From the Guidelines
Nausea and vomiting in hypoglycemia occur primarily due to the body's stress response to low blood sugar, which triggers the release of stress hormones and irritates the digestive tract, and the most effective treatment is consuming 15-20 grams of fast-acting carbohydrates. When blood glucose levels drop below normal (typically less than 70 mg/dL), the autonomic nervous system activates, triggering the release of stress hormones like adrenaline, norepinephrine, and cortisol 1. These hormones stimulate the sympathetic nervous system, which can directly irritate the digestive tract and activate the chemoreceptor trigger zone in the brain that controls vomiting. Additionally, the brain depends heavily on glucose for energy, and when glucose levels fall, brain function becomes impaired, potentially affecting the areas that regulate nausea and digestive function. The vagus nerve, which helps control digestion, may also become dysregulated during hypoglycemia, contributing to these symptoms. Some key points to consider in managing hypoglycemia include:
- Glucose (15–20 g) is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate that contains glucose may be used 1.
- After 15 min of treatment, if SMBG shows continued hypoglycemia, the treatment should be repeated.
- Once SMBG returns to normal, the individual should consume a meal or snack to prevent recurrence of hypoglycemia.
- Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger re-evaluation of the treatment regimen 1. It is essential to note that the most recent and highest quality study, which is from 2014 1, provides the most up-to-date guidance on managing hypoglycemia, and its recommendations should be prioritized in clinical practice.
From the FDA Drug Label
Most common adverse reactions ( >5% or greater incidence): Injection site swelling, injection site erythema, vomiting, nausea, decreased blood pressure, asthenia, headache, dizziness, pallor, diarrhea, and somnolence. ( 6)
Nausea and vomiting are common adverse reactions to glucagon administration, including in the treatment of hypoglycemia.
- Key points:
- Nausea and vomiting are listed as common adverse reactions to glucagon.
- The exact mechanism of why nausea and vomiting occur in hypoglycemia treated with glucagon is not explicitly stated in the label.
- Hypoglycemia treatment: Glucagon is used to treat hypoglycemia, and nausea and vomiting are potential side effects of this treatment 2.
From the Research
Hypoglycemia and Nausea/Vomiting
- Nausea and vomiting are common symptoms associated with hypoglycemia, but the exact mechanisms are not directly addressed in the provided studies.
- However, it is known that hypoglycemia triggers a counterregulatory response, which involves the secretion of hormones such as adrenaline, glucagon, and cortisol 3, 4.
- This response is mediated by glucose-sensing neurons in the brain, which detect low blood glucose levels and activate the release of these hormones 4.
- Adrenaline, in particular, plays a crucial role in counterregulation, helping to mobilize energy stores and restore normoglycemia 3.
- The symptoms of hypoglycemia, including nausea and vomiting, may be related to the activation of these hormonal responses, but further research is needed to fully understand the underlying mechanisms.
- The provided studies focus on the treatment and prevention of hypoglycemia, as well as the pathophysiology of the condition, but do not specifically address the causes of nausea and vomiting in hypoglycemia 5, 6, 7.