Abstract
A 70-year-old woman with insulin dependent diabetes mellitus presented with symptoms suggestive of senile dementia. Outpatient assessment failed to reveal poor diabetic control with frequent nocturnal hypoglycaemia. Eventual appreciation of the poor control resulted in several failed attempts at improving therapy with various subcutaneous insulin regimes. Intramuscular and intravenous routes produced acceptable blood glucose levels with striking reversal of the patient's symptoms. The possible causes of nocturnal hypoglycaemia in this patient are discussed.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Agardh C. D., Kalimo H., Olsson Y., Siesjö B. K. Hypoglycemic brain injury. I. Metabolic and light microscopic findings in rat cerebral cortex during profound insulin-induced hypoglycemia and in the recovery period following glucose administration. Acta Neuropathol. 1980;50(1):31–41. doi: 10.1007/BF00688532. [DOI] [PubMed] [Google Scholar]
- Boden G., Reichard G. A., Jr, Hoeldtke R. D., Rezvani I., Owen O. E. Severe insulin-induced hypoglycemia associated with deficiencies in the release of counterregulatory hormones. N Engl J Med. 1981 Nov 12;305(20):1200–1205. doi: 10.1056/NEJM198111123052007. [DOI] [PubMed] [Google Scholar]
- Bonser A. M., Garcia-Webb P. C-peptide measurement and its clinical usefulness: a review. Ann Clin Biochem. 1981 Jul;18(Pt 4):200–206. doi: 10.1177/000456328101800402. [DOI] [PubMed] [Google Scholar]
- Dornan T. L., Peckar C. O., Mayon-White V. A., Knight A. H., Moore R. A., Hockaday T. D., Bron A. J., Turner R. C. Unsuspected hypoglycaemia, haemoglobin A1 and diabetic control. Q J Med. 1981;50(197):31–38. [PubMed] [Google Scholar]
- Freidenberg G. R., White N., Cataland S., O'Dorisio T. M., Sotos J. F., Santiago J. V. Diabetes responsive to intravenous but not subcutaneous insulin: effectiveness of aprotinin. N Engl J Med. 1981 Aug 13;305(7):363–368. doi: 10.1056/NEJM198108133050702. [DOI] [PubMed] [Google Scholar]
- Gale E. A., Tattersall R. B. Unrecognised nocturnal hypoglycaemia in insulin-treated diabetics. Lancet. 1979 May 19;1(8125):1049–1052. doi: 10.1016/s0140-6736(79)92950-7. [DOI] [PubMed] [Google Scholar]
- HARWOOD R. Insulin-binding antibodies and "spontaneous" hypoglycemia. N Engl J Med. 1960 May 12;262:978–979. doi: 10.1056/NEJM196005122621908. [DOI] [PubMed] [Google Scholar]
- Pickup J. C., Home P. D., Bilous R. W., Keen H., Alberti K. G. Management of severely brittle diabetes by continuous subcutaneous and intramuscular insulin infusions: evidence for a defect in subcutaneous insulin absorption. Br Med J (Clin Res Ed) 1981 Jan 31;282(6261):347–350. doi: 10.1136/bmj.282.6261.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pickup J. C., Keen H., Parsons J. A., Alberti K. G., Rowe A. S. Continuous subcutaneous insulin infusion: improved blood-glucose and intermediary-metabolite control in diabetics. Lancet. 1979 Jun 16;1(8129):1255–1257. doi: 10.1016/s0140-6736(79)92225-6. [DOI] [PubMed] [Google Scholar]
- Taylor S. I., Grunberger G., Marcus-Samuels B., Underhill L. H., Dons R. F., Ryan J., Roddam R. F., Rupe C. E., Gorden P. Hypoglycemia associated with antibodies to the insulin receptor. N Engl J Med. 1982 Dec 2;307(23):1422–1426. doi: 10.1056/NEJM198212023072303. [DOI] [PubMed] [Google Scholar]