Endocrine Abstracts

Introduction: Hyperglycaemia, the result of under-treating diabetes mellitus, is associated with long-term complications. On the contrary, hypoglycaemia (the result of over-treatment), can lead to sudden harm; the latter of which can be due to a myriad of causes. We present a case of a patient on an insulin pump with recurrent nocturnal hypoglycaemia from an error in the settings of her pump that has not previously been described within the literature.

Case Presentation: A 36-year-old female with Type 1 Diabetes Mellitus presents to the clinic. Although she had a history of poor compliance with insulin (with recurrent admissions for diabetic ketoacidosis), she had recently improved her adherence to treatment, and was now being upgraded to an insulin pump. Following this transition, she demonstrated multiple episodes of nocturnal hypoglycaemia, requiring intranasal glucagon. She feared entering automatic mode on the pump (despite reassurance), and therefore her nocturnal basal rate was reduced. Despite this adjustment, she had three further admissions for nocturnal hypoglycaemia. Upon closer inspection of the pump, it appeared that the programmed time had been reversed by 12 hours. It appeared that the reduced basal rate set for night-time had erroneously been delivered throughout the day; moreover, the cause of her nocturnal hypoglycaemia was simply the elevated day-time basal rate being delivered overnight. Following the correction of the time programmed on the pump, no further nocturnal hypoglycaemia was noted.

Conclusion: This case is serves as a reminder of the importance of considering all causes of hypoglycaemia. Despite the many points of contact with a medical professional, the cause of the hypoglycaemia was missed. It was later found to be iatrogenic due to improper time programming. This case has not been described previously in the literature and serves to avoid overlooking common areas for fallacies with diabetes technology.