Alternative cause for hypoglycaemia in insulin-treated diabetes mellitus

Parmar, V; Sritharan, V; Lawrence, C; Dhere, A

Alternative cause for hypoglycaemia in insulin-treated diabetes mellitus

Authors

Parmar, V

Sritharan, V

Lawrence, C

Dhere, A

Issue Date

2021

Type

Scientific Paper

Keywords

Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Endocrinology

Abstract

Abstract We present a case of a 73-year-old woman who developed recurrent hypoglycaemia during a prolonged hospital stay following a mechanical fall. She had a complex history of insulin-treated diabetes mellitus, hypothyroidism, diffuse systemic cutaneous sclerosis, Raynaud’s disease, previous breast cancer, Barrett’s oesophagus and previous partial gastrectomy for a benign mass. Hypoglycaemia persisted despite weaning of insulin. She had no clinical features of adrenal or pituitary insufficiency with an acceptable cortisol on stopping prednisolone and had an optimal thyroid replacement. A 72-hour fast elicited hypoglycaemia with corresponding low insulin level. Although the C-peptide was detectable, there were no clinical, biochemical or radiological features suggestive of insulinoma. Reactive hypoglycaemia post partial gastrectomy was ruled out based on limited relation of the hypoglycaemia to meals and the low insulin levels. Hydroxychloroquine (HCQ)-induced hypoglycaemia was considered based on previous case reports and the recent literature, with a successful resolution of hypoglycaemia on discontinuation of HCQ. https://doi.org/10.1136/bcr-2020-241439 Statistics from Altmetric.com Article has an altmetric score of 1 See more details Posted by 1 X users 11 readers on Mendeley Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways. Request permissions View Full Text Footnotes Contributors AD, VP and VS: planning, conduct, conception and design of the article; AD, VP, CL and VS: clinical care, organisation and arrangement of the tests; AD, VP and VS: drafting the article; AD and CL: revision and critical analysis; AD: final approval of the version published. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Provenance and peer review Not commissioned; externally peer reviewed.

Citation

Parmar V, Sritharan V, Lawrence C, et alAlternative cause for hypoglycaemia in insulin-treated diabetes mellitusBMJ Case Reports CP 2021;14:e241439.