Signs and Symptoms of Hypoglycemia (Diabetes Mellitus) What all nurses and patients should know.

Hypoglycaemia is defined as low blood sugar. Many authors consider 3.3 mmols to be low (Farrell, 2005), others accept 4.0mmols/L to be on the lower side. There is general consensus that the normal range of blood sugar, on the metric scale, is between 4.0 and 8.0mmols per/L.

High blood sugar is called hyperglycemia. It is the opposite of hypoglycemia. Hyperglycemia is said to occur when the blood sugar is more than 10 mmols per liter.

A sign is any objective evidence of disease. For example, gross blood in stool is a sign of disease. It can be recognized by the patient, doctor, nurse, or others. It forms part of objective data gathered from a patient during history taking and other examinations.

A symptom is a subjective statement made by a patiet. For example, I have abdominal pain is a pain is a symptom. It is something only the patient can know or feel and report.

When hypoglycaemia occurs, the bood sugar falls to below 3.3mmols/L. This condition can occur at any time of the day or night. The signs and symptoms of hypoglycaemia are due to stimilation of the sympathetic nervous system which results in the production of adrenaline and noradrenaline. Surges in the level of adrenaline and noradrenaline will produce the following signs and symptoms. It will be helpful to note that Adrenaline and Noradrenaline are the naturally occuring hormones which bring about the “flight and fright” response in mammals.

Figure: Hypoglycaemia in diabetes can be prevented by giving a simple sugars to conscious patients.

Tachycardia: One of the early signs of hypoglycaemia is tachycardia. Tachycardia is a heart rate of more than 100 beats per minute. The pulse is generally thready.

Sweating: Patients in hypoglycaemic states are usually diaphoretic (sweat excessively). Quite often all their clothes become wet with sweat and my require to change them.

Tremours: The hypoglycaemic patient often displays fine tremour of the hands. This is due to the high levels of adrenaline and noradrenaline.

Palpitations: Complaints of palpitations in the chest are usual. The patients heart tries to get as much energy to the brain as is possible. It does this by working harder than usual. Hence the palpitaions.

Hunger: The low blood sugar stimulates the patients hunger centre. If the patient consumes something containing sugar then the hypoglycaemic condition will be corrected and the sumptoms will disappear.

Nervousness: The excessive stimulants (adrenaline and noradrenaline) are making the patient anxious and nervous at the same time.

When the bloood sugar levels fall futher (around 2.0 mmols/L) then the functioning of the brain will be compromised the the following signs and symptoms will become evidant. These symptoms are produced because the amount of avaialbe energy is insufficient to keep the brain functioning optimally.

Fluctations in Levels of consciousness and concentration. These symptoms indicate very low levels of available energy. Immediate action must be taken to correct the situation. This patient will also display light headedness, may be confused, have numbness of the lips and tongue and have slurred speech. Hand eye coordination too will be compromised.

In some instances the patient’s blood sugar may be extremely low. When this happens, the body’s functions will become impaired. Initially, the patient may suffer from seizures. These seizures will look like epileptic seizures. Then, the patient will become disorientated to time, person, place and situation. Finally he/she may become unconsciousness as there is no energy available in the body to perform bodily functions. At this point the patient may not respond to any form of stimuli, including pain. Remember, all bodily functions require energy. Since there is no energy, bodily functions will cease and death will occur if the situation is not rectified.