Plasma glucose concentration is closely regulated by the autonomic nervous system. Insulin, synthesized by pancreatic β-cells, and glucagon synthesized by pancreatic β-cells, have opposing effects on circulating glucose levels. Glucagon is a hyperglycemic agent that promotes hepatic glycogenolysis and gluconeogenesis. Insulin is a hypoglycemic agent that stimulates cellular glucose uptake. Hyperglycemia is the hallmark of inadequately treated diabetes mellitus (DM).
Type 1 DM is defined as absolute insulin deficiency. Type 2 DM is due to inadequate insulin secretion and/or resistance to the actions of insulin. The treatment of DM includes daily administration of antidiabetic agents (Table 8).17 In the absence of adequate intake of carbohydrates, the treatment leads to hypoglycemia. Patients monitor their blood glucose levels regularly (Figure 1). Key recommendations for practice are presented in Tables 9 and 10.25-29