Endocrine Abstracts

Background: Hypoglycaemia unawareness is thought to be due to very tight control of diabetes but may also be due to very longstanding slowly progressive hypoglycaemia. We describe a patient who had no warning of very severe hypoinsulinaemic hypoglycaemia.

Case Presentation: A 65-year-old gentleman presented with recurrent hypoglycemia that responded to IV glucose. A chest X-ray revealed a space occupying lesion and further investigations during short fast are in the table below. He was managed with continues glucose monitoring (CGM) and his family were alerted to hypoglycemia before he became confused. The family described repeated episodes of him being unarousable in the morning. He was able to have regular meals as needed until he underwent left hemi-clamshell thoracotomy with the resection of the solitary tumor that resulted in complete cure.

Discussion: Insulin levels while hypoglycemic were low and ketones were 0.1 mmol/l, suggesting non-insulin derived hypoglycemia. He was managed with regular meals and CGM which enabled his family to feed him whenever his glucose fell below 3 mmol/l until surgery