Neurogenic hypoglycemia

Neuroglycopic symptoms occurring due to a deficiency in the supply of glucose to the brain, and symptoms caused by compensatory stimulation of the sympathoadrenal system should be separated. The first are manifested by headache, inability to concentrate, confusion, inadequate behavior. In cases of increasing hypoglycemia - convulsions, coma. The second are heartbeat, nausea, agitation, anxiety, sweating, trembling in the body, a strong feeling of hunger. These symptoms are usually harbingers of a hypoglycemic attack. The patient can break them, taking glucose.

[1], [2], [3]

Causes of the neurogenic hypoglycemia

There is idiopathic hypoglycemia after eating in young women. Its genesis is unclear. It is also unclear whether it should be attributed to neurogenic hypoglycemia. Hypoglycemia can be observed as a result of long periods of abstinence from food, alternating with periods of bulimia, with intake of carbohydrate-rich food. The hypoglycemic state in this case is determined by the excessive carbohydrate load and precedes the new episodes of bulimia. Observed within anorexia nervosa and bulimia nervosa syndrome.

[4]

Pathogenesis

A violation of the hypothalamic control of carbohydrate metabolism with a decrease in contrainsular hormones (mainly GH, ACTH, cortisol), which leads to increased insulin levels and hypoglycemia. However, only in rare cases, the expanded picture of an isolated hypoglycemic syndrome can be attributed to the defeat of the hypothalamus. Localization of damage to the central nervous system in neurogenic hypoglycemia has not been definitively established.

[5], [6], [7]

Symptoms of the neurogenic hypoglycemia

There are two types of hypoglycemia: fasting hypoglycemia (more severe form) and hypoglycemia after eating. It is important to differentiate these types of hypoglycemia, since fasting hypoglycemia may be accompanied by life-threatening conditions and requires careful medical monitoring. In addition, the treatment tactics of these states is different.

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

1. blood glucose level in adult men and women after an overnight fast below 50-60 mg%;
2. after a 72-hour fast, plasma glucose levels in men are below 55 mg%, in women - below 45 mg%.

A milder form of the disease is hypoglycemia after eating. It occurs 2-3 hours after a meal and is mainly manifested by complaints of the asthenic circle. Hypoglycemia after eating is mainly observed in women 25-35 years old. During the glucose tolerance test, the lowest glucose level (and the corresponding symptoms) is observed, as a rule, at 3–4 hours after a meal, followed by a reactive increase in blood sugar levels. The subjective improvement associated with glucose intake is not a specific sign of hypoglycemia, since glucose intake can act on placebo mechanisms. The main diagnostic technique is to identify the correlation of symptoms of hypoglycemia with a simultaneous decrease in blood glucose (usually below 50 mg%). Therefore, it is recommended to take a blood test for sugar before the appearance of appropriate symptoms before trying to relieve symptoms by administering glucose.

[8]

Differential diagnosis

Differential diagnosis should be carried out with conditions accompanied by insulin hypersecretion in insulin producing islet cell tumors (insulinoma); with extrapancreatic tumors that cause hypoglycemia (fibromas, fibrosarcomas, neuromas of retroperitoneal and mediastinal localization); with hepatic hypoglycemia (with viral hepatitis, congenital liver disease 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; hypoglycemia due to insulin overdose and alcoholic hypoglycemia. Hypoglycemia after eating can be observed in patients who have undergone surgery on the gastrointestinal tract (after subtotal gastrectomy).

Chronic hypoglycemia is often observed in conditions of fear, anxiety, various forms of neurosis, schizophrenia, and depression. Perhaps the development of a hypoglycemic state in response to acute emotional stress. Hypoglycemia can be observed with subdural hemorrhage, but the mechanisms of the development of hypoglycemia are not clear. Tendency to hypoglycemia is noted with growth hormone deficiency (hypopituitarism, isolated growth hormone deficiency) and cortisol deficiency (hypopituitarism, isolated ACTH deficiency, Addison's disease), with obesity, accompanied by hyperinsulinemia.

[9], [10], [11], [12], [13]

Treatment of the neurogenic hypoglycemia

In case of hypoglycemia. After eating you should adjust the diet (frequent, split meals) with the restriction of carbohydrates. This is the main therapeutic tactic for hypoglycemia after eating.

When hypoglycemia on an empty stomach restriction of carbohydrates is contraindicated. The ingibitory of insulin secretion 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, and does not remove it completely. In any case, it is necessary to treat the underlying disease that caused hypoglycemia.