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Recurrent mild hypoglycemia may fit a reactive hypoglycemia pattern, but this is also the peak age for idiopathic postprandial syndrome, and recurrent "spells" in this age group can be traced to orthostatic hypotension or hyperventilation as often as demonstrable hypoglycemia. [citation needed] Insulin-induced hypoglycemia
In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise. [medical citation needed] The symptoms of a single person do tend to be similar from episode to episode. In the large majority of cases, hypoglycemia severe enough to cause seizures or unconsciousness can be reversed without obvious harm to the brain.
When individuals take insulin without needing it, to purposefully induce hypoglycemia, this is referred to as surreptitious insulin use or factitious hypoglycemia. [ 3 ] [ 2 ] [ 24 ] Some people may use insulin to induce weight loss, whereas for others this may be due to malingering or factitious disorder , which is a psychiatric disorder . [ 24 ]
The first description of children with congenital hyperinsulinism was made in 1954 by Dr Irvin McQuarrie in his presidential address to the American Pediatric Society. McQuarrie termed the disorder "idiopathic hypoglycemia of infancy" and several of his patients required removal of most of their pancreas to control their hypoglycemia.
Three CDG subtypes PMM2-CDG, PMI-CDG, ALG6-CDG can cause congenital hyperinsulinism with hyperinsulinemic hypoglycemia in infancy. [6] Because glycoproteins are involved in many central nervous system processes important during early development, intellectual disability and developmental delays are also common in CDG [7]
Alanine is a direct precursor in gluconeogenesis and can be used for treatment of ketotic hypoglycemia. If an episode begins, affected children should be given fluids and carbohydrate-rich foods immediately, if swallowing is not compromised. [2] A carbohydrate gel can be applied to the inside of the mouth in children who are unable to swallow.
Hypoglycemia is the most common metabolic problem in newborns. [2] Neonatal hypoglycemia is hypothesized to occur in between 1 in 3 births out of every 1,000 births, but the true number is not known since there is no international standard for measurement. It often occurs in premature and small babies and babies of diabetic mothers.
Fasting hypoglycemia is often the most significant problem in GSD I, and typically the problem that leads to the diagnosis. Chronic hypoglycemia produces secondary metabolic adaptations, including chronically low insulin levels and high levels of glucagon and cortisol. Lactic acidosis arises from impairment of gluconeogenesis.