Endocrine Abstracts

JOINT1654

Hypoglycemia is a common complication in patients with diabetes, particularly in those treated with insulin, sulfonylurea, or glinide. Impairments in counter regulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia. Episodes of hypoglycemia are associated with physical and psychological morbidity, particularly those with pre-existing mental health issues or learning disabilities. Here, we describe a case of 37 years old male, with Type 1 DM, with ESRD on hemodialysis, diabetic proliferative retinopathy, Charcot neuroarthropathy, and diabetic foot. He had repeated episodes of hospital admissions with a history of severe disabling hypoglycemia. He was only on a few units of insulin Tresiba and novorapid to control his blood sugar. Any minor adjustment of insulin doses caused him severe hypoglycemia particularly on the day of hemodialysis. Blood sugar in hospital was between 1.3 to >27.5 mmol/l. We had a multidisciplinary discussion to start HCL insulin pump but as he is having learning disabilities, it was not considered later. Furthermore, reductions of insulin dose to prevent hypoglycemia caused him to develop episodes of DKA. Personally, he is non-smoker and non-alcoholic with no history of taking any illicit drugs. Physical examination was unremarkable except for having features of chronic diabetic Charcot neuroarthropathy. His insulin injections sites were normal. His observations, including NEWS, were stable in between episodes of hypoglycemia. His investigations including blood test showed creatinine about 500umol/l (baseline) after dialysis with normal liver function test. His HBA1c was between 57 and 73 mmol/mol with C peptide level was <50 pmol/l. Then we consulted with tertiary Centre for consideration of renal and pancreatic transplant for him. After discussion of his thorough case history with tertiary Centre, it was decided to proceed for renal and pancreas transplantation for him. He recovered well after the surgery. His diabetes is now on the way to remission after about 3 months of the pancreatic and renal transplant. Recent blood sugar readings in libre sensor showed his target in range of blood sugar was 99% without having any episodes of hypoglycemia with GMI was 43mmol/mol off insulin therapy. This case highlights the importance of involving multidisciplinary teams including diabetologist, DSN, dietitian, transplant surgeon, psychiatrists, and nephrologist for coordinated effort in complex cases of hypoglycemia especially in type 1 DM patients. Those Patients who are not suitable for insulin therapy, considering pancreatic/pancreatic and renal transplants can be life-changing, especially those who are young and fit for surgery.