Hypoglycemia: varieties of etiopathogenesis and clinic. Observations from practice

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.