a condition of postprandial *hypoglycaemia, of varying severity, induced by excessive levels of insulin release from the pancreas. It can be divided into early and late forms, depending on whether the insulin release occurs less than or more than three hours after the meal. The early form is due to the rapid discharge of ingested carbohydrate from the stomach into the small bowel, immediately triggering hyperinsulinaemia. It can occur without obvious cause but is most commonly associated with upper-bowel surgery. The late form is due to a loss of the early-phase insulin response causing excessive postprandial *hyperglycaemia, which then itself triggers an exaggerated insulin response with subsequent hypoglycaemia.
A de?ciency of glucose in the blood – the normal range being 3·5–7·5 mmol/l (see DIABETES MELLITUS). It most commonly occurs in diabetic patients – for example, after an excessive dose of INSULIN and heavy exercise, particularly with inadequate or delayed meals. It may also occur in non-diabetic people, however: for example, in very cold situations or after periods of starvation. Hypoglycaemia is normally indicated by characteristic warning signs and symptoms, particularly if the blood glucose concentration is falling rapidly. These include anxiety, tremor, sweating, breathlessness, raised pulse rate, blurred vision and reduced concentration, leading – in severe cases – to unconsciousness. Symptoms may be relieved by taking some sugar, some sweet biscuits or a sweetened drink. In emergencies, such as when the patient is comatose (see COMA), an intramuscular injection of GLUCAGON or intravenous glucose should be given. Early treatment is vital, since prolonged hypoglycaemia, by starving the brain cells of glucose, may lead to irreversible brain damage.... hypoglycaemia
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