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A review of hypoglycemia, its physiology and pathology, symptomatology and treatment

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The American Journal of Digestive Diseases

Summary

We have seen that it is important to maintain the level of blood sugar in our bodies because if it is reduced beyond the lower normal limits, the brain is deprived of its foodstuff, glucose. The relative danger of hypoglycemia may be measured by the methods which have been provided for their prevention. Only one mechanism — the parasympathetic-insulin apparatus — acts to limit arise in blood sugar, while the symptoms working against afail in blood sugar are many and intricate: the sympathetic-adrenalin apparatus, the thyroid and posterior pituitary, as well as the anterior pituitary and adrenal cortex. Hypoglycemia may arise from 3 general causes: (1) failure of the liver, (2) excessive insulin, and (3) a disturbance in the neuroendocrine defense.

It has been shown that when hypoglycemia does arise, the symptoms are the same irrespective of the cause, and fall into a definite sequence of five stages. This sequence is ascribed to different metabolic rates in the various regions of the brain, the highest beingfound in the newest portions, and each succeeding part possessing a lower rate. Since the areas with the most intense metabolic rate will be the first to suffer upon withdrawal of energy, the earlier symptoms of hypoglycemia are allocated to the new phyletic layers, and each succeeding phase is localized according to the decreasing metabolic activity in the subcortical layers.

Using these 5 stages as a guide, it is possible to prevent dangerous hypoglycemia by proper treatment upon recognition of the initial symptoms. An examination of the patient will reveal his stages of hypoglycemia, and carbohydrate administered at any time before the symptoms of the 5th phase last too long will insure immediate recovery. But any delay after that time will render the prognosis more and more precarious.

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  1. Department of Physiology and Pharmacology, Albany Medical College, Union University, Albany, New York

    Harold E. Himwich

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Himwich, H.E. A review of hypoglycemia, its physiology and pathology, symptomatology and treatment. Jour. D. D. 11, 1–8 (1944). https://doi.org/10.1007/BF03003241

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