Case history
Case history #1
A 25-year-old man is brought to the emergency department because he has been feeling weak, faint, and dizzy since the morning and has been unable to stand up. He has been sweating more than usual and has felt like his heart has been beating very fast. For the last couple of days he has also had a mild fever, nausea, vomiting, and diarrhea, and has been unable to eat as usual. He was diagnosed with type 1 diabetes at age 12 and is taking a basal bolus insulin regimen (insulin glargine 15 units at night and insulin aspart 4 units with meals and a sliding scale), which he has continued while feeling unwell. While monitoring his finger stick blood glucose at home, he has noticed that this has been in the range of 70-80 mg/dL (3.9 to 4.4 mmol/L), which is lower than usual. On arrival at the emergency department, his finger stick blood glucose is 46 mg/dL (2.6 mmol/L).
Case history #2
A 5 year-old boy with type 1 diabetes is brought to the emergency department by his parents, because they had difficulty waking him up that morning. He normally wakes up around 7 a.m., but his parents went in to check on him at 9 a.m. because he had not woken up. His parents say he was able to open his eyes and was aware that someone was with him, but he could not speak normally and was unable to sit up in bed. His bed sheets were wet with urine. The previous day, he was well during a busy day at a theme park. Blood glucose on his home glucose meter was 61 mg/dL (3.4 mmol/L).
Other presentations
Some patients with diabetes may present with recurrent or frequent episodes of hypoglycemia, which can indicate other causes such as hypothyroidism or Addison disease. See Differentials.
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