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Lessons to be learned: a case study approach

Severe hypoglycaemia in insulin-dependent diabetes mellitus (IDDM) - living to tell the tale

Human & Ecological Risk Division Dept. of Toxic Substances Control PO Box 806 Sacramento California 95812-0806 USA

David Donaldson, MB, ChB, MRCP, FRCPath

Consultant Chemical Pathologist Department of Chemical Pathology East Surrey Hospital Redhill Surrey and Crawley Hospital Crawley West Sussex

The case is presented of a 62 year old doctor with insulin-dependent diabetes mellitus (IDDM) who experienced severe nocturnal hypoglycaemia following a total intake for the day of fruit and yoghurt (providing 230 kcal) for breakfast, four pints of beer (providing 540 kcal - which included the energy from 37.0 g carbohydrate) later in the day and an evening meal containing approximately 123 g of carbohydrate (providing 1050 kcal). He had taken insulin, as was his custom, just before breakfast, half-an-hour prior to the evening meal and again two-and-a-half hours afterwards. He felt entirely well when he retired to bed at 2100 h. He awoke later, having dreamt that he was practically immobile - but then found to his horror that the dream was true. He soon realised that he was severely hypoglycaemic and, as he had no glucose immediately available, had no alternative but in some way to attempt the journey to the kitchen where there was non-diet mandarin drink available in tin cans inside a refrigerator. He was able later to recall and, in consequence, describe the whole terrifying experience in great detail, on account of the remarkable preservation of mental clarity. The clinical features of the episode are viewed in terms of the relationships between alcohol intake, carbohydrate ingested and the insulin administered. Exercise was minimal on this day.

Key Words: Glucose non-availability • hypoglycaemia • muscular pain • paralysis • terror

The Journal of the Royal Society for the Promotion of Health, Vol. 117, No. 6, 377-380 (1997)
DOI: 10.1177/146642409711700608


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