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Most patients experience the early warning symptoms of hypoglycaemia and can take sugar before more serious symptoms develop. These warning symptoms are well known and are described in the box. Tremulousness and sweating are by far the commonest symptoms, while circumoral paraesthesiae is the most specific. Many patients have highly individual symptoms of hypoglycaemia which range from quite inexplicable sensations to peripheral paraesthesiae. In three patients carpal tunnel compression resulted in tingling fingers when they were hypoglycaemic, representing their sole warning. Neuroglyopenic symptoms and diminished cognitive function follow if corrective action is not taken, with progressive confusion and eventually unconsciousness and occasionally convulsions. There is a prolonged debate as to whether recurrent hypoglycaemia causes long-term intellectual decline; the evidence in general is unconvincing although major and recurrent episodes in childhood may have an adverse effect in this regard.

Patients who become unconscious from hypoglycaemia need urgent treatment. Brain damage and death do not normally occur because the blood glucose concentration tends to increase spontaneously as the effect of the insulin wears off and the normal counter-regulatory responses become effective. Many diabetics, especially children, need reassurance that they will not die in their sleep. Nevertheless, a very small number of otherwise unexplained deaths at night have been reported in Type 1 diabetic patients (described as the "dead in bed" syndrome) and no precise cause has ever been established. Deaths from prolonged hypoglycaemia are most likely to occur after insulin overdoses, as a result either of a suicide or murder attempt, but even in these circumstances most patients recover.

Symptoms of hypoglycaemia

• Early warning

Shaking, trembling Sweating

Pins and needles in lips and tongue



Headache (occasionally)


• Mild

Double vision Difficulty in concentrating Slurring of speech

Change of behaviour Truculence

Naughtiness in children

• Unconsciousness

Restlessness with sweating Epileptic fits, especially in children Hemiplegia, especially in older people (but rare)

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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