Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
I am fortunate to have a team of great nurses and a wonderful nutritionist in my office. As I was
on my way into see a patient, I overheard one of our nurses
going into a great deal of detail educating a young patient with diabetes about
the concerns of low blood sugar. Her talk reminded me that this is a subject of great importance to
patients with diabetes. I will take this opportunity to highlight information on
issues related to hypoglycemia. Namely, what are the signs and symptoms of
hypoglycemia, when should you be concerned, what to do for treatment, and when
you should seek medical attention.
Despite significant advances in diabetes treatment,
hypoglycemia (low blood sugar or glucose) is still a common problem among
patients who are trying to achieve better control of their blood sugar.
Hypoglycemia is the clinical syndrome that results from
low blood sugar. The symptoms of hypoglycemia can vary from person to person, as
can the severity. Classically, hypoglycemia is diagnosed by a low blood sugar
with symptoms that resolve when the sugar level returns to the normal range.
Who is at risk for hypoglycemia?
While patients who do not have any metabolic
problems can complain of symptoms suggestive of low blood sugar, true
hypoglycemia usually occurs in patients being treated for diabetes (type 1 and
type 2). Patients with pre-diabetes who have insulin resistance can also have
low blood sugars on occasion if their high circulating insulin levels are further
challenged by a prolonged period of fasting. There are other rare causes for
hypoglycemia, such as insulin producing tumors (insulinomas) and certain
medications. These uncommon causes of hypoglycemia will not be discussed in this
article, which will primarily focus on the hypoglycemia occurring with diabetes
mellitus and its treatment.
Despite our advances in the treatment of diabetes, hypoglycemic episodes are
often the limiting factor in achieving optimal blood sugar control. In large
scale studies looking at tight control in both type 1 and type 2 diabetes, low
blood sugars occurred more often in the patients who were managed most
intensively. This is important for patients and physicians to recognize,
especially as the goal for treating patients with diabetes become tighter blood sugar control.
I thought high blood sugar was bad. Why is low blood sugar also bad?
The
body needs fuel to work. One of its major fuel sources is sugars, which the body
gets from what is consumed as either simple sugar or complex carbohydrates. For
emergency situations (like prolonged fasting), the body stores a stash of sugar
in the liver as glycogen. If this store is needed, the body goes through a
biochemical process called gluco-neo-genesis (meaning to "make new sugar") and
converts these stores of glycogen to sugar. This backup process emphasizes that
the fuel source of sugar is important (important enough for human beings to have
developed an evolutionary system of storage to avoid a sugar drought).
Of all the organs in the body, the brain depends on sugar (which we are now
going to refer to as glucose) almost exclusively. Rarely, if absolutely
necessary, the brain will use ketones as a fuel source, but this is not
preferred. The brain cannot make its own glucose and is 100% dependent on the
rest of the body for its supply. If for some reason, the glucose level in the
blood falls (or if the brain's requirements increase and demands are not met)
there can be effects on the function of the brain.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Hypothermia is having a body core temperature of less than 35 C or 95 F. Most causes of hypothermia are preventable. Risk factors for hypothermia include age, mental status, medical conditions, and medications. Symptoms of hypothermia generally depend upon the severity of the condition. Treatment depends upon the severity of hypothermia. If not treated early, hypothermia can lead to cardiac arrest, coma, or death.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Drowning is a common cause of death and disability worldwide. In the US, it is the third most common cause of accidental death. Brain damage, pneumonia, ARDS, hypothermia, and spine fractures are complications of drowning. At times, there are discussions of wet vs. dry, or salt vs. fresh water drownings. Children and young adults are at most risk for drowning accidents. Medical emergencies in the water may lead to drowning (such as seizures, hypoglycemia, sudden cardiac death, or heart attack). Treatment of a drowning victim depends up on the severity of the injury. Prevention is the key to prevent drowning.
The body maintains a relatively stable temperature whereby heat production is
balanced by heat loss. Normally, the core body temperature (when measured
rectally) is 98.6 degrees F or 37 degrees C. When the outside environment gets
too cold or the body's heat production decreases, hypothermia occurs (hypo=less
+ thermia=temperature). Hypothermia is defined as having a core body
temperature less than 95 degrees F or 35 degrees C.
Body temperature is controlled in the part of the brain
called the
hypothalamus, which is responsible for recognizing alterations in the body
temperature and responding appropriately. The body produces heat through the
metabolic processes in
cells that support vital body functions. Most heat is lost at the skin surface
by convection, conduction, radiation, and evaporation. If the environment gets
colder, the body may need to generate more heat by shivering (increasing muscle
activity ...
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