Hypoglycemia is an abnormal reduction in the blood levels of glucose. Hypoglycemia comes from the Greek word hypo meaning low, gly meaning sugar and emia meaning blood with a literal meaning of “low sugar blood”.

Hypoglycemia should not be confused with hyperglycemia, which is the increased blood sugar level. Hypoglycemia involves an abnormally low blood sugar level below the lower limit of 70 mg/dL. Although any reduction from the lower limit is experienced, significant symptoms usually do not appear, unless the level reached below 50 mg/dL.

Glucose is needed by the body for various bodily functions. When the blood glucose decreases, the body is signalled by feeling hunger to supplement the body with glucose through carbohydrates.

Causes of Hypoglycemia

Hypoglycemia can occur over range of ages from newborns to adults and causes are usually different across the ages. However, hypoglycemia is usually a result of complex factors and not just a single phenomenon such as poor nutrition.

Causes for Newborn Infants

Newborns that are critically ill usually suffer from hypoglycemia as a result of the following:

• Low birth weight or intrauterine growth retardation
• Prolonged fasting or starvation
• Sepsis
• Maternal Diabetes
• Congenital hyperinsulinism or the presence of elevated insulin levels

Causes for Children

Recurrent hypoglycemia in children may be a sign of congenital metabolic errors. Single events may also be caused by nutritional deficits. Specific causes include:

• Diarrhea or gastroenteritis
• Hypopituitarism
• Hyperinsulinism
• Maple syrup urine disease
• Ingestion of mouthwash, alcohol and other drugs

Causes for Adults

The most common cause of hypoglycemia in adults is the presence of insulin dependent diabetes mellitus, which leads to side-effects of insulin administration. Since insulin is used by the body to transport glucose from the blood to the cells, any overdose of insulin can significantly reduce the blood sugar levels. Also, exercising without prior consumption of carbohydrate rich foods may deplete the glucose in the blood. Furthermore, unavailability of food after insulin administration may lead to reduction in blood glucose levels.

Symptoms of Hypoglycemia

Glucose is needed by nearly all cells to perform its function. Any reduction in the blood glucose level; thereby, causes a variety of effects to the organs and cells in the body leading to its clinical manifestations. Hypoglycemia usually causes a variety of symptoms including:

• Dysphoria
Dysphoria is usually a result of neuroglycopenia or a reduction of glucose supply to the cells. A change in the level of consciousness usually is the main sign that inadequate glucose to the brain is present. Prolonged hypoglycemia may eventually lead to loss of consciousness.

• Seizures
Severe hypoglycemia also causes a disruption in the brain signalling in the brain that can cause seizure attacks.
Other symptoms include:

• Anxiety
• Palpitations and tremors
• Sweating
• Cold and clammy skin
• Pallor
• Numbness or paresthesia
• Dilated pupils
• Abdominal discomfort
• Hunger
• Borborygmy or the presence of gurgling sound in the stomach
• Headache
• Poor concentration
• Weakness
• Confusion
• Disorientation
• Flashing lights
• Blurred vision
• Slurred speech
• Ataxia

Hypoglycemia is usually diagnosed using the Whipple’s triad, which is the presence of:

• Low blood sugar levels

• Symptoms of hypoglycaemia

• Resolution of hypoglycemia symptoms when blood sugar levels are increased to normal levels

Treatment of Hypoglycemia

Since the main cause of hypoglycemia symptoms is the reduction in blood glucose levels, the main management for hypoglycemia is to increase the blood glucose levels to normal levels through the following:

• Administration of intravenous glucose.

• Provision of easily absorbed high-carbohydrate rich foods such as orange juice, sodas and candies.

• Monitoring the blood sugar level until stable.

Complications of Hypoglycemia

The most common complication of hypoglycemia is related to the presence of neuroglycopenia. Unmanaged hypoglycemia may eventually lead to permanent brain damage and coma that can potentially lead to death.
Hypoglycemia is highly preventable and prevention is the best management to prevent life-threatening symptoms and complications.