Clinical Case Study

Impaired awareness of hypoglycemia

Dr Rohana J Wright, Specialty Registrar, Endocrinology and Diabetes, Cumberland Infirmary, Carlisle, UK

Diabetic Hypoglycemia September 2008, Volume 1, Issue 2: page 13-14

Abstract

This case study discusses a 22-year old overweight man with an 18-year history of type 1 diabetes. His diabetes was managed with a multiple injection insulin aspart and insulin glargine regimen, but he rarely measured his blood glucose, and seldom attended his local diabetes clinic. He presented at the diabetes clinic having suffered a seizure the previous day, which had been arrested with buccal glucose gel and intramuscular glucagon. His blood glucose was normal after treatment, and he denied any recent problems with hypoglycemia.

He was advised to reduce all of his insulin doses by one-third, and to perform regular home blood glucose monitoring at least four times daily. Following regular blood glucose monitoring, it became clear that he had developed impaired awareness of hypoglycemia. With careful management, he managed to avoid hypoglycemia completely over an eight-week period, and reduced his total daily insulin dose by half. He also began to regain warning symptoms when his blood glucose fell into the hypoglycemic range.

Keywords: hypoglycemia, impaired awareness, type 1 diabetes