Factitious Hypoglycemia

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May 08, 2002

In This Article

Hypoglycemia

Hypoglycemia results in an inadequate delivery of glucose to the central nervous system.[6] The plasma glucose concentration is critical because it is the predominant source of energy for the brain.[9] The brain does not have the capability to synthesize glucose or store glucose in the form of glycogen for more than a few minutes.A brief period of hypoglycemia can cause significant mental dysfunction. However, if the hypoglycemia is severe and prolonged, death can occur.[9]

Normally, the plasma glucose concentration averages between 70 and 100 mg/dL before meals and very seldom exceeds 140 to 150 mg/dL after meals.[10] Glucose homeostasis requires sufficient endogenous substrate for the production of glucose, normal enzymatic activity for hepatic glycogenolysis and gluconeogenesis, and appropriate alteration in hormonal function for the mobilization, interconversion, and utilization of glucose.[11]

Physiologic mechanisms have evolved to prevent or correct hypoglycemia.[9] If the serum glucose concentration drops below 70 mg/dL, glucoreceptors in the hypothalamus stimulate the secretion of counterregulatory hormones (eg, glucagon, epinephrine, and cortisol) in an attempt to maintain glucose homeostasis.[12] However, if the subnormal serum glucose concentrations continue in spite of the response of the counterregulatory hormones, a state of clinical hypoglycemia may occur. As a result, many clinical symptoms that develop may be attributed to low serum glucose itself or to the hormonal responseto it.[12]

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