The treatment of diabetes mellitus includes daily administration of insulin and/or an oral hypoglycemic agent, which stimulate cellular glucose uptake. Increased rates of insulin absorption associated with increased skin temperature, heavy exercise, anxiety, infection, and pain lead to hypoglycemia.39 Insulin and/or oral hypoglycemic agents in the absence of adequate intake of carbohydrates also lead to hypoglycemia.39 Signs and symptoms of hypoglycemia are epinephrine-, glucagon-, and neuroglycopenia-related.39
Adrenergic manifestations include twitching, tremor, anxiety, nervousness, sweating, pallor, cold and clammy skin, and mydriasis. Glucagon-related manifestations include hunger, boborygmus (rumbling, growling, or gurgling noise emanating from the patient’s gut), nausea, vomiting, and abdominal pain. Neuroglycopenic manifestations include fatigue, weakness, lethargy, paresthesia, headache, subtle reduction in mental capacity, impairment of action and judgment, focal or generalized seizure, and coma.
