Case 82: Hypoglycemic Unawareness

Abstract

A 65-year-old man was referred to our clinic for management of type 1 diabetes. He was diagnosed with type 1 diabetes at age 18 years and has developed nonproliferative diabetic retinopathy and albuminuria. His insulin regimen consisted of insulin glargine 8 units in the morning and 6 units in the evening and insulin aspart with meals (6 units with breakfast, 6 units with lunch, 8 units with dinner, and a correction factor of 1:50 >150 mg/dL; 8.3 mmol/L). He also had a past medical history of depression, hypertension, hyperlipidemia, and coronary artery disease (CAD). His family history was significant for a father with CAD. He denied any tobacco, alcohol, or illicit drug use. At the time of consultation, his weight was 100 kg. He was afebrile, blood pressure was elevated at 152/86 mmHg, and pulse was 68. His physical exam was unremarkable. His most recent hemoglobin A1c (HbA1c) was 8.4%.