Neurogenic hypoglycemia

It is necessary to distinguish between neuroglycopenic symptoms, which occur due to a deficiency in the supply of glucose to the brain, and symptoms caused by compensatory stimulation of the sympathoadrenal system. The former are manifested by headache, inability to concentrate, confusion, and inadequate behavior. In cases of increasing hypoglycemia - convulsions, comatose state. The latter include palpitations, nausea, agitation, anxiety, sweating, trembling in the body, and a strong feeling of hunger. These symptoms, as a rule, are harbingers of a hypoglycemic attack. The patient can interrupt them by taking glucose.

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Causes neurogenic hypoglycemia

Idiopathic hypoglycemia after meals in young women is distinguished. Its genesis is unclear. It is also unclear whether it should be classified as neurogenic hypoglycemia. Hypoglycemia can be observed as a result of long periods of abstinence from food, alternating with periods of bulimia, with the intake of carbohydrate-rich food. The hypoglycemic state in this case is determined by an excessive carbohydrate load and precedes new episodes of bulimia. It is observed within the framework of nervous anorexia and nervous bulimia syndrome.

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Pathogenesis

Of importance is the disruption of hypothalamic control over carbohydrate metabolism with a decrease in counter-insular hormones (mainly STH, ACTH, cortisol), which leads to an increase in insulin levels and hypoglycemia. However, only in rare cases can the full picture of isolated hypoglycemic syndrome be attributed to damage to the hypothalamus. The localization of CNS damage in neurogenic hypoglycemia has not been definitively established.

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Symptoms neurogenic hypoglycemia

There are two types of hypoglycemia: fasting hypoglycemia (a more severe form) and postprandial hypoglycemia. It is important to differentiate these types of hypoglycemia, as fasting hypoglycemia can be accompanied by life-threatening conditions and requires careful medical supervision. In addition, the treatment tactics for these conditions are different.

For practice, it is convenient to use the following criteria for identifying fasting hypoglycemia:

1. blood glucose levels in adult men and women after overnight fasting are below 50-60 mg%;
2. After 72 hours of fasting, plasma glucose levels in men are below 55 mg%, in women - below 45 mg%.

A milder form of the disease is postprandial hypoglycemia. It occurs 2-3 hours after eating and is mainly manifested by complaints of the asthenic circle. Postprandial hypoglycemia is mainly observed in women aged 25-35. When conducting a glucose tolerance test, the lowest glucose level (and corresponding symptoms) is usually observed 3-4 hours after eating, followed by a reactive increase in blood sugar levels. Subjective improvement in the condition associated with glucose intake is not a specific sign of hypoglycemia, since glucose intake can act by placebo mechanisms. The main diagnostic technique is to identify a correlation between hypoglycemia symptoms and a simultaneous decrease in blood glucose (usually below 50 mg%). Therefore, when the corresponding symptoms appear, it is recommended to take a blood sugar test before trying to relieve the symptoms by administering glucose.

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Differential diagnosis

Differential diagnosis should be made with conditions accompanied by hypersecretion of insulin in islet cell tumors producing insulin (insulinoma); with extrapancreatic tumors causing hypoglycemia (fibromas, fibrosarcomas, neuromas of retroperitoneal and mediastinal localization); with liver forms of hypoglycemia (in viral hepatitis, congenital liver pathology in the form of glycogenesis and deficiency of gluconeogenesis enzymes); with forms of hypoglycemia in pregnant women, newborns in combination with ketosis, with uremia, with severe malnutrition; with forms of renal glucosuria; autoimmune insulin hypoglycemia; early stages of diabetes mellitus; hypoglycemia due to insulin overdose and alcoholic hypoglycemia. Postprandial hypoglycemia may be observed in patients who have undergone surgery on the gastrointestinal tract (after subtotal gastrectomy).

Chronic hypoglycemia is often observed in states of fear, anxiety, various forms of neuroses, schizophrenia, and depression. It is possible to develop a hypoglycemic state in response to acute emotional stress. Hypoglycemia can be observed in subdural hemorrhage, but the mechanisms of hypoglycemia development are unclear. A tendency to hypoglycemia is observed in growth hormone deficiency (hypopituitarism, isolated growth hormone deficiency) and cortisol deficiency (hypopituitarism, isolated ACTH deficiency, Addison's disease), in obesity accompanied by hyperinsulinemia.

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Treatment neurogenic hypoglycemia

In case of hypoglycemia after eating, it is necessary to establish a diet (frequent, fractional meals) with carbohydrate restriction. This is the main therapeutic tactic for hypoglycemia after eating.

In case of fasting hypoglycemia, carbohydrate restriction is contraindicated. The insulin secretion inhibitor dilatin and anaprilin in individually selected doses have a beneficial effect. However, the latter should be used with extreme caution, as it can cause hypoglycemia in some patients. Most likely, anaprilin blocks the symptoms of hypoglycemia, but does not eliminate it completely. In any case, it is necessary to treat the underlying disease that caused hypoglycemia.