¿Qué es una hipoglucemia?

hipoglucemia

¿A qué denominamos hipoglucemia?

Hablamos de hipoglucemia cuando concurren las siguientes tres características en un mismo paciente (triada de Whipple):

  1. Síntomas compatibles con hipoglucemia (los veremos a continuación)
  2. Baja concentración de glucosa en sangre venosa (<50mg/dl en un individuo sano y <70 mg/dl si se trata de un paciente diabético).
  3. Mejoría de los síntomas tras la normalización de los niveles de azúcar en sangre.

Puede aparecer en personas diabéticas tratadas con insulina y en las tratadas con algunas clases de fármacos (antidiabéticos orales sobre todo), que hacen bajar el azúcar en sangre.  Ambos tratamientos deben adaptarse a los horarios, hábitos de comida y actividad física que realice la persona con diabetes.

¿Por qué se producen las hipoglucemias?

Las causas por las qué nuestro organismo puede sufrir una hipoglucemia se pueden resumir en:

  • Qué la glucosa de nuestro cuerpo se agote con demasiada rapidez.
  • Qué la glucosa que ingerimos se libere al torrente sanguíneo con demasiada lentitud o sea insuficiente.
  • Qué exista demasiada insulina en el torrente sanguíneo.

¿Qué síntomas puedo notar ante una hipoglucemia?

Los síntomas de la hipoglucemia no son más que el reflejo de un déficit de glucosa en el funcionamiento de nuestro organismo. Los podemos dividir en dos subgrupos, según la rapidez en su aparición:

  1. Adrenérgicos o neurogénicos. Se manifiestan como ansiedad, sensación de calor, sudoración, hambre, taquicardia o palpitaciones, hormigueo y/o temblor.

Son los que aparecen en una primera fase (a partir de <60 mg/dl).  Se pueden interpretar como una respuesta protectora inicial que induce a la ingesta de hidratos de carbono.

  1. Neuroglucopénicos. Las manifestaciones principales son fatiga, mareo, dolor de cabeza, alteraciones visuales (visión borrosa o doble), dificultad para hablar o concentrarse, hormigueo o entumecimiento de los labios o la lengua. Pudiendo observarse síntomas más severos como obnubilación, ira o tristeza a partir de glucemias <45-50 mg/dl, llegando incluso a convulsiones, inconsciencia o pérdida del conocimiento con <20 mg/dl.
    Aparecen de forma más tardía, traducen una falta de glucosa más prolongada en el tiempo, la cual afectará a nuestro sistema nervioso central.

¿Qué debo hacer si noto estos síntomas?

Ante la sospecha de estar sufriendo una hipoglucemia es fundamental que el paciente ingiera alimentos ricos en hidratos de carbono de absorción rápida (glucosa) como fruta, zumos o agua azucarada (disolver un par de cucharadas soperas en un vaso de 200 ml).

En los casos en los que el paciente sufra una alteración del nivel de conciencia, siempre que sea posible, un familiar o cuidador deberá administrar por vía oral algunos de los alimentos antes citados. En situaciones extremas, si el individuo no es capaz de tragar de forma efectiva, puede ser necesaria la administración de una inyección de Glucagón por vía subcutánea (hormona que estimula su hígado para que suelte la glucosa que guarda en su torrente sanguíneo cuando sus niveles de glucosa están muy bajos).

La desaparición de los síntomas producidos por un descenso de glucosa en sangre debe ser evidente en unos 10-15 minutos tras la corrección de la glucemia. De no ser así, deberá repetir la toma de alimentos azucarados. Posteriormente, puede reforzar dicha ingesta con algún alimento rico en hidratos de carbono de absorción más lenta (pan, galletas, etc.), para mantener estable la glucemia durante un intervalo más prolongado, hasta la siguiente ingesta programada.

¿Es posible sufrir una hipoglucemia sin que aparezcan los síntomas típicos?

Sí, nos referimos a ella como “hipoglucemia asintomática” y es más frecuente en aquellas personas que:

  • Padecen estos episodios con cierta frecuencia.
  • Han tenido diabetes durante mucho tiempo (por deterioro de los sistemas de alerta de nuestro organismo).
  • Tienen estricto control de su diabetes (lo que aumenta las probabilidades de sufrir reacciones de baja glucosa en la sangre).

¿Cómo puedo prevenir la aparición de hipoglucemias?

Las hipoglucemias pueden causar problemas neurológicos, así como caídas y traumatismos severos. Por ello, es fundamental que todo paciente diabético, tanto los tratados con insulina como los que toman antidiabéticos orales, siga un régimen de vida ordenado, manteniendo siempre unos horarios más o menos estrictos de comidas y ejercicio físico, para evitar la aparición de eventos adversos.

  • Es recomendable realizar varias comidas al día (incluyendo pequeñas cantidades de alimentos tanto a media mañana, como a media tarde).
  • Ante la planificación de una actividad física más intensa de la habitual, se debe comprobar que la glucemia previa es adecuada, así como ingerir mayores proporciones de alimentos ricos en hidratos de carbono en la comida anterior al ejercicio (pan, pasta, arroz, legumbres, etc.) y, además, llevar consigo algún suministro rico en glucosa (pastillas de glucosa, sobres de azúcar, caramelos, etc.) que pueda tomar ante la aparición de los síntomas ya mencionados.
  • Enseñe a sus familiares y personas cercanas como actuar ante una bajada de glucemia.
  • Mantenga el tratamiento según le haya indicado su médico.
  • Si a pesar de seguir estos consejos, sigue detectando síntomas de hipoglucemia, consulte con su Médico de Familia, quizá sea necesario un ajuste en su tratamiento o en su dieta.

Alba Hidalgo Benito
Médico residente, MFyC, Centro de Salud Arturo Eyries, Valladolid
Técnico Superior en Nutrición Humana y Dietética

REFERENCIAS:

  • Manual de Diagnóstico y Terapéutica Médica, Hospital Universitario 12 de Octubre (7ª Ed)
  • Manual de Urgencias, editorial medica Panamericana (3ª edición revisada)

 
Revisado: agosto 2016

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    The traditions of great Bordeaux wines come from diverse origins – the weather, farming practices and soil types found in the region. Syrah remains a difficult grape to grow, especially http://www.ventadecoches.com/wp-content/uploads/2022/06/Art_Gallery.pdf
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