We generally speak of hypoglycemia in the context of diabetes. Nevertheless, it can happen that people without diabetes find themselves in a situation of hypoglycaemia: this is calledorganic or non-diabetic hypoglycemia (HND). According to Swiss Medical Forumin a healthy subject,insulin secretion decreases in parallel with falling glucose (blood sugar) levels, and the release of counter-regulatory hormones (glucagon, adrenaline) increases as blood sugar levels fall from 3.9 to 3.6 mmol/l“.
This condition is often confused with a drop in blood sugar (between 3 and 4 mmol/l), which is relatively more frequent. What are its signs and what to do in case of non-diabetic hypoglycemia?
Definition: what is hypoglycaemia and from what level do we talk about it?
Blood sugar is the concentration of sugar (glucose) in the blood. We speak of hypoglycaemia when the blood sugar level is below 0.5 g/L of blood, but symptoms can already occur for blood sugar levels below 0.65 g/L. “To confirm hypoglycaemia, a venous blood glucose test will be requested in the laboratory, using a blood testspecifies Dr. Thomas Cuny from the outset. Although suggestive, capillary or interstitial blood glucose levels measured using a self-monitoring device (note, a blood glucose meter) does not, in fact, constitute absolute proof of the diagnosis of hypoglycaemia.“
Non-diabetic hypoglycemia: can someone without diabetes have low blood sugar?
Apart from diabetic patients in whom it is an inherent complication of treatment, hypoglycaemia without known diabetes is rare and, once it is suspected, needs to be investigated. “Diagnosing hypoglycemia in a non-diabetic subject at time T is not so simple due to counter-regulatory mechanisms that cause blood sugar to rise in the blood.explains the endocrinologist. A balance constantly operates between so-called hyperglycemic hormones (glucagon, growth hormone, adrenaline or cortisol) and hypoglycemic hormones, the leader of which is insulin. When there is an imbalance in favor of hypoglycemic hormones, hypoglycaemia can be experienced which is poorly or insufficiently controlled by these so-called counter-regulatory hormones.“
Non-diabetic hypoglycaemia: nausea, tremors… What are the symptoms?
When blood sugar levels begin to drop and cross the threshold of 0.65 g/L, patients develop adrenergic and neurovegetative signs linked to the action of these famous counter-regulatory hormones. Symptoms are manifested by:
- pallor of the skin or mucous membranes;
- tachycardia;
- trembling of the extremities or even fatigability of the limbs (wobbly legs);
- nausea ;
- a nagging feeling of hunger;
- sweats.
“Below 0.50 g/L clinical signs related to neurological sugar deficiency may occuradds Dr. Cuny. We then speak of neuroglycopenic signs, which, when present, should always raise the suspicion of an organic cause and lead to a specialist opinion. These result in problems with concentration, speech, behavior and even psychiatric symptoms such as obtundation. In the most serious forms, it is possible to observe sensory or motor disorders, convulsions, confusional syndrome and coma.“
Causes: what can cause hypoglycemia in a non-diabetic?
The causes of non-diabetic hypoglycemia are multiple. These may be related to:
- with drugs whose hypoglycemic effect is not systematic (certain anti-tuberculosis drugs or classes of antibiotics such as Quinolones);
- with the intake (acknowledged or not) of oral hypoglycemic agents (in particular sulfonylureas)
- with tumor pathology (insuloma);
- with excessive alcohol consumption.
“Hypoglycaemia with a drop in insulin – therefore adapted because the body suppresses insulin secretion so as not to amplify the hypoglycaemia further – can be caused by organ failure (renal, adrenal, hepatocellular, pituitary) or malnutrition (anorexia)“, adds the specialist. Apart from any pathology, drug intake or intoxication, functional hypoglycaemia will be suspected. “These most often result from an asynchrony between persistent insulin secretion after meals while blood sugar levels have already returned to normal. These hypoglycemic discomforts occur a few hours after taking a meal but are never accompanied by neurological signs.“
Recurrent hypoglycemia without diabetes: how to detect it?
In healthy people, the diagnosis of spontaneous hypoglycemia is based on the described symptoms, medical history, physical examination, and other miscellaneous tests. If there is no obvious cause and when hypoglycaemia has been confirmed by a blood test, the patient undergoes a fasting test in the hospital to help guide the diagnosis. “This examination remains the gold standard for confirming hypoglycaemiaconfirms Dr. Cuny. The body is put to the test by asking the patient not to eat for 72 hours. The objective is threefold: to provoke the hormonal counter-regulatory response, detect hypoglycaemia and analyze the insulin response.“
Indeed, normally, during a fasting test, in a healthy patient – that is to say who does not suffer from pancreatic pathology – the two markers that are insulin and peptide C (molecule co-secreted with insulin) collapsed. “This means that the body has detected that he was in hypoglycemia and is putting his insulin secretion to rest so as not to make the situation worse., recalls the specialist. On the other hand, increased insulin and C-peptide sign hyperinsulinism and will direct the diagnosis towards a rare disease: insulinoma. “In this pathology, hypoglycemia can occur at any time of the day, unlike functional hypoglycemia.says the specialist. It is a neuroendocrine tumor, often benign, which develops at the expense of insulin-secreting cells. The insulinoma secretes excess insulin then stops and starts again at any time. This is very constraining for the patient in daily life who, most of the time, adopts reflexes of anticipation by rescuing himself in an anarchic way.
Finally, hypoglycaemia with inadequate insulin and collapsed C-peptide will usually be indicative of a patient injecting insulin or receiving insulin without their knowledge. “We sometimes encounter this kind of situation in people who have access to this type of medicine and who suffer from mood disorders or even suicidal tendencies.
Treatment: what to do in case of hypoglycaemia?
Treatment will of course depend on the etiology of non-diabetic hypoglycemia. “In case of insulinoma, the management will be surgical and will consist, ideally, in enucleating the tumour. While waiting for surgery, it is possible to temporarily prescribe the patient a drug that blocks insulin secretion: diazoxide (Proglycem).
Finally, functional hypoglycaemia linked to hypersensitivity of the pancreas will be treated by appropriate dietary management and the splitting of meals.
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⋙ Hypoglycemia: what are the causes and can you suffer from it without being diabetic?
⋙ Hypoglycemia: what are the causes and can you suffer from it without being diabetic?