Introduction

Diabetes mellitus

Diabetes mellitus is a complex chronic illness associated with a state of high blood glucose level or hyperglycemia occurring from deficiencies in insulin secretion action or both. The clinical diagnosis of diabetes is based on either one of the four plasma glucose criteria. (I) elevated fasting plasma glucose (>126 mg/dl) (II) 2h PG during 75 g oral glucose tolerance test (<200 mg/dl), (III) Random plasma glucose (<200 mg/dl) with classic signs and symptoms of hyperglycemia or (IV) Haemoglobin A1C level more than 6.5% [1].

Metformin

Metformin is a biguanide anti hyperglycemic drug which is the most commonly prescribed oral agent to treat diabetes mellitus [2].

Insulin

Insulin is the hormone produced by the pancreas that controls the levels of glucose or sugar in blood. When the body digests carbohydrates, it breaks them down into sugar molecules. Glucose is one of these. Glucose is absorbed directly into the blood stream, but it needs the help of insulin to get into cell and tissues to provide them with fuel [3].

Drug induced hypoglycemia

It is a Ɛsignificant adverse ĞīĞcÆš that should be included in the ĚŝīĞƌĞntiĂů diagnosis of hypoglycemia that results from taking a medicine [4]. Causes for drug induced hypoglycemia include alcohol cŽnƐƵmƉtiŽnÍ• ŐĞƫnŐ more Ä‚ctiǀŝƚy than usual, ŝnƚĞntiŽnĂůůy or ƵnŝnƚĞntiŽnĂůůy overdosing on the medicines used to treat diabetes, missing meals. DÄžtfŽƌmŝn in cŽmbŝnÄ‚tiŽn with sulfonylureas, insulin [5]. Case Report A male ƉĂtiÄžnÆš of 78 years old was Ä‚ÄšmŝƩĞĚ in male surgical ward in King George Hospital, Visakhapatnam with a chief complaint of raw area over right forearm since 30 days. Raw area is preceded by ĨŽƌmÄ‚tiŽn of a papule which enlarged rapidly into the ÄžntiƌĞ forearm associated with pain. He is ƐƵīĞƌŝnŐ from diabetes mellitus and is on Ä‚ntiĚŝĂbÄžtic mĞĚŝcÄ‚tiŽn Tablet DÄžtfŽƌmŝnн'ůŝbÄžncůĂmŝĚĞ͘ He was prescribed with /nÅ©ÄžctiŽn Human mixtard, Tablet DÄžtfŽƌmŝnÍ• /nÅ©ÄžctiŽn Piperacillin+tazobactum, Tablet Paracetamol, Tablet B complex, /nÅ©ÄžctiŽn Tramadol, Tablet Amoxicillin+clavulanate, Tablet Griseofulvin, Tablet Iron, Tablet KŇŽxÄ‚cŝn for 10 days. Surgery was done for cĞůůƵůŝtiƐ of right forearm. ŌĞƌ surgery, he was prescribed with /nÅ©ÄžctiŽn Cefperazone+sulbactum, /nÅ©ÄžctiŽn Metronidazole, /nÅ©ÄžctiŽn Paracetamol, /nÅ©ÄžctiŽn Pantoprazole, /nÅ©ÄžctiŽn Tramadol, /nÅ©ÄžctiŽn Ondansetron, /nÅ©ÄžctiŽn Human mixtard, Tablet Iron+ folic acid, Tablet B complex and /nÅ©ÄžctiŽn Piperacillin+tazobactum for 10 days. On 11th day he was prescribed with /nÅ©ÄžctiŽn͘ Insulin and Tablet DÄžtfŽƌmŝn (Table 1).