Question: "How do you tell if someone is having a stroke vs a hypoglycemic attack?"

Answer:
First a few Definitions:

• Hypoglycemia = Low blood sugar.
• Ischemic stroke = Artery blockage leading to decreased blood flow to the brain.

Stroke vs hypoglycemia:

• This is a really good question and one that ER doctors struggle with all the time. Both conditions can present with similar/same symptoms. In addition, they are both medical emergencies and treated very differently. The easiest way to start to figure out what is going on is to check your blood sugar. This is what is done at the ER and you can do it yourself too. But you should first call 911.

Why are there same/similar symptoms?:

• Since the brain uses glucose as energy and does not store any, low glucose levels quickly lead to impaired brain function. On the other hand, an ischemic stroke is caused by a blocked artery that supplies nutrients to the brain. Blocked flow quickly leads to impaired brain function. Depending on the individual patient and the degree of the problem, someone may have one or many different symptoms.

Some common symptoms of stroke:

• Sudden numbness/ or weakness; face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause
• Seizures
• Loss of consciousness
• Confusion, abnormal behavior or both

Some common symptoms of hypoglycemia:

• Nervousness
• Sweating
• Intense hunger
• Trembling
• Weakness
• Palpations
• Trouble speaking
• Numbness
• Confusion, abnormal behavior or both
• Inability to complete routine tasks
• Visual disturbances, such as double vision and blurred vision
• Seizures
• Loss of consciousness

If you think you are having a stroke, go to the ER:

• Time is brain; the longer an artery is blocked, the more the brain is destroyed. Infarcted (dead) brain does not come back; it is hard enough to remember birthdays.
• Ischemic stroke is treatable; however, the time window to treat a stroke is limited. The major treatment for acute ischemic stroke is via a medication given intravenously known as TPA. This should be available at every ER in the USA. However this medication can only be given intravenously within the first 3 hr of symptoms to be safe & effective (the time starts at the onset of symptoms). That does not leave a lot of time after traveling to the ER, going through admititng, lab tests, CT and exam.
• There are other ways to treat stroke acutely but these more advanced treatments are not available at all institutions. Even if you missed the time window, you still need to go to the hospital as soon as possible because there are other things that can be done to prevent things from getting worse and to prevent future strokes.
• In addition other medical problems can also present with symptoms similar to stroke/ hypoglycemia. Many of the other medical problems that can mimic stroke or hypoglycemia need to be addressed immediately as well.

If you think you are having a hypoglycemic attack, go to the ER:

• Hypoglycemia is potentially life threatening. Treating hypoglycemia is fairly straightforward. However, it is important to get to the bottom of the problem to find out why it has happened and to prevent it from happening again.

What you can do on the way to the hospital:

• If you are diabetic you should carry a glucose monitor. If you have had hypoglycemia before, you should carry a glucose monitor. There are many glucose monitor models out there that are small and easy to carry. I don’t endorse any; just get one that works for you, you’re worth it. If you discover you have low blood sugar, drink or eat something sweet. Obviously, sugar free items are useless as a treatment in this situation.
• (A list of your medical conditions in your wallet or on a bracelet/necklace is also a good idea).