Clinical Case Study
End stage renal failure and hypoglycemia
Dr Emma Robinson, Clinical Research Fellow in Diabetes, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Diabetic Hypoglycemia January 2009, Volume 1, Issue 3: page 13-14
This study reviews the case of a dialysis dependent 44-year old woman with a 28-year history of type 1 diabetes and a wide range of complications, who presented complaining of recurrent episodes of severe hypoglycemia. She denied any previous problems with impaired hypoglycemia awareness, but was failing to anticipate or recognize hypoglycemia, despite using a blood glucose meter. She was referred to the diabetes specialist nurse who reduced her insulin doses, but the patient kept increasing them again as she was fearful of developing further diabetic complications, particularly visual impairment. The patient subsequently stopped attending the nurse appointments, although she continued to attend the diabetes clinic, and declined to be referred to a psychologist. She was listed for a cadaveric renal transplant, and was also being considered for a joint renal and pancreatic transplant, in view of her problems with impaired awareness of hypoglycemia.
Keywords: hypoglycemia, impaired awareness, renal transplant