[quote]Signs and symptoms
Hypoglycemic symptoms and manifestations can be divided into those produced by the counterregulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.
[edit] Adrenergic manifestations
* Shakiness, anxiety, nervousness,
* Palpitations, tachycardia
* Sweating, feeling of warmth
* Pallor, coldness, clamminess
* Dilated pupils (mydriasis)
* Feeling of numbness "pins and needles" (parasthaesia)
[edit] Glucagon manifestations
* Hunger, borborygmus
* Nausea, vomiting, abdominal discomfort
* Headache
[edit] Neuroglycopenic manifestations
* Abnormal mentation, impaired judgment
* Nonspecific dysphoria, anxiety, moodiness, depression, crying
* Negativism, irritability, belligerence, combativeness, rage
* Personality change, emotional lability
* Fatigue, weakness, apathy, lethargy, daydreaming, sleep
* Confusion, amnesia, dizziness, delirium
* Staring, "glassy" look, blurred vision, double vision
* Automatic behavior, also known as automatism
* Difficulty speaking, slurred speech
* Ataxia, incoordination, sometimes mistaken for "drunkenness"
* Focal or general motor deficit, paralysis, hemiparesis
* Paresthesia, headache
* Stupor, coma, abnormal breathing
* Generalized or focal seizures
Not all of the above manifestations occur in every case of hypoglycemia. There is no consistent order to the appearance of the symptoms, if symptoms even occur. Specific manifestations may also vary by age, by severity of the hypoglycemia and the speed of the decline. In young children, vomiting can sometimes accompany morning hypoglycemia with ketosis. In older children and adults, moderately severe hypoglycemia can resemble mania, mental illness, drug intoxication, or drunkenness. In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise. The symptoms of a single person may be similar from episode to episode, but are not necessarily so and may be influenced by the speed at which glucose levels are dropping, as well as previous incidence.
In newborns, hypoglycemia can produce irritability, jitters, myoclonic jerks, cyanosis, respiratory distress, apneic episodes, sweating, hypothermia, somnolence, hypotonia, refusal to feed, and seizures or “spells”. Hypoglycemia can resemble asphyxia, hypocalcemia, sepsis, or heart failure.
In both young and old patients, the brain may habituate to low glucose levels, with a reduction of noticeable symptoms despite neuroglycopenic impairment. In insulin-dependent diabetic patients this phenomenon is termed hypoglycemia unawareness and is a significant clinical problem when improved glycemic control is attempted. Another aspect of this phenomenon occurs in type I glycogenosis, when chronic hypoglycemia before diagnosis may be better tolerated than acute hypoglycemia after treatment is underway.
Nearly always, hypoglycemia severe enough to cause seizures or unconsciousness can be reversed without obvious harm to the brain. Cases of death or permanent neurological damage occurring with a single episode have usually involved prolonged, untreated unconsciousness, interference with breathing, severe concurrent disease, or some other type of vulnerability. Nevertheless, brain damage or death has occasionally resulted from severe hypoglycemia.[/quote]