Hypoglycemia: varieties of etiopathogenesis and clinic. Observations from practice

Authors

  • P.M. Lіashuk Bukovinian State Medical University, Chernivtsi, Ukraine
  • R.P. Lіashuk Bukovinian State Medical University, Chernivtsi, Ukraine https://orcid.org/0000-0001-7228-678X
  • Yu.F. Marchuk Bukovinian State Medical University, Chernivtsi, Ukraine
  • N.I. Stankova Chernivtsi Regional Endocrinology Center, Chernivtsi, Ukraine
  • M.B. Kudina Chernivtsi Regional Endocrinology Center, Chernivtsi, Ukraine

DOI:

https://doi.org/10.22141/2224-0721.18.4.2022.1178

Keywords:

hypoglycemia, etiopathogenesis, clinical features, dia­betes mellitus, hyperinsulinism

Abstract

Hypoglycemic syndrome is often noted in clinical practice in the treatment of patients with diabetes mellitus (DM), especially with insulin. This syndrome is manifested by symptoms caused by neuroglycopenia (insufficient supply of glucose to the brain, which utilizes 20 % of all glucose). Hypoglycemia occurs quite often, in about 40 % of people with type 1 DM. The clini­cal syndrome of postprandial (reactive) hypoglycemia of various etio­logies is considered, which is manifested by a hypoglycemic condition in the next hours after eating, especially easily diges­tible carbohydrates. In most cases, there is a violation of the hypothalamic regulation of carbohydrate metabolism, and the clinical picture is dominated by symptoms of activation of the sympathoadrenal system. Such hypoglycemia is usually transient, as glucose levels return to normal rapidly due to the release of counterinsular hormones. The importance of the latter in the regulation of insulin secretion is evidenced by the fact that after oral glucose loa­ding, a higher level of insulin secretion is determined than in the case of intravenous administration of an equivalent dose. Elderly patients with hypoglycemia are more likely to deve­lop neurolo­gical disorders than adrenergic disorders (palpitations, tremors, hunger). These symptoms may be mistaken for signs of cerebrovascular ischemia, as a result, hypoglycemia is not adequately detected and treated. In addition to the acute adverse effects of hypoglycaemia, a hypoglycaemic episode may have long-term consequences. Frequent hypoglycemic conditions have a significant psychological impact and are also a risk factor for dementia. The paper presents the data, based on scientific sources and own observations, on etiopathogenesis of hypoglycemia, as well as their most frequent clinical varieties, in particular, in the syndrome of unrecognization of hypoglycemia, postprandial hypoglycemia, in chronic insulin overdose in patients with diabetes mellitus in old age and insulinism.

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References

International Hypoglycaemia Study Group. Glucose Concentrations of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2017 Jan;40(1):155-157. doi:10.2337/dc16-2215.

Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes. 2015 Jul 10;6(7):912-926. doi:10.4239/wjd.v6.i7.912.

Ratner RE. Hypoglycemia: new definitions and regulatory implications. Diabetes Technol Ther. 2018 Jun;20(S2):S250-S253. doi:10.1089/dia.2018.0113.

Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies. Curr Diab Rep. 2018 Jun 21;18(8):53. doi:10.1007/s11892-018-1018-0.

Lin YK, Fisher SJ, Pop-Busui R. Hypoglycemia unawareness and autonomic dysfunction in diabetes: Lessons learned and roles of diabetes technologies. J Diabetes Investig. 2020 Nov;11(6):1388-1402. doi:10.1111/jdi.13290.

Szadkowska A, Czyżewska K, Pietrzak I, Mianowska B, Jarosz-Chobot P, Myśliwiec M. Hypoglycaemia unawareness in patients with type 1 diabetes. Pediatr Endocrinol Diabetes Metab. 2018;2018(3):126-134. doi:10.5114/pedm.2018.80994.

Altuntaş Y. Postprandial Reactive Hypoglycemia. Sisli Etfal Hastan Tip Bul. 2019 Aug 28;53(3):215-220. doi:10.14744/SEMB.2019.59455.

Chernetsky VK, Lyashuk PM, Bilous II, Khomenko OD, Meshchishena NO, Batig NO. Diagnosis of syncopal paroxysms in spontaneous hypoglycemia. Bulletin of Psychiatry and Psychopharmacotherapy. 2006;(10):101-102. (in Ukrainian).

Pankiv VI. Antihyperglycemic therapy of elderly and senile patients in real clinical practice. Mìžnarodnij endokrinologìčnij žurnal. 2018;14(2):199-204. doi:10.22141/2224-0721.14.2.2018.130567. (in Ukrainian).

Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58(3):429-442. doi: 10.1007/s00125-014-3460-0.

Liashuk PM, Skhodnytskyi IP, Klimenko LI, Liashuk RP. A case of insulinoma. Bukovinian Medical Herald. 2012;16(2):225-226. doi:10.24061/218554. (in Ukrainian).

Published

2022-06-30

How to Cite

Lіashuk P., Lіashuk R., Marchuk, Y., Stankova, N., & Kudina, M. (2022). Hypoglycemia: varieties of etiopathogenesis and clinic. Observations from practice. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 18(4), 239–243. https://doi.org/10.22141/2224-0721.18.4.2022.1178

Issue

Section

Clinical Case