Talk:Hypoglycemia/Archive 1

Permanent brain damage?

The article notes of course that low glucose levels can impair brain functions. It would be good if the article also noted whether permanent damage can result from certain circumstances. These circumstances should span the various degrees of: hypoglycemic severity, isolation vs recurrence, and duration of the fit. 74.132.209.231 21:56, 29 June 2006 (UTC)

Good suggestion but no simple answer, certainly not a "below x level for y minutes" type of answer. See my recent additions to the article. alteripse 22:10, 29 June 2006 (UTC)

Temperature Extremes

I would like this article to open up debate on whether temperature extremes (either extreme cold conditions or extreme hot conditions) can make risk of hypoglycaemia in diabetics more likely. Any information on this subject will be gratefully received. ACEO 08:12, 24 July 2006 (UTC)

A better place is the talk:Diabetic hypoglycemia page, before putting anything in an article. If you move the question there I will tell you what I know about the topic. alteripse 11:31, 24 July 2006 (UTC)

Thank you Alteripse. I have now raised this question on the Wikipedia site talk: Diabetes, so I do hope that you will be able to respond. By the way, are you a qualified medical doctor? I have seen a number of comments from you on medical articles in Wikipedia, and also believe that your name is in the category Category:Wikipedian physicians. I am not a medical doctor myself (my doctorate is a Ph.D. in Psychology, not an M.D.) but do find medical articles in Wikipedia very interesting and, from what I know about medicine, pretty good compared with some other health information on the web! ACEO 12:44, 26 July 2006 (UTC)

Section titles

The section titles of much of this article aren't very "Wikipedia-ish." It looks like it was copied-and-pasted from another source. While the content seemed okay when I scanned through it, I didn't that that close a look; it seems however, that the only thing really requiring cleanup is the section titles. They all ought to be less than four words, IMO. 205.157.110.11 23:25, 25 August 2006 (UTC)

You are complaining about a style issue. The captions contain too much information for the reader? Why don't you get an account and write some articles and you can make your own decisions about section heading styles. Thanks for your input. alteripse 00:13, 28 August 2006 (UTC)

Hypoglycemia unawarness

There used to be an article on this, but it seems to have been deleted. I wondered whether information on this topic should have been moved here? ACEO 20:38, 7 November 2006 (UTC)

There was an article with the title hypoglycemia unawareness but it was deleted because it was a copyright violation. The topic should probably be included in diabetic hypoglycemia (with a redirect from the empty hypoglycemia unawareness), but the article doesnt cover it. Please go ahead if you know something about it. Or I will when I get a round tuit. alteripse 23:47, 7 November 2006 (UTC)

The total text deleted from that article was the following, which in my opinion isnt worth much and doesnt cover the topic. alteripse 23:53, 7 November 2006 (UTC)

Hypoglycemia (or hypoglycemic) unawareness is the inability to recognize early symptoms of low blood sugar until they become severe. Once symptoms reach this stage, urgent treatment is necessary to prevent further progression and life-threatening health problems, such as a seizure or stroke.

Severe symptoms of low blood sugar include confusion, slurred speech, unsteadiness when standing or walking, muscle twitching, and personality changes. People with diabetes who tightly control their blood sugar levels are more likely to have episodes of low blood sugar. Frequent and severe low blood sugar episodes are likely to evolve into hypoglycemia unawareness. Once a person has had one hypoglycemia unawareness episode, more are likely to occur.

different ethnic normals and different ethnic tendency to reactive hypoglycemia

I removed the following text for reasons explained below.

Additionally, there is some evidence that people from certain ethnic groups with traditional diets very low in simple carbohydrates and high in complex carbohydrates (e.g., Scots, Scandinavians, Japanese) will often develop a propensity for normal body function within a range of blood sugar levels that is lower than for most people (e.g., a normal range of 60 mg/dL or 3.3 mmol/L to 100 mg/dL or 5.6 mmol/L, instead of 80 mg/dL or 4.5 mmol/L to 120 mg/dL or 6.7 mmol/L. These people may be described as "naturally hypoglycemic," but they are actually "hypoglycemic" only by comparison to what is normal for the general populace. That said, their apparently hypoglycemic propensity can present a medical problem if it is accompanied by a sensitivity to simple carbohydrates (sugars). That is, when consumption of foods very high in sugar (e.g., hard candies, fudge, chocolate, pre-sweetened cereals, etc.) can or does cause a rise in blood sugar so sharp that it produces a mild degree of intoxication (in the vernacular, a "buzz"), followed by an equally sharp drop or "crash" that typically produces sensations similar to alcoholic "hangover."

This is a potentially serious form of reactive hypoglycemia. In some individuals, a very serious "crash" of this type can produce unconsciousness and/or cause convulsions, but this is thought to be rare (except in naturally hypoglycemic children, particularly during periods of growth spurt, who routinely eat a diet that is too low in complex carbohydrates to at least 'balance' their intake of simple carbohydrates). When people who function normally with lower than normal blood sugar levels suffer a serious hypoglycemic "crash," they must only take complex carbohydrates (starchy foods) until they fully recover, which usually takes a few minutes to an hour. Consuming more simple carbohydrates will only repeat the cycle of intoxication, and lead to another "crash."

Reasons for removal:

1. This text seems to be suggesting that different ethnic groups have different normal glucose ranges, which is a bizarre idea that needs supportive citations of real evidence to belong here.
2. Even if completely true, this rare subform of reactive hypoglycemia does not deserve half of the text of the introduction to the whole article. We have a reactive hypoglycemia and an idiopathic postprandial syndrome stub which need expansion. If the author can verify this info, one of these would be the appropriate place to put it. Do not put it back at the beginning of this introduction.
3. The primary clue that this is total crap is the ignorance of hypoglycemia implied by the phrases "crash" and "potentially serious". No one familiar with the coma, seizures, and brain damage risks of the truly "serious" forms of hypoglycemia described in this article would think of describing reactive hypoglycemia or idiopathic postprandial syndrome this way. This is "folk medicine" at best. alteripse 11:22, 23 Jun 2005 (UTC)

I'm part Native American and there is clinical evidence that people of Native American heritage are more sensitive to the high-carbohydrate modern American diet than are many people of pure European background.

Diabetes among Southwestern Indian populations is now being treated successfully by a return to lower carb traditional Southwestern Native American diet that also features indigenous low glycemic index vegetables and low glycemic legumes as well.

Phil

67.42.243.184 17:55, 8 January 2007 (UTC)

Carbohydrates

It the recommendation of eating carbohydrates to prevent further episodes correct?

NO not at all-- eating very complex carbs can help (unless you have severe hypo)-- but eating simple carbs will make it much worse over time. Eating more protein in small amopunts all day can also help as can omega 3 oils and Vitimin supplementation.

67.42.243.184 18:02, 8 January 2007 (UTC)

Yes, for most types of hypoglycemia described in this article. You may be thinking about idiopathic postprandial syndrome. alteripse 21:00, 20 August 2005 (UTC)

Sub-clinical Adrenal Insufficiency as one route to Hypoglycemia

I wish I had more time to post, but there is evidence, both in Western medicine and also Traditional Chinese Medicien that elevated insulin levels in hypoglycemia may also be due to sub-clinical adrenal insuficency (adrenals not weak enough to be called 'addisons disease' but weak enough nevertheless for adrenals to underperform in their usual role as insulin antagonists).

The adrenals are widely known for temporarily boosting blood sugar during fight or flight reactions-- but one of the many less well known functions of the adrenal glands is to also counteract insulin under non-emergency conditions-- normally pushing insulin levels lower while the pancreatic system pushes insulin higher-- the two opposing systems therefore creating a balance in healthy individuals. In the case of sub-clinical adrenal insufficiencey (also called 'adrenal exhaustion') the weakness of underfunctioning adrenals in relation to healthy pancreas may cause an overabundance of insulin which therefore sets the stage for hypoglycemia. There is also a theory that years of of this imbalance may overwork the pancreas causing it to eventually begin to fail, so chronic adrenal-insufficiency based hypoglycemia may also eventually lead to diabetes. This has at times been called a part of 'Syndrome X', although there are other problems that influence syndrome X as well-- this syndrome may weaken the adrenals initially, or weak adrenals may trigger this syndrome initially.

In any case-- attending to increased support of adrenal function through vitamins, omega oils and Chinese herbs (under the supervision of a clinically trained Chinese herbalist) can help hypoglycemia along with the more well-known dietary changes.

(NOTE: Although Chinese herbs can help greatly-- there are no one-size-fits all Chinese herbs for hypoglycemia-- or any illness-- because Traditional Chinese Medicine works on correcting unique individual imbalances-- therefore a careful individual evaluation must be carried out by a trained professional before Chinese herbs can be safely administered).

Phil

Sean7phil 15:22, 8 January 2007 (UTC)

Sean7phil 15:24, 8 January 2007 (UTC)

The problem with folk medicine is that the unwary will think "adrenal" in the passage above means adrenal, that "insulin" means insulin, and "hypoglycemia" means hypoglycemia, when in fact none of that entire passage is grounded in measurable phenomena whatsoever and has nothing to do with actual adrenal or pancreatic function or blood glucose levels. There is no better way to knock an animal's insulin levels to undetectable than by removing the adrenal glands. States of adrenal glucocorticoid excess (Cushing's syndrome) reduce insulin sensitivity and produce higher insulin levels. Thanks for not trying to mix this stuff into the article. Why can't the alt med folks spin their stories using different words that do not already have precise meanings? If you stick to words like yin, yang, and chakras, there will be no grounds for reader confusion and I will not argue with you. alteripse 23:09, 8 January 2007 (UTC)

Endocrinologist

Suggest modification of definition of endocrinologist in 1st paragraph--specialty includes, but is more than just disorders of blood glucose metabolism. Hallbrianh 22:42, 19 February 2007 (UTC)

• Sure, but that is the aspect of endocrinology relevant to this article. alteripse 01:14, 20 February 2007 (UTC)

Headers

Some of those sub-titles read like sentences. Could somebody clean it up a little?--76.64.52.237 19:21, 24 April 2007 (UTC)

And that is bad because...? alteripse 16:00, 25 April 2007 (UTC)

Ketone bodies fuel the brain, no?

"inadequate supply of glucose as fuel to the brain"

From a biochemistry course I took this past summer, I remember that ketone bodies fuel the brain, not glucose. Is this incorrect, or am I misinterpreting something? Reid Sullivan 16:00, 21 August 2007 (UTC)

I am not a medical doctor but I myself have been to hospital many times due to episodes of hypoglycemia. (I seem to have some type of glycogen storage disease.) This is what I remember my doctors telling me: Yes the brain can and do use ketone bodies as fuel. Problem is that too much ketone in your blood is poisonous. In my case I get extreme levels of ketones during my episodes of hypoglycemia and my doctors told me that the body and brain then more or less stops burning glucose and instead burn ketone to get rid of it. Although it was about 30 years ago they told me this so I might be remembering wrong or science might have come to other conclusions since then. --David Göthberg 16:49, 21 August 2007 (UTC)

Glucose is the principal fuel of the brain. Ketones can be used as alternate fuel in some circumstances. alteripse 02:49, 22 August 2007 (UTC)

American folk medicine

The words 'discussed in the remained of this article' look like they may have been stolen directly from something else. Is this simply due to weird editing or merging and not a copywright violation or is this whole section taken from something else? 60.228.248.28 12:08, 1 September 2007 (UTC)

What section did that phrase come from? Either you misquoted it or it should have said remainder rather than remainded. It has not been "taken" from anywhere but we can certainly correct an error, unless it's yours. alteripse 22:30, 1 September 2007 (UTC)

Sorry, i made that comment while very tired and didn't bother to quote properly. The bit I'm referring to is the first sentence of this paragraph - "This condition therefore overlaps with the definition and forms of hypoglycemia described in the other sections of this article but is not entirely congruent. When low glucose levels can be measured, this condition is usually described by physicians as idiopathic reactive hypoglycemia." And yes, of course, it's now been fixed. 203.59.83.231 10:32, 3 September 2007 (UTC)

Naturally-occurring hypoglycemia

Just wondering what would cause this. I've dealt with this illness for years and have none of the medical conditions normally associated with it (i.e., diabetes). I am nineteen years old, and the lowest sugar reading I ever had was a 29 that registered about a year ago. That was a fun day. Apparently I was within seizure territory, but nothing happened. —Preceding unsigned comment added by 129.174.73.40 (talk) 03:42, 16 October 2007 (UTC)

Treatment section edited

I added some information which made the treatment section a little more complete, as well as more precise. Not everyone can give glucagon or give IV dextrose, nor should they. —Preceding unsigned comment added by 198.254.16.200 (talk) 10:48, 8 May 2008 (UTC)

fear of dying

until there is an actual reliable source that says fear of dying is a symptom i am going to remove it as it as nonsense and original research, the following 5 websites talk about symptoms of hypoglycemia and not a single one of them say anything about a fear of dying
http://www.nlm.nih.gov/medlineplus/print/ency/article/000386.htm
http://www.medicinenet.com/hypoglycemia/article.htm
http://www.drpodell.org/hypoglycemia_symptoms.shtml
http://www.fred.net/slowup/habul44.html
http://health.learninginfo.org/hypoglycemia.htm
PS: the part "The most effective means of preventing further episodes of hypoglycemia depends on the cause" that is true about all problems so it isn't necessary to keep...

--Ditre 22:55, 9 March 2007 (UTC)

Do not remove the topic sentence. It replaced a series of erroneous assertions that hypoglycemia is treated with oral glucose. There are many ways of treating hypoglycemia depending on cause (oral glucose, IV glucose, oral food, glucagon IM, glucagon infusion, octreotide injections, octreotide infusions, diazoxide, etc, depending on circumstances and cause. It is not a trivial statement. Leave it alone. alteripse 06:20, 11 March 2007 (UTC)

That doesn't prove its not a trivial statement, it doesn't give any information that is useful. all that needs to be there are the methods. --Ditre 04:53, 12 March 2007 (UTC)

If the stylistic reasons for retaining the overview sentence before subdivision do not convince you, the strongest practical argument is simply that in the real world, doctors do not always remember all 3 aspects of management or sometimes confuse one with the other. I'm glad that you have such a comprehensive understanding of this topic that the statement seems trivial to you, but I assure you that others need reminding. Feel free to have the last word here, but thanks in advance for desisting from further removal. And as for including "fear of dying" in the symptom list, I did not insert it and will not contest it, but would remind you that none of your cited symptom lists claims comprehensiveness and it would be easy to find signs or symptoms absent from each of them. alteripse 12:11, 12 March 2007 (UTC)

Fear of Dying fits in with Agitation and nervousness, which are classic signs of hypoglycema. A good quote from this is the AAOS Orange Book, Emergency: Transport and Treatment of the Sick and Injured. Many textbooks will include a fear of dying has been noted with an increased frequence or severity when the patient is suffering from a very dangerous condition (I.e. Myocardial Infarc, Shock. One of the classic shock signs listed in the classic American Red Cross First Aid book was patient stating "I'm Going to Die"). In EMS, we're taught that if a patient says I'm going to die, that it's a very bad sign something is wrong, either physiologically, or emotionally. - Chance —Preceding unsigned comment added by 198.254.16.200 (talk) 10:51, 8 May 2008 (UTC)

Confusion of image

The image on the top of the page represents a blood glucose test; however, even diabetics must have the same test. I find that ambigous, so shouldn't that be removed? Any opionions will help.--Megamanfan3 (talk) 13:49, 15 May 2008 (UTC)

== Great new page on hypoglycemia. It's updated and very accurate... needed a few more updates though. Hyperinsulin/hyperammonia syndrome is more common than people think.

Pregnancy and hypoglycemia

It seems like many pregnant women deal with hypoglycemia. Does anyone know how often and if it should be addressed on this page. Does pregnancy contribute to the likelihood of a hypoglycemic attack?

Most of the net metabolic changes of pregnancy would make hypoglycemia less likely rather than more likely (which is why diabetes so often develops during pregnancy). There is not a recognized "hypoglycemia of pregnancy". It should not be added this page unless you have citations from the medical literature demonstrating its recognized nature and frequency. alteripse 02:49, 12 July 2006 (UTC)

In families with a high risk of genetically inherited diabetes and metabolic disorders, the risk of hypoglycemia is higher and pregnant women from those families are more prone to develop both hypoglycemia (in my Mom's case before I was born) and gestational diabetes (more common by overproduction of insulin), but after giving birth, many of those women (esp. my Mom after my younger bro's birth) reported sudden changes in blood sugar levels that increase the likelihood of diabetes later in life.

I came to believe ones' genes can determine their metabolism to go slow, go fast or abnormally change for many reasons, such as a woman gets pregnant and they can gain too much (or even too little) weight by typical metabolic changes can vary in each woman, such as their insulin produced in their bodies while biologically supporting the developing baby/fetus. + 71.102.10.169 (talk) 08:34, 27 August 2008 (UTC)

Functional hypoglycemia

When I eat anything with sugar in it, I get bad headaches and start to shake 2 hours later. I have had this sensitivity for 20 years. Until I started avoiding sugar I was miserable. Don't you tell me this problem doesn't exist.

By the way-- The speed of the sugar drop (how rapid a drop per unit of time) has been showed to be more critical in causing these symptoms than the baseline level that it drops to. It is therefore a mistake to measure the lowest-sugar-level hit and call it a day. People in these studies reporting 'hypoglycemia' or 'hypoglycemia-like' symptoms were found to have a 'speed of sugar drop' that was faster (per unit of time) than control groups. However the 'bottom level' that their blood sugars hit was not remarkable. It is hypothesized that the associated discomfort comes instead from the nervous system not having adequate time to adjust to the rapid change in sugar levels, rather than having to do with the 'actual depth of the patients lowest-sugar mark'

Part of the problem here is also the very uneven way that scientific medical and nutritional studies are propagated throughout the medical world. Something can be 'well proven' and yet remain unknown if the news simply doesn't travel. A lot of scientifically verified medical news does travel quickly and thoroughly, but some doesn't.

Sean7phil (talk) 00:11, 24 September 2008 (UTC)

Some members of the medical community believe that functional hypoglycemia does not actually exist, as a disease, at all. They only recognise hypoglycemia as a side-effect of diabetes - if a diabetic takes in too much insulin for the amount of sugar in their blood, the effect is a severe and potentially life-threatening hypoglycemic attack or a 'hypo'.

Agree...hypoglycemia is in reality a very rare disorder, rarer than what the lay perception would lead you to believe. Andrew73 00:12, 14 October 2005 (UTC)

Okay, well, I have it in the total absence of diabetes. When I was born they had me in an incubator and were feeding me sugar water through an I.V. I typically get really shaky and whatnot at least once a day, and I've had some pretty low readings. Last winter my blood sugar came up as 29, after which my parents made me go to a doctor. Weirdly enough, I haven't actually had a seizure or anything! Knock on wood, ha, ha.

Mild hypoglycemia is common I thought, or is this hypohypoglycemia? —Preceding unsigned comment added by 69.113.123.1 (talk) 19:14, 31 October 2007 (UTC)

Hypoglycemia is caused by not eating sugar?

I'm a person that doesn't eats much sugar, and my doctor has suggested that i might have hypoglycemia because of my thing of not eating much sugar, can this be possible? —Preceding unsigned comment added by Tahine2 (talk • contribs) 22:50, 20 December 2008 (UTC)

YOU NEED A NEW DOCTOR!!!
Your doctor is either an idiot or a fraud. Either way he/she ( because of the sugar obsession, I am leaning toward female) should not be practicing medicine. Most of the literature out there recommends a sugar free diet as a treatment for hypoglycemia. Not that this true either, being that idiopathic or reactive hypoglycemia is a made up disease invented by lazy doctors.
He/She says you "might" have hypoglycemia. Has he/she bothered to give you a blood test? And a glucose tolerance test doesn't count, that's a test for diabetes only. You need to be tested while you're having symptoms, and they need to test whether sugar alleviates your symptoms. Then they need to figure out why your sugar is low, because if it is, there is an underlying cause, they are just too lazy to figure it out.
What you have is a doctor that practices folk medicine. They really don't have any medical knowledge that you couldn't learn from watching the Today Show (drink more tea, eat more fish, eat fruits and vegetables, drink 1 or 2 glasses of red wine every day, drink plenty of water, get moderate exercise). Unfortunately, due to the lack of regulatory control in this country, many PCPs are turning to this half-assed form of medicine because it allows them to "treat" more patients in less time.
Please print this out and take it to your idiot doctor. Let Him/her know that not everyone is stupid enough to fall for their deceit. And please find a real doctor. I know it is hard. So many doctors these days are frauds. But I was mislead for years by doctors talking about hypoglycemia, until I ended up in the hospital with a potentially fatal heart condition. It took the nurses a couple of days to make me really understand that my life was in danger.
That's my point, pseudo-doctors will try to dismiss your health problems as benign, but left undiagnosed and untreated, they can come back and kill you
Don't take shit from these mot@$&*!$^ers, they think that they are so smart that the world owes them a free ride. Report your Doc to the state authorities, it won't do much good but at least it might make it harder for him/her to get another job.

Rarely is not never

I believe in the first paragraph below the title where it says that hypoglycemia (rarely) causes death is inaccurate. Any Diabetic (or anyone for that matter) that experiences a severe enough episode will indeed die as their brain will not recieve oxygen.--Commodore64 18:33, 26 June 2006 (UTC)

Hypoglycemia rarely causes death. The statement is true. Many people with well-controlled diabetes by current methods suffer 1-2 symptomatic episodes of hypoglycemia each week and even more asymptomatic episodes for perhaps a common frequency of at least 300 per year. Average lifespan of someone with type 1 diabetes now is well over 30 years from diagnosis and those with closer to normal glucose levels live longer, not shorter. So if only 1 in 10,000 episodes of hypoglycemia is fatal the statement is true. Rarely is not never. alteripse 12:34, 27 June 2006 (UTC)

Alteripse,

I see what you are trying to get at by analyzing the data like that, but I think there are two different ideas that haven't been explored in your reasoning. Perhaps an example might better show what I am getting at...

This past year my blood sugar severely plummeted at rugby practice and if it weren't for some friends keeping an eye on me I probably would have gone into a coma or worse. I was fortunate that one of the guys on my team has had experience with hypoglycemia (he has diabetes) and was prepared in case something had happened to him, however, if it weren't for someone recognizing what was going on then I was surely hopeless because not even I knew what was happening.

The point of my story is that I don't think those numbers that you used accurately portrays how fatal having low blood sugar can be. Your statement completely overlooks scenarios where people who don't have diabetes experience hypoglycemia, and it also doesn't acknowledge that people who knowingly have diabetes are more prepared for these "episodes." Having taken endocrinology I have learned about how quickly things could take a turn for the worse...

Mike —Preceding unsigned comment added by 76.180.153.183 (talk) 06:11, 12 June 2008 (UTC)

It could be argued that hypoglycemia is in fact one of the greatest killers on earth, although they usually call it starvation, and it usually causes people to die of a secondary disease like cholera first. Anyway, when it comes to people in the industrialized world, you both make good points. Maybe the article should be changed to say that while potentially fatal cases of hypoglycemia are not common, they are extremely dangerous, like stroke, and they should always be taken seriously. Something everyone should be taught is that when someone passes out, has a seizure, or even starts acting "out of their mind" for no reason; first, call 911, then give them some soda or whatever carb you have, especially if you know they have diabetes. You don't know if they are having a stroke, an epileptic seizure, or hypoglycemia; but a glass of 7-UP can't make things worse, and may save them.
--Police Cat (talk) 13:37, 13 January 2009 (UTC)

Newer sources

The sources used in this article strike me as being kind of on the elderly side. I count six from the 1980s, which is a lifetime ago when it comes to diabetes management. If someone is interested in this subject, here's a sample of recent review articles that address this issue and are also available free on the web:

• PMID 16415765 (elderly diabetics)
• PMID 16639972 (diagnosis and risks)
• PMID 16990690 (among insulin users)
• PMID 18215172 and PMID 16306561 (among Type 2 diabetics)
• PMID 18215172 (definition)
• PMID 15117175 (with intensive control)
• PMID 18227470 (prevention)

As usual, Dave Iberri's tool will quickly convert these PMID numbers to proper refs if you decide to use them. WhatamIdoing (talk) 03:42, 6 February 2009 (UTC)

Conversion shown from mg/litre to mmol/litre

This section of the article strikes me as incorrect:

This article expresses glucose in milligrams per deciliter (mg/dL or mg/100 mL) as is customary in the United States, while millimoles per litre (mmol/L or mM) are the SI (International System) units used in most of the rest of the world. Glucose concentrations expressed as mg/dL can be converted to mmol/L by dividing by 18. For example, a glucose concentration of 90 mg/dL is 5 mmol/L or 5 mM.

To convert this you actually need to divide by the molar mass of glucose, which is approx. 180 g/mol - not the 18 g/mol assumed here. I'm not sure if this was a simple typo, or the original writer of this section used the molar mass of water instead (which is about 18 g/mol).

Also, the correct SI unit here would be mg dm^-3 and mmol dm^-3, not mg/L or mM, though they are equivalent. I've left that part unaltered for now, though. —Preceding unsigned comment added by JMatopos (talk • contribs) 17:12, 14 April 2008 (UTC)

The above passage should be removed from the article, as mg/dL and mmol/L are dimensionally inequivalent, and therefore can't be alternatives to each other. Moles are not a measure of mass, whereas grams are. It must, by definition of the relevant terms (grams and moles), be incorrect. The passage, as stated, also implies that mg/dL is somehow non-SI, which is false. Grams and liters are both SI units. --76.203.3.19 (talk) 20:04, 12 July 2008 (UTC)

Both of the above are correct, mmol/L and mg/dL are different measurements, but they can be converted. In the case of blood glucose levels, to convert mmol/L to mg/dL multiply by 18. To convert mg/dL to mmol/L divide by 18.[1] However converting a mmol/L blood glucose reading to mg/dL is a different conversion to say a 5mmol/L cholesterol to mg/dL conversion, because it depends on the molecular weight of the substance involved.[2][3] As for the confusion over (non)US, the US still uses mg/dL whereas most of the world now uses mmol/L, the US is slowly moving towards mmol/L. As such I think both should be included. KristianF (talk) 17:51, 28 February 2009 (UTC)

Diabetic Coma

There are forums and medical websites. Wikipedia is not the best place for asking hypoglycemic questions. Try to get more professional advice because Wikipedia is just regular folks.

How low can your blood sugar go before a person goes into a coma? - (unsigned)

 I've gone as low as 34 mg/dL and 39 mg/dL on two occasions - measured three times with two different units both times, and while I could barely move and was unable to move out of bed, I fortunately did not slip in coma. It took several hours to recover and then I felt like I had been beaten down for days after. I also suffered mild panic attacks as I recovered. WinkJunior (talk) 01:17, 5 July 2008 (UTC)

 60 mg/dL is the definition of hypoglycemia, and glucose levels of 50 mg/dL (3 mmol/L) or so puts you at risk of coma (though there's no magic number: some people can be conscious with startlingly lower levels). -- Binky 00:33, 15 Jan 2004 (UTC)  The question is not the focus.  The question is like, "From how low of a ledge can I jump without breaking a bone?"  You don't even want to go there.  Try to manage your blood sugar.  Each patient reacts differently.  When you are in a low blood sugar episode, it is called being "symptomatic".  Some people are symptomatic at 88 one time, but at another time they are fine until 70.  People have gone very low and survived, but avoid it and do what you need to do to balance your sugar.

29 is the lowest I've gone, and no seizure or anything! Crazy times. Most home monitors say they vary by 20% off, so even if you use two you may not have an accurate reading, just a ballpark figure. But, a ballpark figure is good. Take your measurement twice over a few minutes to see if it is rising or falling. —Preceding unsigned comment added by 129.174.73.40 (talk) 03:51, 16 October 2007 (UTC)

Remember, at least in non-diabetic hypoglycemics, (I don't know about the others), emotions can bring on a low blood sugar episode. So, avoid controversy, confrontations, arguments, fear, etc... Minimize those in your life. Learn how to handle jerks or avoid the. Build a support system of people you can call before your emotions actually go over the edge. If you have a small or bad family, then if there's no one else, try to build a rapport with a few ministers or call the 24-hour community crisis line. No one is perfect; if you aren't treated well by one, then hop to another or wait and hope you get someone else next time.

The symptoms of hypoglycemia can vary much more than the list presented might indicate. I have suffered all of those listed. There is a mortal risk with low blood sugar, so anxiety is more than just a "fear" of dying. There are reasons why patients feel this way, and the reasons are very serious. Other symptoms extend to anxiety and panic, and I have also vomited on several occasions, with no other physical reason for such a thing present other than my very low blood sugar reading. Other type 1 diabetics I have come in contact with have also described a wide variety of symptoms, though many can clearly be linked to the wild release of other kinds of hormones (such as adrenaline) and their effect on the system.

In addition to the above when you begin to feel symptoms changes, for example if your blood sugar is on average quite high you will feel hypoglycaemic earlier (say 3mmol/L or 54mg/dL). Whereas if on average your blood sugar is lower you will feel hypo later (for example 2mmol/L or 36mg/dL). Note: The coma that results from a low blood sugar level(hypoglycaemia) is called a 'Insulin Coma'. The 'Diabetic Coma' in the heading is when your blood sugar levels are too high(hyperglycaemia).KristianF (talk) 18:58, 28 February 2009 (UTC)

Hypoglycemia can be fatal. Adrenal glands are like a last resort as the body struggles to find fuel with which to function. The body cuts off unnecessary functions, like the strength in your wrist or arms, and conserves the glucose for your brain and organs to keep you alive until more fuel for your cells is found.

People with low blood sugar that have other health problems like heart conditions or other vulnerabilities, especially with their organs, may have compound problems. Even young, healthy people are at risk during episodes, because they may be driving or not able to think clearly and this can cause pedestrian and vehicular accidents. Don't operate dangerous machinery or get involved in situations with no food that you cannot exit (fights, chases, elevators, away from shore, too-far walks, too far-away parking, stiff meetings, overcrowded rooms, long lines that will skew your judgment of time, productions, traffic jams, jury or other sequestrations, roads with no easements, in the sun, etc.... and none of us get drunk because that's toxic and takes hours to escape out of) unless you are prepared with a kit or pack and you are monitoring your sugar and just had a meal. The risk of dying is slipping into a coma and not receiving proper medical attention if your levels to not self-correct. WinkJunior (talk) 01:26, 5 July 2008 (UTC)

---

Blood sugar drops can feel as harrowing as actual low blood sugar. If you suddenly drop from 170 to 130, you are going to feel similar as if your reading was 70. Blood sugar relates to adrenalin, so panic is common. As someone who has suffered from blood sugar level panic attacks and anxiety attacks - for example, my blood sugar was high this morning, not dangerously so by standard levels, but enough to trigger by adrenal system, leading to an anxiety attack. Fortunately I can recognize the cause and try to deal with it. WinkJunior (talk) 01:26, 5 July 2008 (UTC)

French article is better

That article has a "causes" section which actually talks about how one is much more likely to see hypoglycemia in people taking diabetes medications (misconception: all diabetics need to constantly eat small amounts of carbs). —Preceding unsigned comment added by 18.202.1.175 (talk) 02:18, 12 April 2009 (UTC)

Fasting

Can a 24 hour fast of all foods cause Hypoglycemia which will go away after food is ingested? —Preceding unsigned comment added by 12.216.168.198 (talk) 21:54, 30 March 2009 (UTC)

• In a normal young infant, yes. Young children should be able to go 24 hours, and a normal adult should be able to maintain a glucose above 70 mg/dl for a 72 hr fast. If hypoglycemia occurs, it will be reversed by ingesting carbohydrates. alteripse (talk) 03:29, 12 April 2009 (UTC)

Contraindicated treatments

Recently, I've heard that it's contraindicated to give a patient with Hypoglycemia energy drinks such as red bull. They're supposed to induce a circulatory collapse due to their huge content of caffein. So I was wondering: is there anything you really shouldn't drink or eat in this case? --62.203.125.2 (talk) 13:08, 2 July 2009 (UTC)

Whipple's triad

There's been some concern over whether Whipple's triad is strictly related to reactive hypoglycemia, or might apply to any form of hypoglycemia.

For those not up on the terms, Whipple's triad is this:

1. Symptoms known to be caused by hypoglycemia
2. Low glucose at the time the symptoms occur
3. Reversal or improvement of symptoms or problems when the glucose is restored to normal

So the argument apparently runs something like this: the patient presents with a known insulin overdose (not a reactive hypoglycemia event). His hands are shaking, he's sweating, he's crying, he's having trouble carrying on a conversation, and so forth. A quick blood sugar test shows clearly low glucose. You feed him some sugar, and in a little while he feels much better.

In this situation, an endocrinologist is not going to say, "Eh, it probably wasn't hypoglycemia, because those criteria only apply to reactive hypoglycemia, and that clearly wasn't a reactive problem. I'll start an investigation for all the other things that might cause these symptoms." S/he is also not going to say, "Wow, insulin overdoses cause reactive hypoglycemia, because if you take too much insulin, you get Whipple's triad, and that's only reactive hypoglycemia!"

Whipple's triad may not be important for establishing non-reactive hypoglycemias any more (because we all know what happens if you take too much insulin), but it still accurately describes the reality of non-reactive hypoglycemias. Please quit deleting this accurate information. WhatamIdoing (talk) 23:45, 5 July 2009 (UTC)

Exactly why we need a disambiguation. Whipple's triad is central to the definition of the first type of hypoglycemia described immediately above (including your example insulin reaction) and is explicity rejected as a criterion for the second popular usage type of hypoglycemia. Reactive hypoglycemia is where the two forms have a slight overlap, but even in this, whipple's triad is considered necessary for the diagnosis of the first type but not the second. alteripse (talk) 02:27, 6 July 2009 (UTC)

Proposed disambiguation

I suspect some of the people check this article for facts on hypoglycemia and others check this article for facts on hypoglycemia, and clearly some commenters and presumably many readers do not understand the difference, even though the two conditions are almost completely non-overlapping, with only superficial similarities. The intro paragraphs originally attempted to explain the difference but various editors have chipped away at them over the last couple of years and the article is now confusing. In the interest of providing more accurate and clearer information I am proposing we provide a disambiguation page and allow two useful articles to coexist.

Hypoglycemia is a medical term referring to conditions involving measured low blood glucose. Most cases occur in persons with diabetes taking glucose lowering medications, but this type of hypoglycemia also results from various genetic and congenital disorders of insulin secretion, tumors, hormone deficiencies, alcohol, and several types of major organ system failure. In moderate to severe cases of this type of hypoglycemia, objective brain malfunction occurs, and occasionally permanent brain damage or death. Treatment may include ingestion of sugar, injection of glucagon, various medications, hormone replacement, or even surgical removal of part of the pancreas.

Hypoglycemia is a folk medicine and popular culture term referring to a condition usually involving a combination of autonomic symptoms and altered mood or mental function that responds to changes of eating habits. Although often popularly attributed to low or rapidly falling blood glucose due to insulin excess, these are rarely demonstrated and not required for the diagnosis. No consistently present objective measurements or evidence defines this condition. Symptoms may be dramatic and disruptive but objective neuroglycopenic effects do not occur and there is no risk of seizures, brain damage or death.

There are numerous possible references for both types of hypoglycemia, but the references for one type are quite irrelevant for the other, and few references deal accurately with both. Patients who have one type rarely have the other, and entirely different types of doctors tend to specialize in the two types. Both conditions are real and worth an article, but I would like to avoid (1) labeling that suggests one type is somehow more "real" than the other, and (2) tempting editors who have strong knowledge or opinions about one of the two types to make erroneous assertions about the other type.

So I am asking for objections to a disambiguation page and two separate articles since each type is clearly worth a separate article, and there is very little overlap of content? And useful suggestions for distinctive non-pejorative labeling? alteripse (talk) 20:00, 3 July 2009 (UTC)

I think the name you want is Hypoglycemia (alternative medicine). The altmed jargon is entirely misleading (as it has bloody nothing to do with "hypo" or "glycemia", and everything to do with the rise of this idea at a (recent) historical moment in mainstream medicine when regular physicians sloppily used hypoglycemia as a trashcan diagnosis), but it is the title they've chosen, and it's not our job to change that.

I suggest that you first expand the existing, unsourced section in this article. If/when it exceeds a stub-length description, there will be plenty of time to spin it off, leaving a summary and a {{Main}} link to the new article at the end of this one. The mainstream definition should remain at this title per WP:COMMONNAME. WhatamIdoing (talk) 05:05, 6 July 2009 (UTC)

The names are what I am wrestling with. I originally wrote this article to cover type A Hypoglycemia and included an explanation that type B was something else (see mid-2007 versions) but as you can see, the distinction was not supported by those who understand only type B. Type B has had many alternative terms, including reactive hypoglycemia, functional hypoglycemia, idiopathic postprandial syndrome, idiopathic hypoglycemia, pseudohypoglycemia, but the problem is that many of those interested in this type tend to claim it is the "main" type of hypoglycemia. It seems closest but not quite accurate to describe type B as folk medicine because because the concept arose in the 1930s among practitioners of mainstream medicine, and was explicitly separated from type A hypoglycemia by scientifically inclined doctors in the early 1970s as accumulating evidence demonstrated that type B is not a disorder of blood sugar. In other ways it perfectly fits the definition of folk medicine or a culture-bound syndrome: recognized and considered a proper disease in general American culture though nearly completely absent from medical textbooks. Type B hypoglycemia is known better to lay people than any form of type A hypoglycemia. You are correct that alt med practitioners deal almost exclusively with type B, but in the US the condition is dealt with daily by mainstream doctors in one of 3 ways— (1) by fully accepting both the label and the folk pathophysiology, (2) by recognizing the condition but attempting to educate the patient past the erroneous pathophysiology, or (3) by simply denying that it is a discretely identifiable disease. Your use of the dismissive term wastebasket diagnosis suggests to me that you favor the third approach, but I do not find that concept very constructive with either real patients or real editors. Will you support me in promulgating approach 2 as the most appropriate for Wikipedia?

Experts on type B hypoglycemia, does hypoglycemia (alternative medicine) seem like a clear and acceptable term?

I am looking for a term that is accurate and non-pejorative, and likely to be accepted by afficionados of both types. I had thought reactive hypoglycemia was the best bet, but it’s problematic because there is such a thing as reactive hypoglycemia that meets Whipple criteria (e.g., post-Nissen, post-bowel bypass), and you can see how successful I was at keeping assertions relevant only to type B reactive hypoglycemia out of the type A hypoglycemia article. Maybe we should try to start a movement to call them type A hypoglycemia and type B hypoglycemia and see if Wikipedia can influence medical terminology? alteripse (talk) 15:54, 6 July 2009 (UTC)

Wikipedia has no business promoting new terms like "Type A" and "Type B".

I agree that reactive hypoglycemia really is an as-measured-with-the-glucometer hypoglycemia -- despite the fact that some people incorrectly adopt that label for a different condition (or even normal physiology: eating only highly refined carbohydrates can produce unpleasant symptoms in anyone, including "sugar highs" and "crashes"). It is also important for us not to shoehorn all lab-verified hypoglycemias into the "reactive" label, because there are many non-reactive hypoglycemias that are lab-verified.

I still think that your first step must be finding proper reliable sources to support the existing claims. WhatamIdoing (talk) 19:06, 6 July 2009 (UTC)

I was joking about calling them type A & B in the articles, but it sure makes the discussion a lot simpler and less ambiguous, doesnt it? Maybe I will publish a review article and introduce the term in a medical journal (sort of like type A and B lactic acidosis)... I have plenty of references for both types that document every assertion I made above, but rather than just adding references to the entropic mess it has become, I was trying to figure out a better way to keep both topics unconfused than has been the case over the last couple of years. Let's see if we can get an opinion from at least one of the type B "experts" before I do the disambiguation. alteripse (talk) 19:22, 6 July 2009 (UTC)

I am concerned that I have not been clear: I refuse to support any move that puts the mainstream medical use of this term on any page other than plain Hypoglycemia. This article must maintain all mainstream information. It can link to a separate article on the altmed concept, but it cannot become a two-line "If you're looking for mainstream, click here, and if you're looking for the altmed idea, click there" disambiguation page. Am I clear? WhatamIdoing (talk) 22:07, 7 July 2009 (UTC)

I wrote nearly all of this article to begin with, as you will see if you check the history-- and it was exactly as you demand, an article on the real low blood sugar form of hypoglycemia. The biggest defect was that it had only a few references, but at the time i wrote it most scientific articles on WP were minimally referenced. It included the central importance of the concept of Whipple criteria and at the end of the introduction distinguished low blood sugar hypoglycemia from the American folk medicine form of hypoglycemia diagnosed by symptom list and self-diagnosis. And immediately drive-by anonymous editors began to degrade the distinction. You can see how many of the comments on this talk page reflect the fact that few people with an interest in type B hypoglycemia know enough about carbohydrate physiology to leave basic facts unmolested. Eventually I got tired of defending it and the current state reflects nearly 2 years of undefended entropy. I suspect we can maintain a decent type A article if we provide an attractive alternative hypoglycemia article for the type B editors to leave their opinions in and we have a few people willing to exclude the irrelevancies. That's why i was searching for a term that would be considered more acceptable than folk medicine (which is objectively accurate but people always want "folk medicine" to apply only to "other folk"). So perhaps your suggestion of hypoglycemia (alternative medicine) would be better; I have a bit of fear that some type B editors will reject the term but I would be happy to be wrong. I am not especially interested in playing rounds of "trump my credentials" with someone who doesn't do this for a living but was trying to confirm basic support for repairing this article from any recent editors with a modicum of scientific literacy. If I can't even sell you on this, it's probably not worth my trouble. Are you on board? alteripse (talk) 02:08, 9 July 2009 (UTC)

Separate articles works for me. If the altmed people don't like the name, the page can be moved.

I suspect that the real source of entropy is not with altmed people, though, but with people that have lab-verified hypoglycemia and then attribute every unpleasant symptom to that, regardless of the plausibility of the connection. (The phenomenon happens in every other disease, and there's absolutely no reason to assume that people with hypoglycemia are magically more informed than other people, or that they find that identifying an explanation, no matter how specious, to be less powerful than anyone else.) WhatamIdoing (talk) 02:01, 13 July 2009 (UTC)

Some of that no doubt, but we'll have to see if we can confine it at reactive hypoglycemia. I asked one other editor who is mainly interested in type B and has included some links suggesting more of a shared perspective with the alt med folks to give an opinion as to preferable terminology. I was going to give her a couple of days to look this over and give an opinion before I make a major change. And JFW and I made you a jenuwine good faith offer on your talk page... alteripse (talk) 02:17, 13 July 2009 (UTC)

I don't understand why you want to "confine it at reactive hypoglycemia." If someone has an insulin-producing cancer, and they blame "hypoglycemia" for the symptoms actually produced by the tumor (i.e., symptoms that are present even when the blood sugar has been sustained at normal levels for an extended period), then why would we want to include any of that at reactive hypoglycemia? It has nothing to do with reactive hypoglycemia. If someone has hypoglycemia due to an extended period of fasting, then what does that have to do with reactive hypoglycemia? This doesn't make sense. WhatamIdoing (talk) 04:04, 13 July 2009 (UTC)

What I meant is that nearly all the disputed changes were offered by editors interested in reactive hypoglycemia, with the exception being those who wanted to add one more symptom variation to the long list. I think an excessively long list of slight variations on neuroglycopenic symptoms doesnt add much to the article, but I chose not to fight over that. Much more damaging to the sense of the article are those who confuse types A and B. Nearly all of that can be confined to either the reactive hypoglycemia article or the hypoglycemia (alternative medicine) article. If it doesnt make sense yet, watch what happens and it will. alteripse (talk) 04:40, 13 July 2009 (UTC)

I’m coming in fairly late in the discussion here, but I hope I can add some useful input. I originally came to Wikipedia as a starting point to research my condition (which I believed at the time was “reactive hypoglycemia”). I would have appreciated at the time a clear distinction between the different types of hypoglycemia so that I didn’t unnecessarily have to worry. I’m going to go so far as to say The Wikipedia article as I found it was alarmist and confusing! I thought I had prediabetes and was at risk of coma and death. Then I thought I might have the type-B, and that it was “all in my head.” It took some dogged research to figure out they were two distinct entities. Therefore, I believe a disambiguation page is necessary. I think Wikipedia is here to provide a starting point for research and in its current form it just confuses.

Approach 2 seems to the most appropriate for Wikipedia. Hypoglycemia (alternative medicine) seems acceptable to me as long as the article covers the fact that although hypoglycemic symptoms appear, the actual blood sugar drop does not. I think the term “reactive hypoglycemia” should apply only to hypoglycemia that occurs in relation to food intake. Brit67chick (talk) 14:33, 16 July 2009 (UTC)

An ancient source?

In the Mishnah (that is the early section of the Talmad) there seems to be reference to Hypoglycemia. In Yoma 8:4 it mentions a desiese called "bulmos" which occurs from fasting. its treatment is eating and this must be done at the onset because it the deseise is extremely dangerous. Comentators note that the symptoms include blurred vision and paleness. it seems like Hypoglycemia to me. if anybody would make a history section i recomend that they include this possible source. —Preceding unsigned comment added by 98.140.123.161 (talk) 00:16, 9 January 2009 (UTC)

We'd have to have a reasonably modern source that asserts that this is probably hypoglycemia (and not, say, maple syrup urine disease). WhatamIdoing (talk) 19:27, 14 March 2009 (UTC)

MSUD causes other problems. I like the description if it can be verified. There is a higher incidence of congenital hyperinsulinism in both the Ashkenazi and Bedouin populations due to some founder mutations but I am not sure how far these can be traced back. What is the age range for the Mishnah, and can someone provide a definite citation for verification? This is a far better description of a recurrent hypoglycemic disorder than the Biblical reference (Esau giving up his birthright for food) that is usually trotted out for this purpose. alteripse (talk) 22:27, 14 March 2009 (UTC)

Here's the passage, which sounds like a good description of hypoglycemia. http://www.ou.org/pdf/luach/2003/luach0103.pdf I lack the background knowledge to date this. What era does it reflect? Is the hebrew word transcribed as bulmos really a derivative from a hellenic word for hunger? alteripse (talk) 16:18, 11 July 2009 (UTC)

It looks like this is bulimia. (Hypoglycemia of the sort induced by fasting is unpleasant, but it's not actually life-threatening.) WhatamIdoing (talk) 01:54, 13 July 2009 (UTC)

Thanks for reference-- I wish the footnote referring to "honey and sweet cakes" were itself referenced. See talk:Mishnah#need background info from a mishnah expert for why. Although bulmos seems to be a linguistic cognate of bulimia, both derived from bulimos, the condition is not what we would consider bulimia (induced purging for weight control). alteripse (talk) 00:19, 20 August 2009 (UTC)

Hypoglycemia

My mother often had hypoglycemia, and, unfortunately, she passed it on to me. I have it a LOT. If I eat anything with sugar in it in the morning, I get sick during the day. So, to be safe, I eat Cheerios every day of my life. :( I had 7 years Perfect Attendance until last year, when I got extremely sick and had to go home early. Ugh.

Even cheerios are medium-glycemic carbs. You might try a high protein/low carb diet with low carb veggies and vitamin supplementation-- that may make you feel even better (but keep the meals small and eat 5 or 6 times a day because even protein if eaten in large quanitities can be converted to glucose by the body).

Phil

67.42.243.184 17:59, 8 January 2007 (UTC)

The above statement seems to imply that hypoglycemia is an inherited genetic trait. I also suffer from hypoglycemia, and my mother and grandmother have it too. However, I don't recall seeing anything in this article about whether or not the condition is congenital. Is that my oversight, the oversight of the writers, or is the congenital nature of hypoglycemia a myth? 69.168.108.191 18:13, 29 June 2006 (UTC)

As the article states, there are hundreds of causes and types of hypoglycemia, some inherited and congenital, some inherited but not congenital, some congenital but not inherited, and many that are neither. How can we make it clearer? alteripse 19:44, 29 June 2006 (UTC)

Hypoglycemia can also be caused by the ADD/ADHD medicine Aderall. I have ADD and take Aderall and an effect of the Aderall is Hypoglycemia. Although my case of Hypoglycemia is nearly as bad as the people who have Diabetes. —Preceding unsigned comment added by 76.106.14.148 (talk) 03:31, 30 January 2010 (UTC)

explanation of ongoing changes

I am trying to make two better articles rather than one confusing and contradictory article. The main article about hypoglycemia will be from a medical perspective and about the types of hypoglycemia characterized by measured low glucose (Whipple criteria). The second article will be entitled hypoglycemia (alternative medicine) and will be about the type of hypoglycemia characterized by shakiness, moodiness, brain fog, crashes, and so forth, a condition for which a low blood glucose at time of symptoms is not required for diagnosis, carries no risk of death or brain damage, and which is treated mainly by diet changes rather than glucose, glucagon, drugs, hormones, or surgery. I will take out of this hypoglycemia article any material that is purely about hypoglycemia (alternative medicine) and park it here so it can be used in that new article. I am open to a different term for the article on hypoglycemia (alternative medicine) as I am trying to respect and preserve this body of cultural knowledge, but to mix it in this article simply confuses and misleads readers looking for one or the other. I will reference this article carefully, but feel free to ask questions or make suggestions here. alteripse (talk) 01:21, 16 July 2009 (UTC)

Just a commment: I made a change in the article that was later deemed to be incorrect. Since it doesn't really matter much, I'll post the correct again here, but it's not worth the time to argue much about it. Again-- ColOmbia is the country. ColUmbia is the university or the district. If someone is correcting someone else, they should learn their geography. —Preceding unsigned comment added by 74.72.176.193 (talk) 14:44, 2 November 2009 (UTC)

The body of this article is confusing and needs an extensive rewrite. The lead is fairly good Hypoglycemia is a condition of low blood sugar. Maybe move more of the alt med stuff to a section on society and culture?Doc James (talk · contribs · email) 01:21, 18 May 2010 (UTC)

references

I am parking these here before adding them to the article.

TYPE A HYPOGLYCEMIA

new definitive coverage of hypoglycemia occurring in people w diabetes

best overview of hypoglycemia in adults (weak on children); no single Engl lang text on the general topic has been published since, and Cryer continues to be the go-to authority for the major endocrine texts and the recent Endocrine Society diagnostic guidelines on adult hypoglycemia

collection of papers presented at a symposium in Rome that was one of the last academic attempts to deal with reactive hypoglycemia as a type A topic

Hofelt was a respected endocrinologist who spent considerable effort trying to understand reactive hypoglycemia from a sympathetic scientific perspective

a bit old, but Danowski was one of the principal american authorities on hypoglycemia in the 1960s and early 70s. he argued influentially that reactive hypoglycemia could be part of the prodrome for type 2 diabetes. this was actually the first american book on type A hypoglycemia, but still reflects pre-1973 teachings on type B.

the first book length treatment by Jack Service at Mayo, one of the current authorities on adult hyperinsulinism

mostly historical interest, but provides documentation of the european perspective

this was the 3rd and last edition of the principal book on hypoglycemia in infants that was considered the authoritative treatment of the field from the late 1960s to the early 90s.

good overview of the research on hypoglycemic brain damage

still the most comprehensive text on the topic of diabetic hypoglycemia; Cryer's 2008 text updates the topic

TYPE B HYPOGLYCEMIA

I've cleaned up the list so that the refs will be read to copy and paste without the stray blank lines. I note that most of the second section are much too old to be relied upon. Books published in the 1960s and 1970s do not present the current thoughts of anything, even in altmed contexts. WhatamIdoing (talk) 22:27, 7 July 2009 (UTC)

Thanks for clean up, but don't spend a lot of time on it since they are not going to stay here. You are actually quite mistaken that 1970s books do not represent current thinking on type B hypoglycemia. The alt med stuff does not age-- the "golden age" of hypoglycemia was about 1968-1980 and I challenge you to remove the copyright dates from any of those books and decide what decade they were published in. Many are still in print. I probably won't use all of them for article references but I do not want anyone accusing me of not being familiar with the literature on both types. I cannot think of a single new advance in the concepts and treatment of type B since the 1970s (except many of them have adopted the glycemic index as a good thing). I am open to correction if anyone can offer any advances-- not even evidence based-- just a change of fashion. Stuff that good just doesnt go out of style! And in contrast, give me any paper on type A hypoglycemia since the 1960s, cover the date, and I bet I could tell you to within 5 years when it was published. alteripse (talk) 00:21, 8 July 2009 (UTC)

This seems like the debate over emotional shock ( ie. I was scared and went into shock ) vs medical shock ( ie he lost 2 - 3 l of blood and is now in shock ).Doc James (talk · contribs · email) 01:32, 18 May 2010 (UTC)

Mainstream approach

The medical literature divides the approach to hypoglycemia into those with diabetes were the main issue is treatment and those without diabetes were the main issue is determining the diagnosis. Uptodate has some great articles if anyone is interested.Doc James (talk · contribs · email) 01:39, 18 May 2010 (UTC)

References

As much of the text is unreferenced I will be referenced text. If references are available please add them for verification. Hope to rewrite this based on review articles. Doc James (talk · contribs · email) 01:54, 18 May 2010 (UTC)

The basic version of this was based on review articles. Adding refs would be helpful and appreciated. I have no desire to argue over heading style, so have it your way. However, vague and pointless platitudes like "good nutrition and prompt intake is essential" was considerably less clear and pointed than what it replaced. Nothing in this article except some of the added junk about reactive hypoglycemia is incompatible with your favorite review sources. Rather than remove correct but unsourced material, why not improve the article with references? Before you get too critical of my style and organization take a look at the original article I rewrote severa l years ago. alteripse (talk) 02:31, 18 May 2010 (UTC)

I have returned the review which I added. It does need a bit of updating and more referencing throughout so that the text can be verified. I will see what I can do.Doc James (talk · contribs · email) 04:01, 18 May 2010 (UTC)

hypoglycemia

Get familiar with how to measure your blood sugar so that you can enjoy normal activities. Remember to eat in the best ways for hypoglycemics and carry remedies and instant meal substitutes like bars and drinks. These might cost more, or you can cook from scratch. Otherwise you could be like the youngster below:

i got hypoglcemia from my grandmother, i didnt know i had it intill i got my bracese on ive gone 13 yaers without knowing that i had it. it seems to get better but then it gets worse. whenever i have the attack im in p.e. or during lunch when im about to eat. that is why its very important to eat in the morning or eles youll never know when it will hit you ether in the buzyest of times or the weakest of times. to me it kinda sucks because i cant ever do the things i love now like hang with my friends or swim or go on late night walks with my cousin. —Preceding unsigned comment added by 209.147.123.72 (talk) 19:12, 22 September 2010 (UTC)

News Media Reporting New Discovery Related to One Form of Hypoglycemia

It's for a relatively rare form of juvenile hypoglycemia, but it may also shed light on some of the more common yet enigmatic forms of hypoglycemia.

This should be a good citation source, http://www.bbc.co.uk/news/health-15196926

98.245.172.142 (talk) 06:14, 9 October 2011 (UTC)

There are many potential causes of hypoglycemia. You can research these by doing online searches. There may be over 20 causes. Liver desease is one of them.

Liver disease Acute liver failure can also cause hypoglycaemia. The liver can't metabolise insulin as well so it hangs around the body, and lowers the blood sugar. Impaired gluconeogenesis and decreased glycogen breakdown don't help either. 217.44.242.224 (talk) 09:47, 22 April 2012 (UTC)

Added cause

I added a cause of iatrogenic hypoglycemia recently but I don't know how to reference it. Basically it was a pharmacy refill error that happened to me. I received a sulfonylurea instead of my usual estrogen pills (they look alike) and wound up in the ER with a blood sugar of 22. After a perceptive resident asked if I had had any prescriptions refilled lately I realized that five days earlier I had gotten a new batch of pills that looked "slightly' different. Indeed that turned out to be the cause of my hypoglycemia- 90 glimeperide instead of 90 1 mg estrogen. So how do you reference personal experience in Wikipedia? I am sure this would make a nice news article but I am not going to the press with this (am waiting for a settlement from CVS, though).Ilindb (talk) 21:09, 28 June 2013 (UTC) Cases of accidental sulfonylurea hypoglycemia have been reported in the medical literature back to the 1950s, including those do to pharmacy dispensing error. But thanks. alteripse (talk) 02:53, 30 June 2013 (UTC)

Emotional lability

>Neuroglycopenic manifestations

Abnormal thinking, impaired judgment....Personality change, emotional lability.

Could someone please translate "emotional lability" from medical speech to everyday reader speech? And if that's a misspelling and should be "liability" could that then be translated instead? Thank you. Rissa, copy editor (talk) 04:05, 11 January 2015 (UTC)

alchol consumption

</ref></ref>an dibetic can consume alchol? if so which product brandy, wishky or beer which is better?

This isn't the place to ask that kind of question. You should go see your doctor or local health clinic and ask him or her. Rissa, copy editor (talk) 04:08, 11 January 2015 (UTC)

The impact of hypoglycaemia on cardiovascular outcomes

Review doi:10.1161/CIRCULATIONAHA.115.015946 JFW | T@lk 09:28, 15 December 2015 (UTC)

Systematic review

Glucose tablets work better than dietary carbohydrates in awake patients doi:10.1136/emermed-2015-205637 JFW | T@lk 13:33, 22 January 2017 (UTC)

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Alcohol

The opening says that hypoglycemia is more common in alcoholics who have taken alcohol, and then goes on to say hypoglycemia is more common in alcoholics who have taken drugs "including alcohol". Is not this being unnecessarily repetitive?Vorbee (talk) 14:19, 21 August 2017 (UTC)

The first is in those with DM who have drunk ETOH. The second is ETOH by itself. Doc James (talk · contribs · email) 07:35, 23 August 2017 (UTC)

Box in top right-hand corner

The box in the top right-hand corner of this article says that treatment of hypoglycemia may be eating simple sugar foods, such as glucagon. It could mention that in severe cases of hypoglycemia, a sugary drink such as lucozade may be drank, as this will increase blood sugar more quickly. Following ingestion of quick-acting carbohydrates, ingestion of long-acting carbohydrates (typically starch-based carbohydrates) should be taken to ward off risk of further hypoglycemic episodes. N.B. I AM NOT A MEDICAL DOCTOR - just a diabetic who has had to cope with Type One Diabetes Mellitus for a good part of my adult life. Vorbee (talk) 17:00, 21 August 2017 (UTC)

Those are three individual treatments. Glucagon is not a simple sugar. Doc James (talk · contribs · email) 07:35, 23 August 2017 (UTC)

External links modified

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Types

Can u please describe all the types of hypoglycemia.. — Preceding unsigned comment added by Mjmanan (talk • contribs) 15:10, 26 March 2018 (UTC)

Hypoglycemia: Symptom v Condition

This article is describing the symptom and physiological occurrence of low blood sugar, however there is also a group of conditions known as "hypoglycemia" which do not yet have a page to themselves.

The Diabetes article at my time of writing states "Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time.[11]" These hypoglycemia conditions are characterised by low blood sugar level. I have a draft page for fasting hypoglycemia and there was an existing page for reactive hypoglycemia. (There are many other pages, some of which do not include hypoglycemia in its name--but those conditions' effect on the body is hypoglycemia.)

I want to create an article/draft that can list and explain together the varieties of hypoglycemia conditions as a whole. Could anyone help me with choosing the best name this new article about hypoglycemia? How can the existing Hypoglycemia article be improved to express these two different concepts of hypoglycemia (and link them together?) These are things I would like help with, or if you decide to begin this yourself, please let me know! I will gladly contribute! CastellamareAsh (talk) 05:00, 17 June 2020 (UTC)

Low sugar and prolonged fasting

It should be noted that prolonged fasting (> 4-5 days) may lead to blood sugar somewhere between 3-4 mmol/l without any (major) symptoms. When combined with certain type of physical activity the glucose level may go even lower (from my personal experience it may be as low as 2.5mmol/l!) with only very mild symptoms. This seems to be due to the fact that during a prolonged fast the body adapts itself to take its energy from the fat-cells through ketogenesis so that the need for a glucose is much lower and thus such low level of blood sugars doesn't pose a life-threatening condition.

It would seem to me that under such condition the low blood sugar should not be treated the same way (diabetic) hypoglycemia is treated. The standard treatment by taking mono- or dissacharides may even be dangerous as it may trigger the refeeding syndrom by increasing insulin (especially when fasting for a couple of weeks). Sadly, from what I known, medical professionals are rarely taught about the physiology of fasting/starvation in the medical schools as it is nowadays not common to find a patient with this condition. — Preceding unsigned comment added by 79.194.26.235 (talk) 21:31, 15 February 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article is currently the subject of a Wiki Education Foundation-supported course assignment, between 10 January 2022 and 4 February 2022. Further details are available on the course page. Student editor(s): NM UCFCOM.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:10, 17 January 2022 (UTC)

Project WikiMedicine Edits

Hello Wiki Community! My name is Nicole and I am a fourth year medical student currently enrolled in Project WikiMedicine at the University of Central Florida College of Medicine. Throughout the next 2-3 weeks I will be editing this article and receiving feedback in a peer review integrated into my course. Below you will find my work plan for this topic. A bulk of my focus will be streamlining/updating the information, removing jargon, and addressing/removing plagiarism.

• Article Organization: In accordance with the Manual of Style from Project WikiMedicine, a section for “Definition” will be added; a section for “Differential Diagnoses” will be added, thus shifting that topic from Section 4 Diagnosis into its own section; Section 4 Diagnosis will be renamed “Diagnostic Approach;” a section on “Epidemiology” will be added.
• Introduction: This section has a great start with a lot of information - I plan to shorten this section to make it more succinct focusing on the definition, causes, prevention, and treatment, with language that is geared towards the general population. I will update citation #1 from the National Institute of Diabetes and Digestive and Kidney Diseases, as it leads to an archived version of the website as opposed to the most recent version. This is one of my main references found in my literature search as well, so I am glad resources align.
• Addition of Definition section: I see value in this being an individual section, as hypoglycemia can be a serious situation and so the easier it is to find relevant information quickly, the better for the individual seeking the information.
• Addition of Differential Diagnosis section: I would like to move the Differential Diagnosis subsection from the Diagnosis section into its own separate section in accordance with the Project WikiMedicine Manual of Style. I plan to add other relevant diagnoses, as this section only has the mention of alcohol intoxication.
• Signs and symptoms: I plan to transform the lists of adrenergic and neuroglycopenic symptoms into a streamlined table, and will simplify or define some jargon. The bulk of this section is without citations, so information will be cross-checked and properly cited as well. Seemed to be very closely sourced from “Critical Issues and Diabetes” with concerns for plagiarism. I also plan to make a subsection for hypoglycemic unawareness. I plan to remove the paragraph beginning with “Recovery from severe hypoglycemia” and the subsection on Long-term effects, in order to declutter some of the irrelevant information included in this section.
• Causes: I like how this section begins with the most common cause of hypoglycemia – this will be further elaborated to include that people may take insulin in preparation of a meal then not consume that meal. I will separate the causes into subsections related to Diabetic Causes vs. Non-Diabetic causes. The current subsections on Serious Illness and Hormone Deficiency will be moved under Non-Diabetic Causes. I will also add surreptitious use of insulin and a brief overview of inborn errors of metabolism.
• Pathophysiology: This section will be updated with appropriate references as it is largely unreferenced and seems to be directly pasted from the following sources: http://keymedinfo.com/site/667KeyM/8.0_Hours_Diabetes_and_Hypoglycemia_Self_Study_2015_for_Posting.pdf and https://www.chemeurope.com/en/encyclopedia/Hypoglycemia.html. The focus is largely on how hypoglycemia affects the brain discussed at a very advanced level, as opposed to a focus on the pathophysiology of hypoglycemia. Due to copywrite and plagiarism concerns, this section will be revamped. Perhaps the author of that section would like to make the discussion on neural effects a separate section within the article, upon reworking the language and proper references? Thoughts?
• Diagnostic Approach: Plagiarized sections will be removed (portions seem to be from: http://hackmydiabetes.com/2021/11/21/normal-values-of-blood-glucose-level-pdf/ ), however I will attempt to find the source of unreferenced information to maintain some of the content while cross-checking the content with current literature, adding appropriate phrasing, and adding citations. The Differential Diagnosis subsection will be removed and made its own section in accordance with the Project WikiMedicine Manual of Style.
• Prevention: Information will be cross-checked and properly cited; language will be updated in order to be geared towards a more general audience.
• Treatment: I will switch the order so that Treatment is placed above Prevention to improve the general flow of the article. This section has very helpful information in terms of treatment, so uncited information will be again cross-checked and updated based on current treatment guidelines.
• Addition of Epidemiology section: This will be added in accordance with the Project WikiMedicine Manual of Style.

Looking forward to this work and improving this important page! Open to any feedback and thoughts. NM UCFCOM (talk) 15:16, 12 January 2022 (UTC)

Hi Nicole!

I think you did a fantastic job improving this article! You've added a lot of previously lacking information, resulting in a more comprehensive article. In addition, I think the article's organization made the topic easy to follow, and I didn't find myself having to jump back and forth between different sections to understand the information.

-Lead section: succinct and provided a good overview of the topic.

-Definition: I think the addition of Whipple's triad is beneficial for patients and their families to learn what signs/symptoms they can look out for to recognize a possible hypoglycemic episode.

-Signs & symptoms: I especially like the table you created explaining adrenergic and neuroglycopenic symptoms. This graphic was helpful and made it easy for me to quickly categorize and understand the differences between the symptoms without being too technical.

-Medications that can cause hypoglycemia in diabetics: Perhaps some of the pharmacologic properties of the different medications (peak action, peak steady-state of action, half-life, etc.) may be too technical for the average Wikipedia reader unless there is a more straightforward way to explain the meanings and significance of these terms.

-In the "causes" section, it may be difficult for an average reader to understand the roles of various hormones involved in glucose regulation. This seems like a tricky part of the article to write since discussing hormones can become very technical. Perhaps some of this information can be explained briefly in the "pathophysiology" section?

-Pathophysiology: although this suggestion does not coincide with the guidelines from Wikipedia's manual of style, I think the article could benefit from moving the "pathophysiology" section to earlier in the article. A lot of important information/concepts written in the pathophysiology section might make the rest of the article easier to understand since there will be context.

-Sources of measurement errors: I'm not sure that most of this information is relevant to or significant for the average Wikipedia reader and may be too technical.

-Treatment and prevention: these sections were my favorite additions to the article! I think this information is vital for both patients and their families, co-workers, etc. because helping someone become familiar with interventions and feel more prepared to act in these situations can improve patient outcomes. You did a fantastic job providing this education and making it easily understandable!

I really enjoyed reading your article and I think others will too. Good work!

Rnr11b (talk) 05:53, 2 February 2022 (UTC)

Hi Rachel,

Thank you so much for your wonderful feedback! I really appreciate the time you to took to read the article and provide your helpful insights! I equally value your complements and constructive comments.

Medications: I went ahead and removed the information on timing/half-life/peak action, because I certainly agree it was a bit too technical for our readers.

Pathophysiology & Causes: I love your suggestion to be bold and move the Pathophysiology section higher in the article to help improve our readers understanding. I agree that reading this section before the Causes section helps to provide valuable insight for the Causes section. I also defined some additional terms in the Pathophysiology section like "insulin" and "glucagon" - that was an excellent suggestion to provide our readers a toolkit of the basic terminology surrounding the hormones involved in these processes!

Sources of Measurement Error: I also agree that perhaps this information is beyond the scope of the article. I went ahead and removed this subsection.

Again, thank you so incredibly much for being my peer reviewer and helping me with the article! :) NM UCFCOM (talk) 21:58, 2 February 2022 (UTC)

Jameson (2008) needs verification and clarification

The Epidemiology sections says that hypoglycemia causes death in 6-10% of people with T1 diabetes. It sounds high, and [4] gives the number 6 % for "dead in bed syndrome" for people under 40 which is where the 6 % figure might come from. Please check the source to see if the 6-10% number is total or restricted to some age group.

Also, "treatment assistance" is an unclear term; what does it mean? And the sentence reads as if the source says that all T1 diabetics suffer from one such episode per year, which I find very doubtful. Sjö (talk) 06:39, 5 June 2022 (UTC)

hypoglycemia cause query

why is there no mention of anorexia as a cause of hypoglycemia in non-diabetic individuals? 2601:547:C503:DD50:9D45:B365:C8A4:A05D (talk) 17:33, 5 February 2023 (UTC)