Non-Diabetic Hypoglycemia



When the blood-glucose drop to below normal levels, hypoglycemia is the result. Though uncommon, people who do not have diabetes can have hypoglycemia, caused by medication, diseases, tumours, or hormone/enzyme deficiencies. The symptoms are similar to diabetes-related hypoglycemia, which may include hunger, shakiness, sweating, light-headedness, sleepiness, dizziness, confusion, anxiety, speaking difficulties, and weakness.

There are two types of non-diabetic hypoglycemia:

  • Reactive hypoglycemia - also called postprandial hypoglycemia, occurs within four hours after meals.
  • Fasting hypoglycemia - also called postabsorptive hypoglycemia, often related to an underlying disease.

We cannot change the cards we are dealt, just how we play the hand



Reactive Hypoglycemia


Diagnosis

  • Laboratory blood plasma analysis from a blood sample taken while having symptoms. A personal blood glucose meter cannot be used to diagnose reactive hypoglycemia.
  • The doctor may ask about the signs and symptoms.
  • See if the symptoms ease when the blood sugar returns to above 70 mg/dL after eating.
  • The oral glucose test is no longer used, as it can actually trigger hypoglycemic symptoms.

Relief from the symptoms after eating and a blood-glucose level below 70 mg/dL at the time of the symptoms constitutes a confirmation of reactive hypoglycemia.

 

Causes

Debatable causes

  • Sensitivity to the hormone epinephrine.
  • Deficiencies in glucagon secretion.

Certain causes, though uncommon

  • Gastric surgery - causing the rapid passage of food into the small intestine.
  • Rare enzyme deficiencies such as hereditary fructose intolerance.


Treatment

  • Small meals every three hours.
  • Being physically active.
  • Eating foods high in fiber.
  • Avoiding foods high in sugar, especially on an empty stomach.
  • A low-carbohydrate diet.




Fasting Hypoglycemia


Diagnosis

Fasting hypoglycemia is diagnosed when the blood-glucose level is below 50 mg/dL after an overnight fast, between meals, or after physical activity.

Treatment

Each underlying problem requires a different treatment approach, and is discussed with the following respective causes. 

Causes

Medications

Some medications used to treat diabetes are the most common cause of hypoglycemia.

Other medications that can cause fasting hypoglycemia

  • Salicylates (including aspirin) when taken in large doses.
  • Sulfa medications - used to treat bacterial infections.
  • Pentamidine - used to treat a serious kind of pneumonia.
  • Quinine - used to treat malaria.

Treatment would be to stop the medication or changing the dose

Alcohol

Alcohol interferes with the liver's function to raise blood glucose.

Hypoglycemia caused by excessive drinking is very serious and can even be fatal.

The treatment would be to cease alcohol use/abuse.

Critical illnesses

Illnesses that can cause fasting hypoglycemia

  • Illnesses that affect the liver, heart and/or kidneys
  • Sepsis - which is a devastating infection
  • Starvation

Treatment would be to address the illness and/or any other underlying cause.

Tumours

Insulin-producing tumours in the pancreas, called insulinomas, raise the insulin levels too high in relation to the blood-glucose level.

Insulinomas are rare and do not normally spread to other parts of the body.

Short-term treatment would be to correct the hypoglycemia. Surgically removing the tumour is the long-term solution.

Hormonal deficiencies

Usually occurring in very young children, but rarely in adults.

Shortages of hormones that can cause fasting hypoglycemia

  • Cortisol
  • Growth hormone
  • Glucagon
  • Epinephrine
  • Pituitary hormones
  • Adrenal hormones

Laboratory tests for hormone levels will confirm a diagnosis and establish a treatment regimen.

The treatment is with hormonal replacement therapy.

Fasting hypoglycemia in children

Hypoglycemia seldom happen to children, but might occur due to

  • Intolerance to fasting - when something like an illness disturbs the regular eating pattern. This is usually outgrown by the age ten.
  • Hyperinsulinism  - the overproduction of insulin. Common in infants of mothers with diabetes.
  • Enzyme deficiencies that affect carbohydrate metabolism.
  • Hormonal deficiencies




Reactive hypoglycemia; also called postprandial hypoglycemia. And Fasting hypoglycemia; also called postabsorptive hypoglycemia.




Summary for Consideration


In reactive hypoglycemia, symptoms occur within four hours of eating. Treatment for reactive hypoglycemia is to follow a healthy eating plan recommended by a registered dietitian.

Fasting hypoglycemia can be caused by certain medications, critical illnesses, hereditary enzyme or hormonal deficiencies, and some kinds of tumours.

Treatment targets the underlying cause.

 


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