Hypoglycemia is relatively uncommon in sepsis. The pathogenesis is not fully understood but may relate to depletion of hepatic glycogen stores and inhibition of gluconeogenesis. Hyperglycemia may be one of the first clues to infection in the diabetic patient, and blood glucose levels may be difficult to control. Body temperature in humans is controlled mostly by the hypothalamus. Regulation is achieved primarily from balance between heat loss from the periphery and heat production from tissues, particularly the liver and muscles.
Fever raises the hypothalamic set point, triggering the vasomotor center to begin vasoconstriction.
Blood is then shunted from the periphery, decreasing the usual heat loss with a resultant increase in body temperature. Shivering, which increases heat production from muscle contraction, may also be triggered. Heat conservation and production continue until the temperature of the blood bathing the hypothalamic neurons reaches the new setting. The hypothalamus then maintains the new febrile temperature. Resetting the hypothalamic set point downward initiates the process of heat loss through sweating and vasodilation.