Hypoglycemia - is the most common of all the urgent situations in diabetes mellitus type 1.The most frequent causes of hypoglycemia are intense physical activity, missed meals, errors in the administration of insulin.Hypoglycemia usually corresponds to the level of blood glucose less than 2.5-3 mmol / L and may be symptomatic or asymptomatic.
Symptomatic hypoglycemia may be:
• Light (1st degree): the patient can to stop an episode of self-
• Moderate (2nd degree): hypoglycemia stopped by introducing glucose through the mouth, but with the help ofunauthorized
• Severe (3rd degree): the patient is unconscious or having convulsions;can not be stopped by introducing glucose through the mouth
Mild hypoglycemia occur frequently in patients with type 1 diabetes and is the price the patient pays for a good metabolic control and intensive treatment of diabetes.Very young children can not help themselves, so children under 5-6 years no hypoglycemia, which may have been regarded as the lungs.In a
Symptoms and Treatment
Symptoms of hypoglycemia may manifest itself differently in different patients, and vary with age.
Symptoms of hypoglycemia can be divided into:
• Neurogenic: sweating, hunger, tremor, anxiety, pallor
• Neyroglikopenicheskie: weakness, headache, changes in behavior, fatigue, blurred vision and speech, dizziness,lethargy, stupor, convulsions and loss of consciousness
After 4-5 minutes of severe hypoglycemia is necessary to measure the level of glucose in the blood, as well as several times to make measurements during the next hours.Blood glucose should be between 10 to 15 mmol / L, after the child has regained consciousness, he must offer simple carbohydrates (in the form of white bread).Lack of consciousness half an hour after the normalization of blood glucose indicative of cerebral edema, which requires appropriate treatment.
After the episode of severe hypoglycemia is necessary to understand the causes of the incident and, if possible, to eliminate it.Warning of severe hypoglycemic episodes is carefully matched doses of insulin, diet and physical activity.The child should always be with a simple carbohydrates in the form of glucose tablets, as well as identification amulet indicating that he / she is ill with diabetes.
Treatment depends on the severity of hypoglycemia, as shown in the following table:
nocturnal hypoglycemia in children is relatively frequent and usually occurs about 4 o'clock in the morning.Given its damaging effect on the brain, you must try to avoid these hypoglycemia.The patient should be recommended to measure blood glucose at bedtime.If the numbers & lt;6 mmol / liter - the child must additionally eat foods containing complex carbohydrates.Higher numbers of blood sugar before going to sleep, it is desirable to have children who in the evening or during the day this day was an intense physical activity, recommended in these cases, the numbers may be different in different children, but they should not be less than 10 mmol / L.
nocturnal hypoglycemia (hypoglycemia between midnight and 8 Mew am) and the phenomenon of dawn (increase in blood glucose levels between 4 and 8 Mew am) are quite common in children with disease duration of several years, which seek to achieve optimal glycemiccontrol via a double mode of insulin administration.One reason for this problem is the reduced need for insulin with up to three hours of the night in comparison with the time period of six to eight in the morning.Desire compensate need night insulin by administering the insulin NPH 5-6 pm with the aim to have good performance in glucose 6-8 o'clock leads to hypoglycemia with 1 to 3 nights.In children and adolescents under the conditions of two-time injections of insulin a day, nocturnal hypoglycaemia is rarely leads to hyperglycemia 6-8 o'clock in the morning, except in cases of excess introduction of carbohydrate in the treatment of nocturnal hypoglycemia.Therefore, regulation of insulin night profile should be measured using a blood glucose measurement from 1 to 3 o'clock in the morning and before breakfast.Sometimes it is necessary to move the NPH jokes evening from 5-6 pm at the later hours, increasing the number of injections from two to three, but reducing the problems associated with very high levels of insulin to the H-1 o'clock in the morning and too lowinsulin level at dawn.
Reduced ability to detect hypoglycemic state
After a few years of onset kontrregulyatorny response to hypoglycemia is reduced.Therefore, in patients with a long history of disease susceptibility to hypoglycemia may be lost, and symptoms may not be recognized by the patient up to the severe stage.
The same phenomenon can be observed in very young children due to the immaturity of kontrregulyatornoy system.
Insensitive to hypoglycemia can be caused by frequent hypoglycemic undiagnosed cases that lead to autonomic neuropathy.Careful prevention of such cases, hypoglycemia can restore sensitivity to low blood sugar.In this regard, it is important to know that hidden cases of hypoglycemia often occur at night.