Patient's question:
Please ask the doctor: What are the causes of hypoglycemia? If you have these symptoms, how should you be treated! Thank you very much!Doctor's answer:
The main causes are:(1) Fasting hypoglycemia:
1. Excessive glucose utilization:
(1) Hyperinsulinemia: Insulinoma; neonates of obese diabetic mothers (mothers with hyperinsulinemia); drugs (e.g., excessive use of insulin, sulfonylureas, salicylates, propranolol, disopyramide, monoamine oxidase inhibitors), autoimmune hypoglycemia.
(2) Tumors: Such as large mesenchymal tumors, primary liver cancer, gastrointestinal tumors, and lymphosarcoma, etc.
2. Insufficient glucose production:
(1) Endocrine diseases: Hypopituitarism; adrenal cortical hypofunction; hypothyroidism, etc.
(2) Glycogen storage disease in the liver.
(3) Severe liver disease and liver congestion.
(4) Advanced renal disease.
(5) Galactosemia (due to a deficiency in galactose-1-phosphate uridyltransferase, which prevents galactose from being converted to glucose).
(6) Other: Long-term alcoholism (inhibiting gluconeogenesis); sepsis; starvation; cachexia; intense exercise, etc.
(2) Postprandial (reactive) hypoglycemia:
1. Functional hypoglycemia (emotional instability and neurosis, more common in middle-aged women).
2. Nutrient-induced insulin hypersecretion: Such as dumping syndrome after gastric resection; pyloroplasty and gastrojejunostomy.
3. Idiopathic spontaneous hypoglycemia in children.
4. Mild, early diabetes (delayed insulin peak).
Emergency treatment: For mild cases, rapidly administer sugary foods or drinks. If unable to take orally or symptoms are severe, immediately administer 40 ml of 50% glucose intravenously, followed by continuous infusion of 5–10% glucose. Cases with no significant response to glucose supplementation may include:
① Chronic hypoglycemia;
② Hypoglycemia with fever;
③ Hypoglycemia due to endocrine dysfunction.
In such cases, larger amounts of glucose should be administered, along with intravenous infusion of 100–200 mg of hydrocortisone mixed with glucose. Pancreatic glucagon can also be administered via intramuscular injection or intravenous push.
II. Etiological treatment:
For functional and reactive hypoglycemia, a low-carbohydrate, high-fat, high-protein diet with small, frequent meals is recommended, along with mild sedatives and drugs that inhibit the vagus nerve. For hypoglycemia caused by tumors or other reasons, corresponding etiological treatment should be given.
(Refer to: "Trustworthy 120 Internal Medicine Diseases")