A change for good may not be always good! An interesting case of recurrent hypoglycaemia

Abstract

Good control of plasma glucose levels always remains a desired goal for both diabetic patients and their physicians. However, unintended tight glucose control should always be alarming to the treating physician, although, it may seem to be a blessing to the patient. A downward trend in blood glucose profile in an elderly male with long standing diabetes generally points to developing renal insufficiency. Apart from that, other causes responsible for lowering of blood glucose have to be considered at times when clinical scenario is slightly different. Here, we present a case of an elderly man who presented with an unintended tight control of blood glucose over a period of few months, which upon neglecting culminated into recurrent hypoglycaemia. The etiology of recurrent hypoglycaemia in this patient was non-islet cell tumor hypoglycaemia (NICTH). The causes, pathophysiology, and management of NICTH are discussed briefly.

Keywords: Hepatocellular carcinoma; Insulin like growth factor 2; non-islet cell tumor hypoglycaemia; recurrent hypoglycaemia; tight blood glucose control.

Figure 1

CT chest showing large hypodense space occupying lesion in right lobe of liver (red arrow)