Hypoglycemia and diabetes are conditions related to blood sugar levels. Diabetes is a disease associated with elevated blood sugar level while hypoglycemia is low blood sugar level. However, hypoglycemia is a known complication of diabetes. This article will talk about both hypoglycemia and diabetes in detail highlighting their clinical features, symptoms, causes, investigation and diagnosis, prognosis, and also the course of treatment/management they require.
What is Diabetes?
Diabetes is characterized by the classical triad of symptoms; those symptoms of diabetes are excessive thirst, excessive hunger, and frequent urination. All these symptoms are due to elevated blood sugar levels. There are two types of diabetes; diabetes mellitus (DM) and diabetes insipidus (DI). Diabetes insipidus is not associated with blood sugar levels like diabetes mellitus. Diabetes starts as impaired glucose tolerance. This is a golden opportunity for life style changes. Then the symptomatic phase comes followed by complications. Complications of diabetes involve small and large blood vessels. Complications involving large arteries are stroke, heart attacks, and peripheral avascular disease. Heart attacks are five times commoner in diabetes. Many are silent. Vascular disease is the commonest cause of death due to diabetes. Stroke is twice as common. Females usually are at a lower risk of vascular events than men, but diabetes removes this gender advantage. Complications involving small arteries are nephropathy, retinopathy and neuropathy. Nephropathy features loss of protein, high blood pressure leading to chronic renal failure in advanced disease. Retinopathy causes blindness. Blindness due to diabetes is rare and preventable. Regular ophthalmological review is essential. Bleeding in the retina, small aneurysms, and small infarctions are seen in retinopathy. Neuropathy features glove and stocking type paraesthesia, autonomic neuropathy, mononeuritis multiplex, sensory polyneuropathy, and motor polyneuropathy. This leads to flat foot, wounds, and joint pains.
There are two types of diabetes mellitus; type 1 and 2. Type 1 diabetes mellitus results from a lack of or diminished effectiveness of insulin formed in the body. Type 1 DM is of juvenile onset but may occur at any age. It is characterized by insulin deficiency. Patients always need insulin and are prone to ketoacidosis and weight loss. It is associated with other autoimmune diseases. Concordance is 30% in identical twins. There are 4 important genes. Type 1 DM presents as an acute ketoacidosis, or as a long standing lethargy and recurrent infection. In diabetic ketoacidosis, the patient is unwell, dehydrated, hyperventilating, polyuric, and thirsty. Fast acting insulin and intravenous fluids treat the acute stage. Regular blood sugar monitoring and insulin dose adjustment is needed for normo-glycemia. Hypoglycemia is a common side effect of insulin therapy.
Type 2 DM appears to be prevalent at pandemic levels in many places. Part of the increase is actually due to better diagnosis and improved longevity. In some areas of Australia, 7% of the people above 25 years of age have diabetes. Higher prevalence occurs in Asians, men and the old. Most type 2 diabetics are over 40 years, but younger people increasingly get diabetes. Type 2 diabetes is present as an incidental finding, infection, hypoglycemia, and ketoacidosis. Patients usually do not need insulin. Oral hypoglycemic drugs like sulfonamide, biguanides, azides, and acarbose lower the blood sugar in type 2 diabetes. Insulin therapy should be considered when oral hypoglycemic, dietary and lifestyle management fail to show satisfactory results.
What is Hypoglycemia (Low Blood Sugar)?
Hypoglycemia is low capillary blood sugar, which is less than 50 mg/dl. Signs and symptoms of hypoglycemia (or low blood sugar) are anxiety, sweating, tiredness, lethargy, and dizziness. Treatment for hypoglycemia (or low blood sugar) is to treat with a sweet drink and administration of intravenous or oral glucose solutions.
What is the difference between Hypoglycemia and Diabetes?
• Hypoglycemia features low blood sugar while diabetes features high blood sugar.
• Hypoglycemia causes dizziness, blurred vision, and tiredness while diabetes causes polyuria, polydipsia and polyphagia.
• Diabetes is managed with oral hypoglycemic drugs, insulin while hypoglycemia is treated with oral sugar or intravenous glucose.
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