Clinical Case Study

Recurrent severe hypoglycemia in an adolescent with type 1 diabetes

Dr Tim Jones MD, DCH, FRACP

Diabetic Hypoglycemia September 2009, Volume 2, Issue 2: page 17-18

Abstract

The subject of this case study is a 13 year old girl with a 5–year history of type 1 diabetes, who presented with recurrent severe nocturnal hypoglycemia. Her insulin regimen was continuous subcutaneous insulin infusion using a pump. No obvious predisposing cause was identified, but her warning symptoms of hypoglycemia had become less apparent in the preceding 3 months. She was admitted to hospital for monitoring, and was found to have given herself an additional insulin bolus, both while in hospital, and several times in the preceding 6 months, as a way of “relieving pressure and stress”.

She was referred to a clinical psychologist who identified a significant amount of anxiety both in the patient and her family; resulting in treatment of the patient’s mother for a depressive disorder. The entire family also underwent six months of family therapy with a clinical psychologist. There was subsequently no recurrence of the patient’s hypoglycemic events after the initial disclosure, and after 3 months her normal hypoglycemic symptoms returned.

Keywords: nocturnal hypoglycemia, adolescent, insulin self-administration