1/5. Reversible amnesia in a Type 1 diabetic patient and bilateral hippocampal lesions on magnetic resonance imaging (MRI).AIMS: Intensive insulin therapy of Type 1 diabetes limits its chronic complications, but is associated with an increased risk of severe hypoglycaemia and its neuroglycopenic consequences. methods: Case report. RESULTS: A 24-year-old male with 15 years' history of Type 1 diabetes, who was missing for 48 h, was found at home in ketoacidosis coma. intensive care permitted a rapid improvement revealing an unexpected severe anterograde amnesia, confirmed by neuropsychological testing. MRI performed 4 days after admission showed abnormal bilateral hyperintensity signals on T2-weighted images in the hippocampus. Three months later, the patient had nearly completely recovered and resumed work. MR images and neuropsychological testing returned to normal. CONCLUSIONS: The most likely course of events favours an initial prolonged hypoglycaemic coma following insulin overdose. The hippocampal injury may be a result of hypoglycaemia. Neuropsychological testing and MRI abnormalities were completely reversible. This case underlines the potential risks of intensive insulin therapy.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
2/5. Unexplained deaths of type 1 diabetic patients.The suggestion of an increase in the number of sudden deaths of young people with Type 1 diabetes in the UK has been investigated. It was suggested that such deaths were due to hypoglycaemia and related to the increasing use of human insulin. In total we were notified of 50 deaths of people with Type 1 diabetes under age 50 years in the UK in 1989 which our informants (relatives, physicians, and pathologists) considered sudden and unexpected. An autopsy had been done in all cases and we supplemented this with detailed clinical information from relatives and case records. Of the 50 cases we excluded five with a definite cause of death, 11 suicides or self-poisonings, six cases of ketoacidosis, and four in which there was insufficient information about the circumstances of death to drawn any conclusions. Of the other 24 cases, two patients had been found with irreversible hypoglycaemic brain damage and died after a period of artificial ventilation. The most puzzling group were 22, aged 12-43 years, most of whom had gone to bed in apparently good health and been found dead in the morning. Nineteen of the 22 were sleeping alone at the time of death and 20 were found lying in an undisturbed bed. Most had uncomplicated diabetes and in none were anatomical lesions found at autopsy. There are major difficulties in diagnosing hypoglycaemia post-mortem, but the timing of death and other circumstantial evidence suggests that hypoglycaemia or a hypoglycaemia-associated event was responsible. All patients were taking human insulin at the time of death but most had been changed from animal insulin between 6 months and 2 years earlier and there was nothing to implicate the species of insulin as a factor in these deaths.- - - - - - - - - - ranking = 2keywords = hypoglycaemia (Clic here for more details about this article) |
3/5. Hypoglycaemia unawareness in diabetics transferred from beef/porcine insulin to human insulin.The case-histories of 3 patients with insulin-dependent diabetes mellitus (IDDM) suggested that, after a switch from beef/porcine to human insulin, a given level of hypoglycaemia may cause less pronounced sympathoadrenal symptoms (tremor, sweating, &c), so that there is less warning of impending unconsciousness. This possibility was investigated by questioning of 176 IDDM patients who had switched from beef/porcine to human insulin with negligible change in dosage 1-48 months earlier. 66 (36%) said that their symptoms of hypoglycaemia had changed from those of sympathoadrenal activation to those of neuroglycopenia. This disadvantage of human insulin is an argument for continued availability of beef/porcine insulin.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
4/5. Nocturnal convulsions and insulin-induced hypoglycaemia in diabetic patients.Convulsions may occur as a consequence of insulin-induced hypoglycaemia. We report three patients with insulin-dependent diabetes, who presented with generalized tonic-clonic seizures associated with nocturnal hypoglycaemia. None of the patients had experienced hypoglycaemia during waking hours and the convulsions were mistakenly diagnosed as idiopathic epilepsy. Recognition of the possible hypoglycaemia aetiology of these convulsions permitted appropriate alteration of the insulin regimens with no recurrence of convulsions. In one case, the seizure was associated with bilateral fractures of the neck of the humerus. Unrecognized hypoglycaemia should be considered as a possible cause of convulsions in insulin-dependent diabetic patients.- - - - - - - - - - ranking = 4.5keywords = hypoglycaemia (Clic here for more details about this article) |
5/5. Lessons to be learned: a case study approach. Severe hypoglycaemia in insulin-dependent diabetes mellitus (IDDM)--living to tell the tale.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.- - - - - - - - - - ranking = 2.5keywords = hypoglycaemia (Clic here for more details about this article) |