Hypoglycemia - What You Need to Know
(Baonghean) -Part 15. Non-insulin-dependent fasting hypoglycemia
Cases of fasting hypoglycemia without hyperinsulinism include:
1. Disorders associated with reduced hepatic glucose output.
- Due to loss of a number of liver cells such as acute yellow liver atrophy, acute liver poisoning.
- Due to disorders in the supply of amino acids to the liver (anorexia nervosa, long-term fasting, high blood urea syndrome, adrenal insufficiency).
- Due to abnormal glucose metabolism in infants (lack of glycogen degradation enzymes, gluconeogenesis enzymes).
2. Alcohol-induced hypoglycemia:
Alcohol (ethanol) is metabolized in the liver by NAD and catalyzed by ethanol dehydrogenase. Therefore, long-term alcohol use reduces the amount of NAD in the liver. This is an essential substance in the gluconeogenesis reaction. Alcohol-induced hypoglycemia is due to decreased gluconeogenesis and decreased glycogen reserves in the liver. In addition, decreased blood insulin favors increased blood and urine ketones.
Patients with alcohol-induced hypoglycemia often have acute vitamin B1 deficiency (Beriberi), so in addition to using glucose, vitamin B1 should be combined. In addition, due to the two factors mentioned above, the use of Glucagon in alcohol-induced hypoglycemia is ineffective.
Symptoms usually occur 8-12 hours after eating. Patients who have previously consumed large amounts of alcohol over a long period of time have reduced glycogen stores partly due to inadequate dietary intake.
3. Extrapancreatic tumors.
Retroperitoneal fibrosarcoma, liver cancer, adrenal cancer, renal cancer, gastrointestinal cancer, lymphoma and acute leukemia. Insulin level is about 8 U/ml in fasting hypoglycemia. There may be ectopic insulin secretion.
Approximately 50% of tumors secrete low molecular weight peptides with insulin-like activity called uninhibited insulin-like peptides.
Dr. Nguyen Van Hoan (Director of Provincial Endocrinology Hospital)
