetes. […] Insulin is a hormone that helps to control the bodys blood sugar levels. During pregnancy, a persons body requires more insulin because the placenta produces extra blood sugar. […] This, along with hormonal changes during pregnancy, can make it difficult for a persons body to regulate glucose. […] When the body cannot produce enough insulin, a pregnant person who did not previously have diabetes may develop gestational diabetes. […] People also tend to become more insulin resistant as their pregnancy continues, which means that the body responds less well to insulin.

• #1 Hypoglycemic and pregnant: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/321734

  When someone does not eat enough carbohydrates or takes too much insulin, they may develop dangerously low blood sugar. […] Mild hypoglycemia may not harm a developing baby. […] However, regular hypoglycemia during pregnancy may harm a developing baby. […] People who have severe hypoglycemia may need hospitalization or monitoring. […] Whatever the cause of hypoglycemia during pregnancy, careful monitoring of the parent and baby can reduce the risk of serious complications.

• #1 Neonatal hypoglycaemia | BMJ Medicine

  https://bmjmedicine.bmj.com/content/3/1/e000544

  Low blood concentrations of glucose (hypoglycaemia) soon after birth are common because of the delayed metabolic transition from maternal to endogenous neonatal sources of glucose. […] Here, the current understanding of the pathophysiology of neonatal hypoglycaemia and recent evidence regarding its diagnosis, management, and outcomes are reviewed. […] Although the pathophysiology of this common problem is beginning to be understood, high certainty evidence on which to base clinical decisions is scarce. […] The physiological mechanisms underlying impairments in metabolic transition are not fully understood. […] The main metabolic consequence of a failure to adequately suppress secretion of insulin after birth as blood concentrations of glucose fall is reduced hepatic glucose output and impaired ketogenesis.

• #1 Neonatal Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/802334-overview

  A prospective cohort study by Hoermann et al found that in neonates in the report who were at risk for hypoglycemia, increased umbilical cord blood concentrations of catecholamine and metanephrine showed a correlation with the number of episodes of postnatal hypoglycemia. […] These findings were consistent with an animal model that pointed to an association between fetal catecholamines and neonatal beta-cell physiology, and that indicated that perinatal stress or growth restriction is associated with subsequent neonatal hyperinsulinemic hypoglycemia. […] Congenital hyperinsulinism is most commonly associated with an abnormality of beta-cell regulation throughout the pancreas. […] Genetic defects have been delineated and now replace the older terms, such as nesidioblastosis, leucine-sensitive hypoglycemia, PHHI, and islet dysregulation syndrome. […] These defects are in the sulfonylurea receptor (SUR) and the beta-cell potassium adenosine triphosphate (ATP) channel gene located on the short arm of chromosome 11.

• #1 Hypoglycemia and Low Blood Sugar | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hypoglycemia-and-low-blood-sugar

  Hypoglycemia is the state of having a blood glucose level that is too low to effectively fuel the body’s cells. […] The vast majority of episodes of hypoglycemia in children and adolescents occur when a child with diabetes takes too much insulin, eats too little, or exercises strenuously or for a prolonged period of time. […] For young children who do not have diabetes, hypoglycemia may be caused by: Single episodes: Stomach flu or another illness that may cause them to not eat enough, Fasting for a prolonged period of time, Prolonged strenuous exercise and lack of food. […] Recurrent episodes: Accelerated starvation, also known as “ketotic hypoglycemia,” a tendency for children without diabetes, or any other known cause of hypoglycemia, to experience repeated hypoglycemic episodes, Medications your child may be taking, A congenital (present at birth) error in metabolism or unusual disorder such as hypopituitarism or hyperinsulinism.

• #1 Hypoglycemia in Children | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypoglycemia-children

  Low blood sugar or as it is known medically, hypoglycemia refers to blood concentration of glucose (sugar) that is too low to fuel the brain and the body. […] Hypoglycemia results from an imbalance between how much glucose is in the blood and how much glucose the body uses and needs. […] When these mechanisms fail, a child can become hypoglycemic. […] Glucose levels are tightly regulated by hormones that control the activation of these mechanisms. The most important hormone for glucose regulation is insulin. So, when not enough insulin is produced (like in diabetes) blood sugar levels are high (hyperglycemia) and conversely, when too much insulin is produced, blood sugar levels are low (hypoglycemia). […] In children, the most common medical condition that causes hypoglycemia is hyperinsulinism (HI). In hyperinsulinism, the beta cells of the pancreas secrete too much insulin, which results in hypoglycemia.

• #1 Hypoglycemia in Diabetic Kids | Children’s Healthcare of Atlanta

  https://www.choa.org/parent-resources/diabetes/hypoglycemia-in-children

  When the body has too much insulin, cells absorb a greater amount of sugar from the blood, so blood glucose levels fall. […] Common triggers that may cause this buildup of insulin and lead to hypoglycemia include: Too much diabetes medication, Excessive exercise, Not eating enough food to balance out insulin levels, Skipping meals and snacks. […] Low blood sugar, or hypoglycemia, comes on fast and needs to be treated right away. […] In general, a blood sugar level below 70 is considered low. […] For a child with diabetes, any blood sugar level below their target range might be considered hypoglycemia. […] If early signs of hypoglycemia go untreated, your child may experience more severe problems like fainting or passing out, seizures. […] Careful observation and a bit of preparation can go a long way in preventing hypoglycemia. […] The more aware you are of how your child’s body responds in different situations after exercise, when they’re tired or miss a meal, the better equipped you’ll be to take proactive steps to regulate their blood sugar levels.

• #1 Hypoglycemia Without Diabetes: What Does It Mean?

  https://www.healthline.com/health/hypoglycemia-without-diabetes

  People without diabetes can get hypoglycemia, or low blood sugar. This can happen if you take certain medications, have a severe infection, or have other serious issues affecting your organs. […] Hypoglycemia is a condition that occurs when the sugar levels (glucose) in your blood are too low. […] Hypoglycemia can happen in people with diabetes if the body produces too much insulin, which is a hormone that breaks down sugar so that you can use it for energy. […] Low blood sugar means your body doesn’t have enough energy to properly function or carry out its activities. […] Nondiabetic hypoglycemia can result from using certain medications, consuming alcohol in excess, skipping meals, or an underlying health condition. […] On the other hand, ongoing problems with nondiabetic hypoglycemia (not related to food intake) might indicate a decrease in insulin production. This may be related to issues with your metabolism, hormone levels, or organs (kidneys, liver, or pancreas).

• #1 Postprandial hypoglycaemia in adults: pathogenesis, diagnosis and management – Sulaiman – Journal of Laboratory and Precision Medicine

  https://jlpm.amegroups.org/article/view/6042/html

  Following surgery, rapid transition of food to small intestine causes early and higher glycaemic peak and increased GLP-1 secretion, triggering larger insulin synthesis, leading to a rapid drop in blood glucose, with a nadir in 90 to 180 minutes after meals. […] A blunted glucagon response to insulin-induced hypoglycaemia is well documented in patients post-RYGB compared to the same patients before surgery. […] Insulinoma is a rare tumour which causes endogenous hyperinsulinism and typically presents as fasting hypoglycaemia, though occasionally patients develop hypoglycaemia exclusively after meals. […] This rare disorder in adults is characterised by endogenous hyperinsulinemia and diffuse nesidioblastosis. […] Its aetiology is unknown. […] Patients usually show sensitivity to specific proteins in the meal and develop postprandial hyperinsulinemic hypoglycaemia.

• #1 Hypoglycemia Test, Treatment, Causes & Definition

  https://www.emedicinehealth.com/low_blood_sugar_hypoglycemia/article_em.htm

  Hypoglycemia (low blood sugar) is a commonly perceived problem. In actuality, while some or many of the symptoms may be present, it is rarely confirmed or documented. […] The presence of true, documented hypoglycemia in the absence of diabetes treatment must be evaluated comprehensively by an endocrinologist. Hypoglycemia most often affects those at the extremes of age, such as infants and the elderly, but may happen at any age. Generally, hypoglycemia is defined as a serum glucose level (the amount of sugar or glucose in your blood) below 70 mg/dL. […] As a medical problem, hypoglycemia is diagnosed by the presence of three key features (known as Whipple’s triad). Whipple’s triad is: symptoms consistent with hypoglycemia, a low plasma glucose concentration, and relief of symptoms after the plasma glucose level is raised.

• #1 Hypoglycemia – Harvard Health

  https://www.health.harvard.edu/a_to_z/hypoglycemia-a-to-z

  Hypoglycemia is an abnormally low level of blood sugar (blood glucose). Hypoglycemia triggers the release of body hormones, such as epinephrine (adrenaline) and norepinephrine (noradrenaline), which serve to raise the low sugar level. […] Hypoglycemia occurs because of too high a dose of insulin or one of the sulfonylureas (glyburide, glipizide and others), or a change in diet or exercise without adjusting glucose-lowering medications. […] Hypoglycemia can occur, although rarely, in people who do not have diabetes. When it does occur outside of diabetes, hypoglycemia can be caused by a variety of medical problems. […] A pancreatic tumor, called an insulinoma, that abnormally secretes insulin […] If an insulinoma is suspected, the doctor may order a supervised 48-hour fast. During that period, blood levels of glucose and insulin will be measured when symptoms occur. A blood glucose level of less than 60 milligrams per deciliter at the time of symptoms and with a measurable level of insulin strongly suggests the person has an insulinoma. […] An insulinoma is treated with surgery to remove the tumor. Hypoglycemia caused by problems with the adrenal or pituitary glands is treated by replacing the missing hormones with medication.

• #1 Postprandial hypoglycaemia in adults: pathogenesis, diagnosis and management – Sulaiman – Journal of Laboratory and Precision Medicine

  https://jlpm.amegroups.org/article/view/6042/html

  Postprandial hypoglycaemia (PPH) develops due to the dysregulated insulin release from pancreatic -cells in the presence of low blood glucose levels. […] PPH develops when insulin secretion fails to suppress, in response to falling blood glucose concentrations and normal counter-regulatory response of glucagon and epinephrine is blunted. Excessive insulin suppresses glycogenolysis, gluconeogenesis. Therefore, hypoglycaemia results from reduced glucose production rather than its increased utilisation. […] The diagnosis of PPH may prove challenging, and the establishment of its underlying aetiology often requires extensive investigations. This includes measurement of blood insulin, proinsulin, C-peptide, free fatty acids, ketones and a wide range of imaging studies. […] PPH is a well-known late complication of upper gastrointestinal surgery.

• #2 Low Blood Glucose (Hypoglycemia) | ADA

  https://diabetes.org/living-with-diabetes/hypoglycemia-low-blood-glucose

  Low blood glucose is when your levels fall below 70 mg/dL […] It’s important to treat low blood glucose levels as soon as possible, as they can quickly become dangerous […] Severe low blood glucose is an emergency and will require help from others to treat it […] Low blood glucose, sometimes just called a low, is when your blood glucose levels have fallen low enough that you need to take action to bring them back to your target range. This is usually when your blood glucose is less than 70 mg/dL […] When low blood glucose isn’t treated and you need someone to help you treat it, it’s considered severe hypoglycemia. […] During a severe hypoglycemia incident, you may lose consciousness or be unable to eat or drink on your own. In these events, you will need specialized treatment called glucagon.

• #2 Hypoglycemia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_pathophysiology

  The pathophysiology of hypoglycemia depends on the failure of physiological defense mechanisms and hormones such as insulin, glucagon, and epinephrine to correct hypoglycemia. […] The most important and the first mechanism to counter-regulate hypoglycemia is the ability to suppress insulin release. This happens early when blood glucose level is between 80-85 mmHg. This can not occur in patients with absolute beta-cell failure, type 1 diabetes mellitus, and long-standing type 2 diabetes. High insulin levels inhibit hepatic glycogenolysis causing more hypoglycemia. […] Hypoglycemia stimulates secretion of glucagon. This happens when blood glucose level falls between 65-70 mmHg. Failure to secrete glucagon may be the result of beta-cell failure and high insulin level that inhibits glucagon secretion.

• #2 Severe Hypoglycemia | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/severe-hypoglycemia

  Cortisol, catecholamines and glucagon are hormones that work hand-in-hand with insulin and other hormones in your body to control glucose levels in the blood. Made in the pancreas, glucagon helps to raise blood glucose levels if they are low, and insulin helps to lower blood glucose levels if they are high. […] Normally, glucagon begins to act when blood glucose levels are low. It causes the liver to change glycogen (stored glucose) to glucose. This glucose then travels to the bloodstream so the cells can use it for energy. Glucagon also stops the liver from taking in and storing glucose. As a result, more glucose stays in the blood. In addition, glucagon helps the body make glucose from other sources, such as amino acids. This will also add more glucose to the blood. […] Severe hypoglycemia can occur in people with diabetes who are taking insulin and certain diabetes medications, or changes in overall health.

• #2 Hypoglycemia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_pathophysiology

  Epinephrine response to hypoglycemia becomes suppressed in many patients. This happens when blood glucose level falls between 65-70 mmHg. A suppressed epinephrine response causes defective glucose counter-regulation and hypoglycemia unawareness occurs. […] The pathophysiology of hypoglycemia mainly relies on the failure of physiological defense mechanisms and hormones such as insulin, glucagon and epinephrine to correct hypoglycemia. […] Insulinoma is a rare benign pancreatic neuroendocrine tumor that arises from islet cells. It is thought that insulinoma is mediated by a mutation in mTOR/P70S6K signaling pathway. […] The progression to hypoglycemia is actually because of decreased glucose synthesis rather than increased use due to the direct effect of insulin on the liver. […] Non-islet-cell tumors are large tumors of mesenchymal or epithelial cell types originate from the pancreas. NICTH appears to be increased glucose utilization and inhibition of glucose release from the liver. This happens as a result of tumor production of incompletely processed IGF-2. […] The net result is continued glucose utilization by skeletal muscle and inhibition of glucose release, glycogenolysis, and gluconeogenesis in the liver.

• #2 Hypoglycemia in Pancreatic Disease | Pancreapedia

  https://pancreapedia.org/reviews/hypoglycemia-in-pancreatic-disease

  Glucagon deficiency due to defective or absent alpha cells may contribute significantly to the risk of hypoglycemia. This is frequently encountered in persons with post-pancreatectomy diabetes. […] In both longstanding type 1 or 2 diabetes and post-pancreatectomy diabetes, the adrenergic responses to hypoglycemia may also be reduced. The precise mechanisms of this attenuated sympathoadrenal response are not known. […] Hypoglycemia is a common and important problem in both patients who are diabetic due to an underlying pancreatic disorder and in non-diabetic patients with a hyperinsulinemic hypoglycemia due to a primary pancreatic disorder.

• #2 Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/122122-overview

  The threshold at which a patient feels the hypoglycemic symptoms decreases with repeated episodes of hypoglycemia. […] A study by Zhong et al indicated that in patients with type 2 diabetes mellitus, a proximal hemoglobin A1c (HbA1c) level above or below the reference level of 7.0% increases the risk of a first incidence of hypoglycemia requiring hospitalization (HH). […] The investigators found that when the proximal HbA1c level ranges between 4.0% and 6.5%, every 0.5% level increase reduces the first HH risk, while for patients with a proximal HbA1c level of 8.0-11.5%, the risk of first HH rises with each 0.5% increase in HbA1c.

• #2 Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications

  https://www.mdpi.com/2227-9059/12/2/391

  Hormonal dysregulation has been identified as a significant factor contributing to the development of hypoglycemia unawareness syndrome. […] In individuals with T1D or prolonged type 2 diabetes (T2D), unregulated insulin release from subcutaneous depots or the sustained effects of sulfonylureas can result in elevated systemic insulin levels during hypoglycemia. […] The relative insulin excess increases glucose uptake and suppresses glucose production in the liver, despite the development of hypoglycemia. […] The concept of hypoglycemia unawareness also includes that recent antecedent hypoglycemic episodes cause a defective counterregulation by reducing epinephrine levels. […] Physiologically, in response to hypoglycemia, plasma levels of epinephrine increase. […] After recent antecedent hypoglycemia, epinephrine levels are significantly reduced.

• #2 Hypoglycemia and the Central Nervous System | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/hypoglycemia-and-the-central-nervous-system/

  Hypoglycemia is not limited to patients with type 1 diabetes, but frequently occurs in patients with type 2 diabetes as well. As the rate-limiting step for insulin therapy in diabetes, hypoglycemia precludes the maintenance of long-term euglycemia and the long-term benefits associated with tight glucose control. […] Recognizing the impact of hypoglycemia and the development of novel therapies aimed at reducing iatrogenic hypoglycemia are all vital to improve blood sugar management and improve the lives of people with diabetes. […] The exact mechanisms for the shift in the glycemic threshold are not fully understood, but clinical and basic science research has begun to discover critical adaptations within the CNS that contribute to HAAF. Several possibilities have been investigated, including increased brain glucose transport, enhanced glucose metabolism, glycogen supercompensation, and altered neuronal activity. […] Although some studies have shown that glucose transport to the brain may be increased after prolonged hypoglycemia, studies investigating individuals with HAAF and patients with type 1 diabetes found no change in global blood-brain glucose transport after antecedent hypoglycemia.

• #2 Mechanisms of hypoglycemia unawareness and implications in diabetic patients

  https://www.wjgnet.com/1948-9358/full/v6/i7/912.htm

  HAAF is most often caused by recent/recurrent iatrogenic hypoglycemia, and indeed HAAF is maintained by recurrent hypoglycemia. […] Previous hypoglycemia leads to a blunted catecholamine response to a following episode of hypoglycemia. […] Hypoglycemia is associated with an elevation in systemic corticosteroids, and this has been proposed to feedback to the hypothalamus contributing to HAAF. […] Preclinical and clinical studies with opioids demonstrated a rise in endogenous opioids during hypoglycemia. […] Although it is well established that recurrent hypoglycemia leads to HU, the mechanism responsible for this are unknown. […] Several studies have identified specific brain regions that exhibit decrease glucose uptake. […] It has been hypothesized that recurrent hypoglycemia leads to HU through an alteration in the glucose transport or metabolism.

• #2 Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hypoglycemia-low-blood-glucose-in-people-with-diabetes-beyond-the-basics

  Hypoglycemia is the medical term for low blood glucose (blood sugar). People with type 1 diabetes who take insulin to manage their blood glucose levels are at risk for getting hypoglycemia. People with type 2 diabetes who take insulin and/or certain other medications (eg, sulfonylureas, meglitinides) can also develop hypoglycemia, although this is generally less common. The frequency of hypoglycemia among people with longstanding type 2 diabetes increases over time, as the body eventually stops making enough insulin. […] Low blood glucose can happen if you: […] Take too much insulin […] Take too much of oral diabetes medications that cause your body to release more insulin (eg, sulfonylureas, meglitinides) […] Do not eat enough food […] Exercise vigorously without eating a snack or decreasing your insulin dose beforehand

• #2 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  Hypoglycemia happens when the level of sugar (glucose) in your blood drops below the range thats healthy for you. Its also called low blood sugar or low blood glucose. Hypoglycemia is common in people with diabetes, especially Type 1 diabetes. […] Low blood sugar often happens due to excess insulin whether your body naturally makes too much or you inject too much synthetic insulin. Other hormonal and metabolic issues can also lead to low blood sugar. […] Hypoglycemia happens when your blood sugar drops below a healthy range. Several factors can contribute to this for people with diabetes. Hypoglycemia can develop if things like food, exercise and diabetes medications are out of balance. […] Common situations that can lead to hypoglycemia for people with diabetes include: Taking too much insulin, the wrong insulin or injecting it into your muscle instead of in your fat tissue.

• #2 Hypoglycemia (Low Blood Sugar Levels): Symptoms, Causes, Treatment

  https://www.webmd.com/diabetes/diabetes-hypoglycemia

  People with diabetes get hypoglycemia (low blood sugar) when their bodies don’t have enough sugar to use as fuel. […] It can happen for several reasons, including diet, some medications and conditions, and exercise. […] Insulin treatment can cause low blood sugar, and so can a type of diabetes medications called „sulfonylureas.” […] You can also get low blood sugar if you drink alcohol or take allopurinol (Zyloprim), aspirin, probenecid (Benemid, Probalan), or warfarin (Coumadin) with diabetes medications. […] You shouldn’t get hypoglycemia if you take alpha-glucosidase inhibitors, biguanides (such as metformin), and thiazolidinediones alone, but it can happen when you take them with sulfonylureas or insulin. […] You can get low blood sugar if you take too much insulin for the amount of carbohydrates you eat or drink.

• #2 Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hypoglycemia-low-blood-glucose-in-people-with-diabetes-beyond-the-basics

  Wait too long between meals […] Drink a lot of alcohol. […] Hypoglycemia unawareness is when you do not have the early symptoms of low blood glucose. Being unaware of low blood glucose is a common occurrence, especially in people who have had type 1 diabetes for more than 5 to 10 years, and it can be dangerous. […] Hypoglycemia and hypoglycemia unawareness occur more frequently in people who tightly manage their blood glucose levels with insulin (called intensive therapy). […] To prevent low blood glucose, it is important to monitor your blood glucose levels frequently and be prepared to treat it promptly at any time. Continuous glucose monitoring can help prevent hypoglycemia if you have type 1 diabetes or if you have type 2 diabetes and take insulin or other medication(s) that increases risk for hypoglycemia.

• #2 Reactive hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Reactive_hypoglycemia

  Reactive hypoglycemia, postprandial hypoglycemia, or sugar crash is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours after a high carbohydrate meal in people with and without diabetes. […] The condition is related to homeostatic systems used by the body to control the blood sugar level. […] The alleged mechanism for the feeling of a crash is correlated with an abnormally rapid rise in blood glucose after eating. This normally leads to insulin secretion (known as an insulin spike), which in turn initiates rapid glucose uptake by tissues, either storing it as glycogen or fat, or using it for energy production. The consequent fall in blood glucose is indicated as the reason for the „sugar crash”. […] Another cause might be hysteresis effect of insulin action, i.e., the effect of insulin is still prominent even if both plasma glucose and insulin levels were already low, causing a plasma glucose level eventually much lower than the baseline level.

• #2 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  However, certain conditions and situations can lead to fasting hypoglycemia in people without diabetes, including: Excessive alcohol consumption: Alcohol prevents your body from forming new glucose cells (gluconeogenesis). […] Adrenal insufficiency causes lower-than-normal cortisol levels. As cortisol (a hormone) helps regulate your blood sugar by increasing it, having low levels of cortisol can lead to hypoglycemia episodes. […] Non-islet cell tumor hypoglycemia (NICTH): This is a rare but serious syndrome in which a tumor releases excess insulin-like growth factor 2 (IGF-2). This is a hormone that has similar effects as insulin. Excess IGF-2 causes hypoglycemia. […] An insulinoma is a rare tumor in your pancreas that produces excess insulin. It leads to hypoglycemia episodes most commonly in the early morning.

• #2 Hypoglycemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia

  Hypoglycemia, or low plasma glucose level can result in sympathetic nervous system stimulation and central nervous system dysfunction. […] In contrast, hypoglycemia unrelated to exogenous insulin therapy is an uncommon clinical syndrome caused by various disorders or medications. […] Symptomatic hypoglycemia unrelated to treatment of diabetes mellitus is relatively rare, in part because the body has extensive counter-regulatory mechanisms to compensate for low blood glucose levels. Glucagon and epinephrine levels surge in response to acute hypoglycemia and appear to be the first line of defense. Cortisol and growth hormone levels also increase acutely and are important in the recovery from prolonged hypoglycemia. […] Insulin-mediated causes include exogenous insulin, insulin secretagogue (sulfonylurea; eg, glyburide, glipizide, glimepiride) use, insulinoma, post-bariatric surgery hypoglycemia, non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS), and insulin autoimmune hypoglycemia.

• #2 Hypoglycemia – Harvard Health

  https://www.health.harvard.edu/a_to_z/hypoglycemia-a-to-z

  Hypoglycemia is an abnormally low level of blood sugar (blood glucose). Hypoglycemia triggers the release of body hormones, such as epinephrine (adrenaline) and norepinephrine (noradrenaline), which serve to raise the low sugar level. […] Hypoglycemia occurs because of too high a dose of insulin or one of the sulfonylureas (glyburide, glipizide and others), or a change in diet or exercise without adjusting glucose-lowering medications. […] Hypoglycemia can occur, although rarely, in people who do not have diabetes. When it does occur outside of diabetes, hypoglycemia can be caused by a variety of medical problems. […] A pancreatic tumor, called an insulinoma, that abnormally secretes insulin […] If an insulinoma is suspected, the doctor may order a supervised 48-hour fast. During that period, blood levels of glucose and insulin will be measured when symptoms occur. A blood glucose level of less than 60 milligrams per deciliter at the time of symptoms and with a measurable level of insulin strongly suggests the person has an insulinoma. […] An insulinoma is treated with surgery to remove the tumor. Hypoglycemia caused by problems with the adrenal or pituitary glands is treated by replacing the missing hormones with medication.

• #2 Hypoglycemia – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/hypoglycemia

  A rare cause of fasting hypoglycemia is an insulinoma, which is an insulin-producing tumor in the pancreas. […] Disorders that lower hormone production by the pituitary and adrenal glands (most notably Addison disease) can cause hypoglycemia. […] Insulinomas should be removed surgically. However, because these tumors are small and difficult to locate, a specialist should do the surgery.

• #2 Hypoglycemia – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/hypoglycemia

  Hypoglycemia is abnormally low levels of sugar (glucose) in the blood. […] Hypoglycemia is most often caused by medications taken to control diabetes. […] Very low levels of glucose in the blood may interfere with the function of certain organ systems. The brain is particularly sensitive to low glucose levels because sugar is the brain’s major energy source. […] To prevent glucose levels in the blood from falling too far below their usual range, the brain responds by stimulating the adrenal glands to release epinephrine (adrenaline), cortisol, glucagon, and growth hormone. […] All of these hormones cause the liver to release glucose into the blood, but sometimes these hormones do not raise the blood glucose level enough to overcome the hypoglycemia. […] If the blood glucose level remains too low, the brain will get insufficient fuel, resulting in confusion, seizures, or loss of consciousness.

• #2 Neonatal hypoglycaemia | BMJ Medicine

  https://bmjmedicine.bmj.com/content/3/1/e000544

  Neuroglycopenia describes a state of metabolic imbalance caused by low glycolysis that triggers a series of cellular events that impair function, cause injury and, if not reversed, ultimately lead to cell necrosis. […] A key challenge in the management of neonatal hypoglycaemia is the current lack of clinical devices that can detect and monitor neuroglycopenia. […] This phenomenon of glucose reperfusion injury could explain why apparently brief, mild episodes of neonatal hypoglycaemia, if untreated, have been associated with reduced educational achievement. […] The extent to which this effect occurs in humans has yet to be studied.

• #2

  https://link.springer.com/article/10.1007/s00125-020-05369-0

  This review also highlights how hypoglycaemia, as an oxidative stressor, may also exacerbate chronic hyperglycaemia-induced increases in oxidative stress and inflammation, leading to damage to vulnerable brain regions (and other end organs) and accelerating cognitive decline. […] It is proposed that prior glycaemic control, hypoglycaemia and the degree of rebound hyperglycaemia interact synergistically to accelerate oxidative stress and inflammation, which may explain why increased glycaemic variability is now increasingly considered a risk factor for the complications of diabetes. […] We also recognise that, in response to recurrent hypoglycaemia, these specialised glucose-sensing cells adapt, leading (through mechanisms still not entirely worked out) to a clinical syndrome called impaired awareness of hypoglycaemia.

• #2 Hypoglycemia and the Central Nervous System | [current-page:pager]touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/hypoglycemia-and-the-central-nervous-system/

  Enhanced glucose metabolism is another potential mechanism. With more efficient glucose metabolism, the brain could maintain energy levels despite lower blood-glucose concentrations. […] Increased glucokinase activity has been hypothesized to play a major role. […] Increased glycogen content following hypoglycemia (termed glycogen supercompensation) may also contribute to HAAF. […] Both animal and human studies have shown glycogen levels to increase above basal levels following hypoglycemia. […] Alterations on potassium channel (KATP) activity and on the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) have been implicated in the pathogenesis of HAAF. […] Taken together, many mechanisms may contribute to HAAF.

• #2

  https://link.springer.com/article/10.1007/s00125-020-05369-0

  This hypothesis subsequently served as a model for examining the consequences of recurrent hypoglycaemia on glucose-sensing neurons. […] A likely candidate mechanism for this was an increase in glycolytic flux in neurons. […] However, human studies using magnetic resonance spectroscopy or positron emission tomography (PET) have produced conflicting data about the effects of recurrent hypoglycaemia on cerebral glucose uptake and metabolism. […] This effect is not specific to glucose-sensing neurons because the impact of recurrent hypoglycaemia is seen on cognitive functions and emotion, indicating cells in other brain regions are also affected. […] Interestingly, while for many people with type 1 and 2 diabetes strict avoidance of hypoglycaemia can restore hypoglycaemia awareness, there remains a cohort of individuals who have complete and irreversible loss of awareness, which suggests sustained tissue damage.

• #2 Hypoglycemia (Low Blood Sugar): Symptoms, Causes, Treatment, Diet

  https://www.webmd.com/diabetes/hypoglycemia-overview

  In addition to insulin, medications called meglitinides and sulfonylureas can cause low blood sugar. […] If you have diabetes, it’s especially important to pay attention to your blood sugar when you’re sick. Some infections cause hormone changes that lead to high blood sugar. Others make it difficult to eat, which can make your blood sugar drop. […] Hypoglycemia can lead to: Dizziness, Falls and injuries, Car accidents, Higher risk for dementia. In severe cases, untreated hypoglycemia can cause: Organ failure, Heart arrhythmias, Brain damage, Seizures, Coma, Death. […] If you have frequent episodes of low blood sugar, get a medical alert bracelet. This can indicate how people should help you during an emergency.

• #2 Diabetic hypoglycemia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

  Maintaining the balance between insulin, food and activity isn’t always easy. […] If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. […] Recognize the signs and symptoms of hypoglycemia early, because if untreated, hypoglycemia can lead to: Seizures, Loss of consciousness, Death. […] Diabetic hypoglycemia can increase the risk of serious even deadly accidents.

• #2 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Concern about hypoglycemia is a barrier to diabetes treatment and control, while patients experiencing recurrent episodes of hypoglycemia are also at risk of depression and anxiety. […] In more severe cases, hypoglycemia is liable to cause mortality, responsible for 4%-10% of mortality in patients with type 1 diabetes. […] Hypoglycemia in diabetes is associated with increased morbidity and constitutes a barrier to glycemic control. […] Much effort must be invested in hypoglycemia prevention, including patient education, appropriate dietary and exercise regimens, adjustment of the treatment regimen, and implementation of glucose monitoring systems as appropriate.

• #2 Hypoglycemia Without Diabetes: What Does It Mean?

  https://www.healthline.com/health/hypoglycemia-without-diabetes

  If left untreated, hypoglycemia can have several serious side effects that may include confusion, behavior changes, loss of consciousness, blurred vision, seizures, slurred speech, and neurological problems that may mimic a stroke. […] Hypoglycemia unawareness occurs when you don’t experience early warning symptoms of hypoglycemia, such as hunger, sweating, and shakiness. […] Having low blood sugar levels can increase your risk of many conditions, including heart disease.

• #2 Hypoglycemic and pregnant: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/321734

  As a result of these factors, it is more likely that a pregnant person will develop hyperglycemia, which is high blood sugar. However, people may also develop low blood sugar or alternate between the two conditions. […] Diabetes is a common cause of hypoglycemia during pregnancy. […] Low blood sugar levels can occur when a person takes too much insulin or does not eat enough carbohydrates. […] Occasionally, hormonal and other changes during pregnancy may cause people with diabetes to develop hypoglycemia even without medication. […] Gestational diabetes can also cause low blood sugar. […] Blood sugar can become very low in people who do not eat enough carbohydrates. […] People with severe morning sickness may develop low blood sugar if they frequently vomit. […] Diabetes drugs, such as insulin, can lower blood sugar levels.

• #2 Hypoglycemia in Children | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypoglycemia-children

  Low blood sugar or as it is known medically, hypoglycemia refers to blood concentration of glucose (sugar) that is too low to fuel the brain and the body. […] Hypoglycemia results from an imbalance between how much glucose is in the blood and how much glucose the body uses and needs. […] When these mechanisms fail, a child can become hypoglycemic. […] Glucose levels are tightly regulated by hormones that control the activation of these mechanisms. The most important hormone for glucose regulation is insulin. So, when not enough insulin is produced (like in diabetes) blood sugar levels are high (hyperglycemia) and conversely, when too much insulin is produced, blood sugar levels are low (hypoglycemia). […] In children, the most common medical condition that causes hypoglycemia is hyperinsulinism (HI). In hyperinsulinism, the beta cells of the pancreas secrete too much insulin, which results in hypoglycemia.

• #2 Hypoglycaemia (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/hypoglycaemia

  In response to meals these tumours usually respond subnormally, so that postprandial glucose levels are normal or even mildly elevated, although postprandial hypoglycaemia can occur. […] Insulinomas may be too small to be seen on CT scans and further investigation with endoscopic ultrasound should be considered, if no other cause for the hypoglycaemia is apparent. […] True hypoglycaemia should be confirmed by documentation of Whipple’s triad: symptoms or signs of hypoglycaemia, a low plasma glucose concentration, and resolution of symptoms or signs after plasma glucose returns to normal. […] Diazoxide, administered by mouth, is useful in the management of chronic intractable hypoglycaemia caused by excess endogenous insulin secretion, either from an islet cell tumour or islet cell hyperplasia.

• #2 Hypoglycemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia

  Factitious hypoglycemia is true hypoglycemia induced by nontherapeutic administration of sulfonylureas or insulin. […] To differentiate between insulin-mediated and non-insulin-mediated hypoglycemia and to determine the etiology of hypoglycemia, a 48- or 72-hour fast may be required. […] A prolonged fast can trigger hypoglycemia in a person who has a history of fasting hypoglycemia. […] The efficacy of glucagon depends on the size of hepatic glycogen stores; glucagon has little effect on plasma glucose in patients who have been fasting or who are hypoglycemic for long periods. […] Hyperglycemia may follow hypoglycemia either because too much sugar was ingested or because hypoglycemia caused a surge in counter-regulatory hormones (glucagon, epinephrine, cortisol, growth hormone).

• #3 Postprandial hypoglycaemia in adults: pathogenesis, diagnosis and management – Sulaiman – Journal of Laboratory and Precision Medicine

  https://jlpm.amegroups.org/article/view/6042/html

  Following surgery, rapid transition of food to small intestine causes early and higher glycaemic peak and increased GLP-1 secretion, triggering larger insulin synthesis, leading to a rapid drop in blood glucose, with a nadir in 90 to 180 minutes after meals. […] A blunted glucagon response to insulin-induced hypoglycaemia is well documented in patients post-RYGB compared to the same patients before surgery. […] Insulinoma is a rare tumour which causes endogenous hyperinsulinism and typically presents as fasting hypoglycaemia, though occasionally patients develop hypoglycaemia exclusively after meals. […] This rare disorder in adults is characterised by endogenous hyperinsulinemia and diffuse nesidioblastosis. […] Its aetiology is unknown. […] Patients usually show sensitivity to specific proteins in the meal and develop postprandial hyperinsulinemic hypoglycaemia.

• #3 Hypoglycemia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_pathophysiology

  Epinephrine response to hypoglycemia becomes suppressed in many patients. This happens when blood glucose level falls between 65-70 mmHg. A suppressed epinephrine response causes defective glucose counter-regulation and hypoglycemia unawareness occurs. […] The pathophysiology of hypoglycemia mainly relies on the failure of physiological defense mechanisms and hormones such as insulin, glucagon and epinephrine to correct hypoglycemia. […] Insulinoma is a rare benign pancreatic neuroendocrine tumor that arises from islet cells. It is thought that insulinoma is mediated by a mutation in mTOR/P70S6K signaling pathway. […] The progression to hypoglycemia is actually because of decreased glucose synthesis rather than increased use due to the direct effect of insulin on the liver. […] Non-islet-cell tumors are large tumors of mesenchymal or epithelial cell types originate from the pancreas. NICTH appears to be increased glucose utilization and inhibition of glucose release from the liver. This happens as a result of tumor production of incompletely processed IGF-2. […] The net result is continued glucose utilization by skeletal muscle and inhibition of glucose release, glycogenolysis, and gluconeogenesis in the liver.

Zobacz więcej