Endocrine Abstracts

JOINT307

Background: Hypoglycemia is one of the most challenging and potentially dangerous complications faced by individuals with Type 1 Diabetes Mellitus (T1DM). Episodes of low blood glucose not only jeopardize immediate health but also complicate long-term diabetes control. Patients living with this condition may experience a loss of autonomy, anxiety, and fear of the next hypoglycemic event, which impacts their daily lives. Understanding why hypoglycemia occurs is critical for improving treatment strategies and overall patient outcomes.

Methods: This retrospective, descriptive study included patients with T1DM experiencing recurrent hypoglycemia who were hospitalized in the Endocrinology Department of Taher Sfar University Hospital in Mahdia, Tunisia, over a seven-year period.

Results: This study included 42 patients, with a mean age of 42 ± 25 years, the majority of whom were female (71%). The average glycated hemoglobin level was 10.7%. Notably, 26.7% of the patients were receiving insulin analogs. At the time of hospitalization, the mean insulin dose was 0.77 IU/kg/day, which decreased to 0.61 IU/kg/day upon discharge. Hypoglycemia was observed as moderate in 35% of cases and severe in 29%, occurring at a frequency of two episodes per week. The causes of hypoglycemia were multifactorial, with adrenal insufficiency being the most common, affecting 84% of the patients, as reflected in a mean early morning cortisol level of 82 µg/l. Additionally, 6.25% of patients had profound hypothyroidism, while no cases of hepatocellular insufficiency were found. Renal insufficiency was noted in 12.5% of patients, and 3 patients had malabsorption due to celiac disease. Insulin doses exceeding 1.5 IU/kg/day were noted in 21.9% of the cases, and 22.7% exhibited lipodystrophic regions. Moreover, 3 patients experienced hypoglycemia due to toxic factors, particularly alcohol abuse, and 2 patients (6.3%) presented with factitious hypoglycemia.

Conclusion: Hypoglycemia in T1DM poses significant challenges to patient management and quality of life. Understanding its multifactorial causes is crucial for developing targeted strategies to prevent and better manage this complication.