American Medical Association Family Medical Guide - American Medical Association [612]
Symptoms
The symptoms of hypoglycemia vary considerably from person to person, but they often start with a feeling of being hot and uncomfortable, which is followed by profuse sweating and rapid heartbeat. You may also have a feeling of panic and feel hungry. Other possible symptoms include dizziness, weakness, trembling, unsteadiness, blurred vision, slurred speech, tingling in the lips or hands, or headache. You may become aggressive or uncooperative without being aware of it; you may appear intoxicated. Hypoglycemia can sometimes cause seizures (see page 686), especially in children or in people who drink alcohol without eating. If symptoms occur during the night, they usually wake you up. Severe cases can cause unconsciousness; this is referred to as a diabetic coma.
Treatment
If you have an attack of hypoglycemia, your doctor will use it to teach you to recognize an oncoming attack and discuss ways to prevent it. If you are having frequent attacks, your doctor may reduce your dose of insulin or oral hypoglycemic medication. You should always carry glucose gel tablets, sugar cubes, or candy with you. At the first sign of an attack, eat or drink something sweet until you feel the attack has passed, which should take only a few minutes.
Wear a medical identification bracelet or carry a card in your wallet indicating that you have diabetes, and make sure that members of your family and your friends know the symptoms of hypoglycemia so that if you become disoriented or uncooperative they can give you something sweet. Tell them that if they give you even a small drink of fruit juice you will probably recover enough to then be able to eat properly. But make sure they know that they should never try to feed you if you are unconscious (in a diabetic coma), because you could choke. If your hypoglycemia is caused by a medication you are taking for another disorder, talk to your doctor; he or she may recommend discontinuing the drug or may prescribe an alternative.
An alternative to glucose tablets for hypoglycemic attacks is an injection of glucagon, a hormone that helps raise blood glucose level. The injection is especially helpful if an attack makes a person unconscious, because someone else can give the injection. Many people who have hypoglycemic attacks teach their family and friends how to inject the hormone into an arm or leg muscle. Because the glucose-raising effects of glucagon are temporary, you also need to take additional sugar to raise your sugar level. Make sure that your family members and friends know that if these measures are not effective or available, they should call 911 or your local emergency number or take you to the nearest hospital emergency department immediately. You will be given an injection of glucose, which raises blood sugar so fast you may even regain consciousness as the injection is given.
Continuous glucose monitors now enable people with diabetes to check their blood glucose level minute by minute, enabling their doctor to detect patterns of fluctuation in the level and recommend measures to maintain better control. The devices, some of which are worn like a watch or implanted, can give a warning to alert the person if his or her blood glucose gets too high or too low.
Disorders of the Adrenal Glands
The adrenals are a pair of small, triangular glands; one adrenal gland is on top of each kidney. Each adrenal gland has a central core (adrenal medulla) and an outer layer (adrenal cortex). The adrenal medulla produces two hormones—epinephrine and norepinephrine—that have an important role in controlling heart rate and blood pressure and the body’s response to stress. The hypothalamus in the brain stimulates the adrenal glands to produce these hormones.
The adrenal glands
The adrenal glands are on top of each kidney. The adrenal glands produce corticosteroid hormones, which help regulate metabolism (the chemical processes that take place in the body), and the hormones epinephrine and norepinephrine, which help control heart rate and blood pressure and the body