Category: Illness or disabilities
Introduction and description
Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose.
It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function - neuroglycopenia.
Effects can range from mild dysphoria to more serious issues such as seizures, unconsciousness, and (rarely) permanent brain damage or death. It can also cause hallucinations, out of body states and even near death experiences.
The level of blood glucose low enough to define hypoglycemia may be different for different people, in different circumstances, and for different purposes, and occasionally has been a matter of controversy. Most healthy adults maintain fasting glucose levels above 4.0 mmol/L (72 mg/dl), and develop symptoms of hypoglycemia when the glucose falls below 4 mmol/L
Research in healthy adults shows that mental efficiency declines slightly but measurably as blood glucose falls below 65 mg/dL (3.6 mM).
Hormonal defense mechanisms (adrenaline and glucagon) are normally activated as it drops below a threshold level (about 55 mg/dL - 3.0 mM - for most people), producing the typical hypoglycemic symptoms of shakiness and dysphoria.
Obvious impairment may not occur until the glucose falls below 40 mg/dL (2.2 mM), and many healthy people may occasionally have glucose levels below 65 in the morning without apparent effects. Since the brain effects of hypoglycemia, termed neuroglycopenia, determine whether a given low glucose is a "problem" for that person, most doctors use the term hypoglycemia only when a moderately low glucose level is accompanied by symptoms or brain effects.
Hypoglycemic symptoms are divided into those produced by the counterregulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar.
- Shakiness, anxiety, nervousness
- Palpitations, tachycardia
- Sweating, feeling of warmth (although sweat glands have muscarinic receptors, thus "adrenergic manifestations" is not entirely accurate)
- Pallor, coldness, clamminess
- Dilated pupils (mydriasis)
- Feeling of numbness "pins and needles" (paresthesia)
- Hunger, borborygmus
- Nausea, vomiting, abdominal discomfort
- Abnormal mentation, impaired judgment
- Nonspecific dysphoria, moodiness, depression, crying, exaggerated concerns
- Negativism, irritability, belligerence, combativeness, rage
- Personality change, emotional lability
- Fatigue, weakness, apathy, lethargy, daydreaming, sleep
- Confusion, amnesia, dizziness, delirium
- Staring, "glassy" look, blurred vision, double vision
- Flashes of light in the field of vision
- Automatic behavior, also known as automatism
- Difficulty speaking, slurred speech
- Ataxia, incoordination, sometimes mistaken for "drunkenness"
- Focal or general motor deficit, paralysis, hemiparesis
- Paresthesia, headache
- Stupor, coma, abnormal breathing
- Generalized or focal seizures
In older children and adults, moderately severe hypoglycemia can resemble mania.
Diabetes treatments and other pharmaceuticals
The most common forms of hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Too much insulin, for example, can result in hypoglycaemia as can an overdose - albeit an unwitting overdose - of diabetes drugs.
Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 46.9% of emergency department (ED) visits for adverse drug events, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate to severe allergic reactions (antibiotics), and hypoglycemia with moderate to severe neurological effects (diabetes agents). Since 2005-2006, the proportions of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, ….. Among children aged 5 years or younger, antibiotics were the most common drug class implicated (56.4%;). Among children and adolescents aged 6 to 19 years, antibiotics also were the most common drug class implicated (31.8%) in ED visits for adverse drug events, followed by antipsychotics (4.5%). Among older adults (aged ≥65 years), 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics) were implicated in an estimated 59.9% of ED visits for adverse drug events; 4 anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and 5 diabetes agents (insulin and 4 oral agents) were among the 15 most common drugs implicated. PMID: 27893129
If you follow this LINK it will take you to the eHealthme site, which collects the Adverse Drug Reports submitted by doctors to the FDA and SEDA. This should take you to the page for Hypoglycaemia. [If the link has been broken, use the 'Conditions' list to find the symptom].
Scroll down the page and you will find a section 'Drugs that could cause'. If you go to this link you will see ALL the pharmaceuticals that have been implicated in causing hypoglycaemia.
As of December 2016, over 1,750 drugs were in this list, as such it is clear that it is not only Diabetes drugs that are the cause, other drugs also have an effect.
If we just take the diabetes drugs, it is difficult to get the dose right with all these drugs, as the cause of the diabetes is rarely investigated, the pathogen which may be damaging the pancreas, for example or liver, may still be at work, meaning that no single stable dose will keep the person in balance. This is why blood sugar levels have to be constantly monitored.
If we look at some of the other types of drug in this very long list, there are some obvious classes of drug - blood thinners for example. If you thin the blood, less glucose will circulate. But there are numerous other classes - anti-depressants, anti-psychotics, statins, ACE inhibitors, osteoporosis treatments etc where the chain of cause effect is difficult to establish.
The main problem appears to be is that all the drugs were designed in a somewhat naive way, by considering only one aspect of an illness and not the fully holistic consequences of tampering with a system of the body. Thus one may have a treatment for gout like allopurinol, which deals with one of the symptoms of gout. It is a xanthine oxidase inhibitor, an enzyme involved in purine metabolism, thus by inhibiting purine metabolism you may set off a chain of reactions which affects other systems - one of which appears to be that regulating glucose balance.
Source: eHealthme, showing ADRs from pharmaceuticals
Any form of surgery which damages the intestines or stomach runs the risk of also limiting the nutrients the person can absorb. In a sense, the person is suffering from nutritional deprivation caused by surgery damage. There has been a very noticeable rise in the number of people who have undergone bariatric surgery having hypoglycaemia:
Bariatric surgery is [used for] severe obesity …. However, long-term consequences can occur, such as postbariatric surgery hypoglycaemia. This is a challenging medical problem, and the number of patients presenting with it has been increasing. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it is the surgery most commonly associated with the development of postbariatric surgery hypoglycaemia. …… Carbohydrate-rich foods usually provoke hypoglycaemic symptoms, which can typically be alleviated by strict dietary modifications, including carbohydrate restriction and avoidance of high glycaemic index foods and simple sugars. Few patients require further medical intervention, such as medications, but some patients have required a pancreatectomy. Because this option is not always successful, it is no longer routinely recommended. PMID: 26840207
sadly the causes of the obesity are rarely examined, obesity can be caused for example by pharmaceuticals such as anti-depressants, as such the surgery will achieve nothing.
Can result in temporary hypoglycaemia. This is why a person with either vomiting or diarrhoea needs to be given plenty of fluids with salts and sugar added to ensure the levels do not fall. The usual treatment is to drink ‘Oral rehydration solution (ORS)’, which is clean water with modest amounts of salts and sugar, along with zinc to help boost the immune system.
Pancreatic damage can result in some form of malfunction of the pancreas which is producing more insulin than is needed. As there is a complex cycle in place here functionally between the release of insulin and the monitoring by the body of blood glucose levels, damage to other organs in this cycle may also be the cause. For example, liver damage may result in incorrect messages being sent about blood glucose levels. It is possible that the hypoglycaemia occasionally suffered by alcohol consumers might be caused by the temporary or even permanent disruption to the liver signalling systems.
Many people who collapse after or during marathon runs or very long endurance races are suffering from hypoglycemia - their intake of food has not been enough to provide them with the energy they need, or the system supplying glucose - the liver for example as well as the pancreas, is not able to keep up with demand.
Toxins [Gene mutation]
There is, sadly, a very clear link between hypoglycaemia in the very young and gene mutations. Furthermore, these gene mutations are caused by toxins of various sorts attacking the fetus in the womb, including nanoparticles, insecticides and pesticides
Pancreatic β cells are functionally programmed to release insulin in response to changes in plasma glucose concentration. Insulin secretion is precisely regulated so that, under normal physiological conditions, fasting plasma glucose concentrations are kept within a narrow range of 3·5-5·5 mmol/L. In hyperinsulinaemic hypoglycaemia, insulin secretion becomes dysregulated (ie, uncoupled from glucose metabolism) so that insulin secretion persists in the presence of low plasma glucose concentrations. Hyperinsulinaemic hypoglycaemia is the most common cause of severe and persistent hypoglycaemia in neonates and children. At a molecular level, mutations in nine different genes can lead to the dysregulation of insulin secretion and cause this disorder. ….. Rapid diagnosis and prompt management of hyperinsulinaemic hypoglycaemia is essential to avoid hypoglycaemic brain injury, especially in the vulnerable neonatal and childhood periods. PMID: 27915035
How it works
So why do people get hallucinations, visions, out of body or near death experiences from hypoglycemia?
Like most animal tissues, brain metabolism depends primarily on glucose for fuel in most circumstances. A limited amount of glucose can be derived from glycogen stored in astrocytes, but it is consumed within minutes. For most practical purposes, the brain is dependent on a continual supply of glucose diffusing from the blood into the interstitial tissue within the central nervous system and into the neurons themselves.
Therefore, if the amount of glucose supplied by the blood falls, the brain is one of the first organs affected. In most people, subtle reduction of mental efficiency can be observed when the glucose falls below 65 mg/dl (3.6 mM). Impairment of action and judgment usually becomes obvious below 40 mg/dl (2.2 mM). Seizures may occur as the glucose falls further. As blood glucose levels fall below 10 mg/dl (0.55 mM), most neurons become electrically silent and nonfunctional, resulting in coma. These brain effects are collectively referred to as neuroglycopenia.
The importance of an adequate supply of glucose to the brain is apparent from the number of nervous, hormonal and metabolic responses to a falling glucose level. Most of these are defensive or adaptive, tending to raise the blood sugar via glycogenolysis and gluconeogenesis or provide alternative fuels. If the blood sugar level falls too low the liver converts a storage of glycogen into glucose and releases it into the bloodstream, to prevent the person going into a diabetic coma, for a short period of time.
It may be helpful to have read the section on How spiritual experience works.
Functionally the person is shutting down non essential processes and the first function which is likely to be severaly affected is the function of reason then memory, and patients with this condition usually temporarily lose their memory. As more functions shut down, the composer can step in, although the person may not be abe to remember what happened.
Occasionally people lose their memory permanently…………
A case study of an alcoholic with severe long-term hypoglycemia: - Jain H, et als. 2002
“The probable etiology of low blood sugar in our patient was alcohol-induced inhibition of gluconeogenesis along with starvation. The prolonged hypoglycemia caused cortical damage simulating ischemic brain damage. Ten months in to follow-up patient is still in persistent vegetative state with no noticeable neurological recovery.”
References and further reading
- Igaku Kenkyu. 1988 Dec;58(6):421-6. Visual hallucination without the disturbance of consciousness in hypoglycaemic attack: report of an unusual case--consideration on psychic symptoms related to hypoglycaemia. Nakanishi T. PMID: 3252682
- Dtsch Med Wochenschr. 1973 Sep 14;98(37):1722-3. [Neuropsychiatric findings in hypoglycemia]. [Article in German] Neundörfer B. PMID: 4730242
There are some more examples in the section on anti-diabetic drugs as clearly if they are mis-prescribed or the dose is wrong, they too can cause this condition.
- 'Massive' auditory hallucinations from hypoglycemia 013002
- Dextropropoxyphene withdrawal after hallucinations and ADRs 013000
- Ginseng and diabetes 002559
- Hallucinations after operations 013005
- Hallucinations and hypoglycaemia from anti-fungal 013001
- Hallucinations and hypoglycemia from ciprofloxacin 013004
- Hallucinations from high emotion and hypoglycemia 013003
- Hallucinations from morning sickness 012996
- Hallucinations in a toddler 012998
- Hypoglycemia in children 002558
- Pharmaceutical-induced hallucinations amplified by relative hypoglycemia 012999