From the Guidelines
Diaphoresis in hypoglycemia occurs as a result of the body's counterregulatory response to low blood glucose levels, triggered by the release of stress hormones like epinephrine, which stimulates sweat glands through sympathetic nervous system activation. This response is a critical early warning sign of hypoglycemia, prompting individuals to consume carbohydrates to restore normal blood sugar levels 1. When blood sugar drops below normal (typically under 70 mg/dL), the autonomic nervous system activates, triggering the release of stress hormones like epinephrine (adrenaline), norepinephrine, cortisol, and glucagon.
Key Points
- The physiological purpose of diaphoresis in hypoglycemia is to alert the individual to the dangerous drop in glucose levels and prompt them to take action to restore normal blood sugar.
- The intensity of diaphoresis often correlates with the severity and rapidity of the blood glucose drop, with sudden, significant drops typically producing more pronounced sweating.
- Individuals with diabetes exhibiting signs and symptoms consistent with hypoglycemia, particularly altered mental status, agitation, and diaphoresis, should have their CBG levels checked immediately 1.
- Correctional institutions should have systems in place to identify patients at greater risk for hypoglycemia and ensure early detection and treatment 1.
From the Research
Diaphoresis in Hypoglycemia
Diaphoresis, or excessive sweating, is a common symptom of hypoglycemia. The following points explain why diaphoresis occurs in hypoglycemia:
- Hypoglycemia triggers the release of catecholamines, such as adrenaline, which prepares the body for a "fight or flight" response 2, 3.
- This response includes increased heart rate, palpitations, tremors, and sweating, which are all symptoms of hypoglycemia 2, 3.
- The release of catecholamines is a key factor in the development of autonomic symptoms, including diaphoresis, in response to hypoglycemia 4.
- In individuals with diabetes, the interplay between therapeutic insulin excess and compromised physiological defenses against falling plasma glucose concentrations can lead to hypoglycemia, which in turn causes diaphoresis 5.
Mechanisms of Diaphoresis in Hypoglycemia
The mechanisms underlying diaphoresis in hypoglycemia are complex and involve multiple physiological responses, including:
- Reduced neurogenic symptoms, which are largely the result of reduced sympathetic neural responses to falling glucose levels 5.
- Activation of widespread brain regions, including the medial prefrontal cortex, in response to hypoglycemia 5.
- Possible alterations in brain metabolism, which may contribute to the development of diaphoresis in hypoglycemia 5.
Clinical Implications
Understanding the mechanisms of diaphoresis in hypoglycemia is important for the management of hypoglycemia in clinical practice. Key points include:
- Hypoglycemia is a major limiting factor in achieving glycaemic control in patients with diabetes 6.
- A tailored approach to managing hypoglycemia, including individualized glycaemic goals and the use of newer anti-diabetic drugs, can help reduce the risk of hypoglycemia and its associated symptoms, including diaphoresis 6.
- Continuous glucose monitoring and education on hypoglycemia self-management can also help reduce the risk of hypoglycemia and its symptoms 6.