Recognition and Management of Non-Diabetic Hypoglycemia: A Literature Review
By Ryan Weilandich, ATS (Athletic Training Student)
Lindenwood University Athletic Training Department
Introduction:
Hypoglycemia is defined as when your blood glucose (sugar) levels are too low, (<70 mg/dL) [1]. It is most common in patients with diabetes when they have a mismatch of medication, food, and/or exercise. Non-diabetic hypoglycemia is rare condition in which patients that do not have diabetes have chronically low blood glucose. Non-diabetic hypoglycemia is broken into two classes: Reactive hypoglycemia (RH), and fasting hypoglycemia (FH), both of which can be determined by laboratory test results [2]. RH is generally caused by a combination of the timing and type of dietary intakes, in combination with the timing of subsequent exercise. Contributing factors of a RH episode include high training status, gender, timing and type of nutritional intake, hydration, previous hypoglycemic events, time of the day, anxiety/stress, blood pressure, and the athlete’s individual sensitivity to low glucose and counter-regulatory hormones of insulin and glucagon [3]. FH commonly happens early in the morning, after strenuous exercise, or an overnight fast [4]. There are three grades of hypoglycemia. Grade 1 is when the patient is able to detect and treat himself/herself. Grade 2 is when the patient is conscious but requires aid to take oral glucose. Grade 3 or severe hypoglycaemia is when the patient is unconscious, or unable to take oral glucose because of extreme disorientation [5]. Treatment for grad 3 hypoglycemia is either glucagon injection or intravenous glucose.
Pathophysiology:
There are four main mechanisms of RH which include: Islet hyperplasia w...
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...re hours since the last meal. Avoid exercising for one-two hours after eating just simple sugars, as they will cause a dramatic spike then fall in blood glucose levels. Have a glucose containing sports drink close by to drink throughout exercise/competition. Avoid overtraining. Stay properly hydrated at all times. Track blood glucose level to find the optimum blood glucose levels for physical activity. Finally, avoid strenuous activity for at least 4 hours after a bout of hypoglycemia, as this puts the patient at a higher risk for another one [3].
Medical Treatment/Management:
In cases of low hormone levels, hormone replacement is needed. The type of hormone is dependent on the cause of the hypoglycemia, and should be discussed with the physician. If the cause is an insulinoma or other tumors affecting glucose absorbtion, surgery to remove the tumor is indicated.
3: Briscoe VJ, Davis SN (2006) Hypoglycaemia in Type 1 and 2 Diabetes: Physiology, pathophysiology and management. Clinical Diabetes, 24 (3), 115-121
This is monitored by the cells within the Islets of Langerhans, which is located in the control (the pancreas). After skipping a meal or tough physical exercise blood glucose concentration decreases. Alpha cells in the islets detect this drop and are stimulated to secrete glucagon. Glucagon is a polypeptide hormone which influences an increase in blood glucose concentration. Glucagon travels through the bloodstream until it reaches glucagon receptors which are predominantly found in the liver, as well as, the kidneys. Glucagon stimulates the breakdown of stored glycogen to be released into the bloodstream as glucose. It also stimulates the conversion of amino acids into glucose and the breakdown of fat into fatty acids. These effectors cause an increase in blood glucose levels back towards the normal. This increase in blood glucose concentration is detected by the alpha cells which then stop the secretion of
The pathophysiology of diabetes mellitus in is related to the insulin hormone. Insulin is secreted by cells in the pancreas and is responsible for regulating the level of glucose in the bloodstream. It also aids the body in breaking down the glucose to be used as energy. When someone suffers from diabetes, however, the body does not break down the glucose in the blood as a result of abnormal insulin metabolism. When there are elevated levels of glucose in the blood, it is known as hyperglycemia. If the levels continue to remain high over an extended period of time, damage can be done to the kidneys, cardiovascular systems; you can get eye disorders, or even cause nerve damage. When the glucose levels are low in one’s body, it is called hypoglycemia. A person begins to feel very jittery, and possibly dizzy. If that occurs over a period of time, the person can possibly faint. Diabetes mellitus occurs in three different forms - type 1, type 2, and gestational.
I am a Type 1 Diabetic. I have had it for 40 years and I have no diabetic complications. I don’t think of myself as disabled but once in a while I do get low blood sugar, I also forget to take a shot once in a blue moon and get high blood sugar; have you ever forgotten to take your birth control pill? Sometimes I clean house like a madwoman and I get a low blood sugar, sometimes I am at work and we are moving files or I am just being more active than normal and I get low; same with Josefina. She
Other hormones (glucagons, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are often referred to as counterregulatory hormones. These hormones work to increase blood glucose levels by stimulating glucose production and output by the liver and by decreasing the movement of glucose into the cells. Insulin and the these counterregulatory hormones provide a sustained but regulated release of glucose for energy during food intake and periods of fasting and usually maintain blood glucose levels within the normal range. An abnormal production of any or all of these hormones may be present in diabetes.
Glycemic index is the measure of how quickly blood glucose rise after eating a particular kind of food. This is used by estimating the how much each gram of carbohydrate consumed raises a person’s glucose level. During intense exercise, the body uses glucose as energy source before it starts relying of fats. “Prolonged exercise can only be continued when there is an adequate amount of carbohydrate available to fuel muscle and the brain”(William,2004). This shows that the amount of carbohydrate/glucose that is found within the body’s tissue has a significant amount of influence to play on how effective the early hours of an exercise would be. Glycemic index helps one to know how effective the carbohydrate/glucose within the body is functioning during exercise.
Exercise can be used in conjunction to dietary control when diet alone is not maintaining appropriate glucose levels. The American Diabetes Association recommends participating in both aerobic (walking at a fast pace, swimming laps, playing tennis) and resistance training exercises (free weights or weight machines, resistance bands, wall-sits) .However, it is still controversial to endorse exercis...
...ll cause your blood sugars to lower (Mayo Clinic Staff). While working out you will notice that your blood sugar levels will be all over the place so its important to have things such as glucose pills just in case your levels drop too low. Exercise may not be the cure for diabetes but it could be the thing that prevents you from getting it.
A. One condition is known as hyperglycemia, which means that the blood glucose gets too
The care plan is composed of the right food, exercise and medication (Mayo Clinic Staff, 2014). The person needs to know what type of foods affects their blood sugar levels and most of the time the patient is sent to a nutritionist to follow a diabetic diet. The patient needs to keep track of a food log to discuss later with the doctor or nurse on the next appointment (Mayo Clinic Staff, 2014). An exercise regimen also helps to keep the sugar levels balanced. It is important to keep an exercise schedule that will help the person to keep an exercise routine in accord with the medications and meals. It is very important to stay dehydrated and to keep track of the blood sugar levels (Mayo Clinic Staff, 2014). The medications are to lower the blood sugar levels. It is very important to store the insulin properly, check the expiration date and double check the dose before administration. The person will need to report to the doctor if the blood sugar gets too low or still high, because the doctor might need to adjust the dosage or timing. Also, it is important for the doctor to know if the person is taking medications for other conditions, because that will help the doctor to prescribe the correct medication for the person (Mayo Clinic Staff,
When the blood sugar levels aren’t normal, it’s a disease called diabetes. Diabetes (diabetes mellitus) is a deficiency of the hormone insulin or the inhibition of its action with the cells. The insulin acts like a bridge between the glucose and the cells. In the US there are about 16 million people who suffer from diabetes. It is the seventh most common cause of all deaths. Diabetes is most common in Native American females over 45 years of age.
Diabetes is a significant and fast growing health concern in the United States. About 16 million Americans have diabetes – and that number increases every day. Every day there is someone who suffers from a diabetic emergency. What is a diabetic emergency? Well, first we must understand what diabetes is. Diabetes is a disease that affects how your body uses blood glucose (or commonly known as blood sugar) your body isn’t able to take the sugar from your bloodstream and carry it to your body cells where it can be used for energy. There are two types of diabetes; Type I (insulin dependent) and Type II (non-insulin dependent). Both types can cause a diabetic emergency. Both types require medical intervention/treatment.
It was expected that the participants who ingested glucose and rested, to have their blood sugars elevate and slowly return to the normal range. Blood sugars will rise because the glucose isn’t being used, the glucose stays stored and makes blood glucose levels elevate.
That is to say that “People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia” (“Diagnosis”). In order to seek the proper care for diabetes, patients must undergo: distinguishing its symptoms, classifying if it is pre-diabetes or type 2 diabetes, and the proper treatment.
The pancreas uses these two hormones in order to monitor blood glucose levels. After a meal, blood glucose usually rises. This is when insulin secretion will start (Nussey S, Whitehead S. “Endocrinology: An Integrated Approach”). Consequently, blood glucose decrease to the normal range. This is how insulin maintains blood levels when is high. However, when blood level falls below normal range, glucagon comes into play. Low blood glucose occurs usually when hungry and during exercise. This will then triggers glucagon secretion. When blood level falls, the body goes into imbalance. Hence is why in order to maintain homeostasis glucagon is crucial. The body will tell the pancreas to increase more glucose and the pancreas will secrete glucagon by taking glycogen from the liver to produce glucose. The glucose will produce energy and will make blood glucose concentration increase (Homeostasis of Insulin and Glucose, Abpischools.org). When the pancreas cannot maintain homeostasis, many problems will arise in the body. When the pancreas fails to produce insulin, type 1 and 2 diabetes can occur. For those with type 1 diabetes, insulin injections will be needed in order to regulate blood glucose level, otherwise, glucose levels will be out of control. For type 2 diabetes, they are not insulin dependent like type 1, however, the body does not create enough in the body. When blood glucose