Diabetes – can it lead to hypoglycemia?

Updated: Oct 27, 2019

You must be wondering I am crazy to even consider this question.

Hypoglycemia by definition is abnormally low blood glucose level.

And diabetes by definition is abnormally high blood glucose level.

The two things are poles apart.

Then how can diabetes lead to hypoglycemia???

Well, that’s exactly what this article is about.

Before we talk about diabetes, we should know the normal physiology of how our body maintains blood glucose levels.

When a non-diabetic individual eats food, glucose is derived from that food and absorbed into the blood.

This leads to a sudden increase in blood glucose levels.

There is sudden increase in blood glucose levels immediately after eating.

This increase in blood glucose level is temporary, as glucose is taken up by various organs like the brain, heart, muscles, etc. to perform vital functions.

This uptake of glucose is facilitated by insulin (secreted by Beta cells of pancreas).

In the absence of insulin, these organs are not able to utilize the available blood glucose.

Also, not all blood glucose can be utilized by these organs. Some amount of blood glucose will be in surplus.

This blood glucose surplus is converted to glycogen by Insulin and stored in the liver and skeletal muscles.

So, we can say that Insulin reduces blood glucose levels by increasing uptake by various organs and by converting the extra glucose to glycogen.

Insulin reduces blood glucose levels by increasing uptake and by converting the glucose to glycogen.

This stored glycogen is used by the body when there is a sudden requirement of energy like in Fight or Flight response.

This stored glycogen is converted to glucose by cortisol & Epinephrine released during the fight or flight response. (Read about it in detail here)

During fight or flight response, cortisol & epinephrine convert the stored glycogen to glucose so that it can be used by vital organs such as brain & heart.

This leads to an increase in blood glucose levels. Now for the organs to use this glucose, they need insulin.

In a condition where glucose & glycogen levels in the body are depleted, our body resorts to using the stored fat to derive energy to maintain vital functions.

When fat is broken down to derive energy, ketones are formed.

These ketones (if in less amount) can be easily excreted in the urine but in high concentration will lead to something called as KetoAcidosis. (more on this in the next article)

So, this is how our body maintains its blood sugar level in the normal range.

Now let us talk about the Pathophysiology of diabetes.

When an individual eats food, it leads to a sudden increase in blood glucose levels.

Now, we know how insulin helps in reducing the blood glucose level.

Suppose, for some reason, there is not an adequate amount of insulin present in the blood.

Because of this, different organs are not able to utilize the glucose present in the blood.

Also, the surplus blood glucose is not being converted to glycogen.

These two things lead to an increase in blood glucose levels for a prolonged duration.

This is Type 1 Diabetes.

In Type 1 Diabetes, insulin is not being produced in an adequate amount.

Now suppose, in an individual, insulin is produced in the adequate amount in the body but the various organs are not able to respond to that insulin properly due to the absence of the required receptors.

In simple terms, the organs become resistant to the effects of insulin and hence are not able to utilize the glucose present in the blood.

As the blood glucose is not being utilized by the organs, this leads to a prolonged duration of high glucose levels.

This is Type 2 Diabetes.

These diabetic patients will be on Insulin or oral hypoglycemics like Diguanides (Metformin) or sulfonylureas (‎Glimepiride, Glipizide) to maintain the blood glucose level in the normal range of 120-140 mg/dl.

These drugs are administered to mimic endogenous insulin. That means that these are administered at the time of meal intake.

Hence, the sudden increase in blood glucose level (after the meal) is countered by the hypoglycemics (just like the endogenous insulin).

Drugs are important in the management of diabetes, BUT glucose intake in a controlled manner is equally important.

If a diabetic individual, takes his hypoglycemic drugs on time but skips his meal then there will be sudden hypoglycemia.

And that answers our question, can diabetes lead to hypoglycemia?

Although diabetes doesn’t directly cause hypoglycemia, it is indirectly responsible for hypoglycemia.

Now, this was an explanation at a very superficial level. If we delve deep into the pathophysiology of diabetes, that would need 2-3 long articles.

I am more interested in talking about the dental considerations medical emergency caused by diabetes at a dental clinic.

And that will be covered in the next article.

Do let me know what topics would you want me to write about next. The topics can be from local Anesthesia, Oral & Maxillofacial Surgery or Medical emergencies.

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