Diabetic hypoglycemia - Symptoms and causes - Mayo Clinic
A less common problem is the need to distinguish epilepsy from other paroxysmal nausea, sweating, palpitation, greying or blacking of vision, muffled hearing, and feeling distant. The risk of sudden death lends urgency to family screening. Loss of autonomic blood pressure control allows intermittent massive. Many conditions have symptoms similar to epilepsy, including first The symptoms include seizures and a sudden rise in blood pressure. This includes a high fever, low blood sugar, high blood sugar, alcohol or drug is in the occipital lobe (the back part of the brain that is involved with vision), With atonic seizures, there is a sudden loss of muscle tone and the person may fall.
She had difficulty in sitting upright from lying down posture and was unable to walk without support. Patient also faced difficulty in reaching objects around her. These complaints were worst at the time of onset and had slightly improved upon presentation. Patient was a known diabetic for 10 years on glibenclamide therapy at a dose of 5 mg once daily.
Her glycemic status was unknown at presentation. She was not previously diagnosed or treated for hypertension, coronary artery disease, and valvular heart disease.
She had no history of smoking, alcohol, or any substance abuse. There was no carotid bruit. Patients cardiac, respiratory, and abdominal examinations were within normal limits. Her higher mental functions were normal with no meningeal signs. Her pupils were equal and reactive without any nystagmus.
Cranial nerve, motor, and sensory examinations were normal. When to see a doctor Hypoglycemia can leave you confused or even unconscious, which requires emergency care. Make sure your family, friends and co-workers know what to do. If you lose consciousness or can't swallow: You shouldn't be given fluids or food, which could cause choking You need an injection of glucagon — a hormone that stimulates the release of sugar into the blood You need emergency treatment in a hospital if a glucagon injection isn't on hand If you have symptoms of hypoglycemia several times a week, see your doctor.
You may need to change your medication or your dosage or otherwise adjust your diabetes treatment program.
Request an Appointment at Mayo Clinic Causes Hypoglycemia is most common among people who take insulin, but it can also occur if you're taking certain oral diabetes medications.
Common causes of diabetic hypoglycemia include: Taking too much insulin or diabetes medication Not eating enough Postponing or skipping a meal or snack Increasing exercise or physical activity without eating more or adjusting your medications Drinking alcohol Blood sugar regulation The hormone insulin lowers glucose levels when glucose is elevated.
If you have type 1 or type 2 diabetes and need insulin to control your blood sugar, taking more insulin than you need can cause your blood sugar level to drop too low and result in hypoglycemia. Hypoglycemia also may result if, after taking your diabetes medication, you eat less than usual or exercise more than you normally do. Your doctor can work with you to prevent this imbalance by finding the dose that fits your regular eating and activity patterns.
Complications If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. That's because your brain needs glucose to function.
In accidental head injury, particularly road traffic accidents, it may be difficult to distinguish amnesia caused by the injury from cases in which there was a loss of consciousness that caused the accident. Isolated episodes of loss of awareness may also be caused by abuse of psychotropic drugs or other substances.
Occasionally, structural CNS abnormalities may present with episodes of loss of awareness. Non-epileptic attack disorderpreviously known as pseudoseizures typically gives rise episodes of two broad types: The latter are often prolonged, continuing for several minutes or sometimes hours.
Such behaviour is very rare in epileptic seizures: In addition, attacks are often triggered by external events or stress. Patients with NEAD often have a history of abnormal illness behaviour. Non-epileptic attack disorder is much commoner in females than males, and usually commences in adolescence or early adulthood see Table 2. Differentiation of epileptic seizures and non-epileptic attack disorder NEAD.
Generalised convulsive movements Epilepsy A generalised convulsion is generally the most readily diagnosed epileptic phenomenon. Classically, there is a cry, generalised stiffening of body and limbs, followed by rhythmic jerking of all four limbs, associated with loss of awareness, eyes staring blankly, tongue biting and urinary incontinence. The generalized convulsive movements usually last for a minute or so, and as the attack proceeds the jerking slows in frequency and increases in amplitude.
There is often cyanosis, and afterwards irregular breathing followed by confusion, headache and sleepiness. Syncope with secondary jerking movements People who faint often have small, brief myoclonic twitches of the extremities. The myoclonic jerking is usually irregular and short lived.
Primary cardiac or respiratory abnormalities presenting with secondary anoxic seizures Episodes of complete heart block may have syncopal features followed by collapse and secondary anoxic seizures.
Usually the attacks last for less than one minute. Involuntary movement disorders and other neurological conditions There is no alteration in consciousness. The best known is paroxysmal kinesogenic choreoathetosis.
Attacks are usually precipitated by sudden specific movements. They last a few seconds to minutes. Paroxysmal dystonia presents with attacks lasting for minutes to hours. Patients with known involuntary movement disorders such as idiopathic torsion dystonia may show severe acute exacerbations mimicking convulsive movements.
Patients with learning disabilities often have stereotyped or repetitive movements, which may include head banging or body rocking, and more subtle movements which may be difficult to differentiate from complex partial seizures. Hyperekplexia Attacks are characterised by excessive startle, may cause stiffening, and collapse with a sudden jerk of all four limbs.
Attacks are provoked by sudden unexpected stimuli, usually auditory. Hyperekplexia needs to be distinguished from seizures induced by startle. Non-epileptic attack disorder NEAD Non-epileptic attacks involving prominent motor phenomena are commoner than those with arrest of activity. Movements are varied but often involve semi purposeful thrashing of all four limbs, waxing and waning over many minutes, distractibility or interaction with the environment, prominent pelvic movements and back arching Table 2.
Non epileptic attacks may be difficult to differentiate from complex partial seizures of frontal lobe origin, which can present with very bizarre motor attacks. Drop attacks Any cause of loss of awareness may proceed to a sudden collapse or drop attack. Epilepsysyncope and other cardiovascular disorders are the commoner causes of drop attacks.
Epilepsies Sudden drop attacks are common in patients with learning disabilities and secondary generalised epilepsies. The falls may be tonic or atonic. Cardiovascular If cerebral hypoperfusion is sufficient to cause sudden collapse there is usually loss of awareness see above. Syncope and cardiac abnormality are rare causes of a presentation with drop attacks.
Movement disorders Most movement disorders that cause drop attacks have other more prominent features which make the diagnosis clear e. Paroxysmal kinesogenic choreoathetosis may cause drop attacks if there is lower limb involvement. Brainstem, spinal or lower limb abnormalities There are usually fixed neurological signs.
Tumours of the third ventricle may present with sudden episodes of collapse. Spinal cord vascular abnormalities may present with lower limb weakness leading to falls without impairment of awareness.
Cataplexy Cataplexy usually occurs in association with narcolepsy, although it may be the presenting clinical feature. There is no loss of consciousness with attacks. Attacks may be precipitated by emotion, especially laughter.
Differential diagnosis of epilepsy in adults and children - The Epilepsies - NCBI Bookshelf
Often there is only loss of tone in the neck muscles, with slumping of the head rather than complete falls. Metabolic disorders Periodic paralysis due to sudden changes in serum potassium is rare. The condition may be familial or associated with other endocrine disorders or drugs. Usually there is a gradual onset, and the attacks last for hours. Idiopathic drop attacks These attacks are most common in middle aged females.
They take the form of a sudden fall without loss of consciousness. Characteristically the patients remember falling and hitting the ground. Recovery is instantaneous, but injury may occur.
Vertebrobasilar ischaemia This condition is over diagnosed and probably accounts for very few drop attacks. Typically, the attacks occur in the elderly, with evidence of vascular disease and cervical spondylosis. The attacks may be precipitated by head turning or neck extension resulting in distortion of the vertebral arteries and are of sudden onset, with features of brainstem ischaemia such as diplopiavertigo, and bilateral facial and limb sensory and motor deficits.
Transient focal motor attacks The commonest cause of transient focal motor attacks is epilepsy. Tics may develop in adolescence. Paroxysmal movement disorders are rare, although unilateral paroxysmal kinesogenic choreoathetosis may mimic motor seizures. Transient cerebral ischaemia usually presents with negative phenomena.
Tonic spasms of multiple sclerosis are usually seen once other features of the illness have become apparent, but may be a presenting feature. Focal motor seizures Focal motor seizures may involve jerking and posturing of one extremity, or reflect the spread of epileptic activity along the primary motor cortex.
There is often associated paraesthesia. There may be localised transient weakness following the attack for seconds or minutes, sometimes longer. Seizures arising in many different brain regions may cause dystonic posturing. Epilepsia partialis continua is a rare form of epilepsy that often causes diagnostic confusion. There is very frequent focal motor activity such as jerking of the hand. This can persist for hours or days, continue into sleep, and may go on for years.
The movements often become slow and pendulous, with some associated dystonic posturing. Tics Tics usually present with stereotyped movements in childhood or adolescence, sometimes restricted to one particular action e.
Tics may be confused with myoclonic jerks. They can be suppressed voluntarily, although to do so leads to a rise in psychological tension and anxiety that is then relieved by the patient allowing the tics to occur.Symptoms of Diabetes- Dry mouth, weight loss, sweating, blurred vision, seizures
Repetitive tics and stereotypies are particularly common in those with intellectual disability. Transient cerebral ischaemia Transient ischaemic attacks TIAs usually present with negative phenomena, i. Transient ischaemic attacks may last for a few minutes, but may persist for up to 24 hours. TIAs are not usually stereotyped or repeated with the frequency of epileptic seizures, and there are usually associated features to suggest vascular disease. Tonic spasms of multiple sclerosis These spasms usually occur in the setting of known multiple sclerosis, but may be the presenting feature, although other evidence of multiple sclerosis may be found on examination and investigation.
The spasms may last for several seconds, sometimes longer than one minute. Paroxysmal movement disorders Paroxysmal kinesogenic choreoathetosis may present with focal motor attacks that are very similar to epileptic events.
Severe Hypoglycemia Masquerading as Cerebellar Stroke
Tremor may occur in a variety of movement disorders and is usually sufficiently persistent to elucidate the non-epileptic nature, but may be difficult to distinguish from certain forms of epilepsia partialis continua. Myoclonus of subcortical origin may be suspected from the distribution of involved muscles e.
Peripheral nerve entrapment usually presents with weakness but occasionally can present with episodic jerks or twitches. Transient focal sensory attacks Somatosensory attacks Epileptic seizures involving the primary sensory cortex are less common than motor seizures, and may cause spreading paraesthesia.
Seizures involving the second sensory areas or mesial frontal cortex may cause sensory illusions. There are usually other epileptic features due to involvement of adjacent or related brain structures. Transient sensory phenomena may also be seen in peripheral nerve compression or other abnormalities of the ascending sensory pathways, hyperventilation or panic attacks and in TIAs. Lesions of sensory pathways cause persistent symptoms, but diagnostic confusion may arise in the early natural history, when complaints are intermittent, or if they are posture related.
Hyperventilation may be associated with localised areas of paraesthesia e.
Intermittent sensory illusions may be experienced in relation to amputated or anaesthetic limbs. Migrainous episodes may also cause localised areas of paraesthesia, but usually have the distinction of a gradual evolution of sensory phenomena, both positive and negative, and associated features of migraine. Transient vestibular symptoms Acute attacks of vertigo may occasionally be due to a seizure in parietal or temporal lobes.
In these cases there are generally associated features that point to cerebral involvement, such as a focal somatosensory symptoms, deja vu or disordered perception. Peripheral vestibular disease is a much more common cause and may give rise to paroxysmal rotational vertigo and perception of linear motion and there are often also other symptoms of auditory and vestibular disease such as: Visual symptoms Migraine is a common cause of episodic visual phenomena.