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Diabetic Hypoglycemia - an independent electronic journal dedicated to the advancement of hypoglycemia research and clinical management
Diabetic Hypoglycemia Volume 2, Issue 2, September 2009

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


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