A Treatable Cause of Recurrent Severe Hypoglycemia
- Kevin J Hardy, MRCP,
- Mark R Burge, MD,
- Patrick J Boyle, MD and
- John H B Scarpello, FRCP
- Department of Endocrinology and Diabetes, North Staffordshire Royal Infirmary Stoke-on-Trent, U. K.
- Department of Medicine/Endocrinology, University of New Mexico School of Medicine Albuquerque, NM 87131
- Address correspondence and reprint requests to Kevin J. Hardy, MD, Department of Endocrine and Metabolic Diseases, Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland.
Abstract
OBJECTIVE To see if glucocorticoid deficiency might explain increased insulin sensitivity causing severe brittle diabetes in two type 1 diabetic patients.
CASES We describe two patients who developed brittle diabetes characterized by recurrent severe hypoglycemia on small daily insulin doses with severe hyperglycemia on further insulin dose reduction. In both patients, insulin requirements had fallen markedly.
RESULTS Both patients were found to have glucocorticoid deficiency. In one patient, this was a result of hypopituitarism, in which hypoglycemia was aggravated by growth hormone deficiency. In the other patient, glucocorticoid deficiency was the result of primary adrenal failure. Resolution of brittle diabetes and restoration of normal insulin doses followed steroid replacement therapy in both patients.
CONCLUSIONS These patients emphasize the importance of seeking an organic cause for recurrent severe hypoglycemia. Increasing insulin sensitivity in type I diabetic patients should alert clinicians to the possibility of glucocorticoid deficiency.
- Received October 15, 1993.
- Accepted February 17, 1994.
- Copyright © 1994 by the American Diabetes Association
