Clinical Case Study

Hypoglycemic hemiparesis in a woman with type 1 diabetes: evidence of underlying cerebrovascular disease

Anna R Dover, PhD & Siobhan McLaughlin, PhD

Diabetic Hypoglycemia June 2011, Volume 4, Issue 1: page 8-9

Abstract

A 53 year old woman with a history of type 1 diabetes and impaired hypoglycemia awareness presented with recurrent left-sided hemiparesis on waking, associated with capillary blood glucose levels of 3.1, 3.9 and 3.2 mmol/l. On each occasion, her neurological deficit resolved promptly following ingestion of carbohydrate. Investigations revealed evidence of underlying cerebral ischemia and white matter lesions. The recurrent hypoglycemia was eliminated by reducing the dose of basal insulin, and further management was focused on aggressive cardiovascular risk reduction. This case illustrates the importance of seeking an underlying structural brain disease in patients presenting with suspected hypoglycemic hemiparesis.

Key words: cerebrovascular disease, hypoglycemic hemiparesis, impaired hypoglycemia awareness, type 1 diabetes