What causes diabetic hypoglycemia

The blood sugar threshold values ​​for hypoglycemia reactions and complaints given for people with diabetes also apply to people without diabetes, who suffer from spontaneous hypoglycaemia without medication - both on an empty stomach (i.e. without prior food intake) and reactively depending on the food intake - even severe hypoglycaemia may occur.

Blood sugar concentrations below 40 mg / dl (2.2 mmol / l) are a clear indicator of hypoglycaemia, provided the measurement has been carried out using a laboratory-specific method. Pure "Stix" measurements using a rapid test using a drop of blood from the fingertip are not sufficient because of the known inaccuracy in the low range.

Particularly pronounced symptoms usually occur when the blood sugar values ​​drop rapidly, ie at more than 1 mg / dl (0.06 mmol / l) per minute, whereas slowly falling values ​​also below 40 mg / dl (2.2 mmol / l) " can remain symptomless.

Fasting hypoglycaemia occurs more than six hours after food intake, e.g. after strenuous physical exertion or after drinking alcohol the evening before. Chronic liver diseases are also a possible cause. The concentrations of the blood sugar-lowering hormone insulin in the blood are not increased or are only relatively too high. Fasting hypoglycaemia can also indicate massively increased insulin levels, e.g. an insulin-producing tumor or complex autoimmune processes. Measurements of insulin or its hormone precursors under standardized conditions or also special antibodies are essential for the diagnosis and further procedure. With these measurements it is also possible to distinguish it from the accidental or deliberate intake of blood sugar-lowering tablets or insulin, i.e. a "fake hypoglycemia".

Reactive hypoglycemia occurs two to five hours after feeding. Fixed early reactive hypoglycaemia can occur in connection with surgical removal or drastic reduction in size of the stomach as a so-called functional dumping syndrome, late reactive hypoglycaemia about three or four hours after food intake, especially after food rich in carbohydrates or glucose, can be an early sign of a later one Be diabetes. This phenomenon often applies to particularly slim, younger women even if there is no later indication of diabetes. With regard to treatment, it is important to avoid foods that cause hypoglycemia, especially beverages and dishes that contain high levels of glucose or glucose, as well as large meals, and instead switch to smaller but more frequent (between) meals with a higher fiber content and simultaneous intake of fat and protein. Often this readiness for reactive hypoglycaemia disappears after a few years.

In addition, there are also a number of rare, partly genetic forms of reactive hypoglycaemia such as hereditary fructose intolerance or leucine sensitivity or nesidioblastosis in newborns with fasting hypoglycaemia as a result of temporary overactive insulin-producing tissue in the pancreas. Severe hypoglycaemia can also occur in newborn babies born to mothers with poorly controlled diabetes during pregnancy.

Finally, the functional weakness of some hormonal organs such as the thyroid, adrenal or pituitary gland can lead to reactive hypoglycaemia. On the other hand, multiple insulin-producing tumors in the pancreas indicate the possible presence of a MEN-1 syndrome with tumor development in the parathyroid gland or the anterior lobe of the pituitary gland and other endocrine glands.

All of these rare causes of hypoglycaemia, including insulin-producing tumors, require the special expertise of the hormone specialist, i.e. the endocrinologist, both in diagnostics and in therapy.