Artifactual hypoglycemia in a patient with systemic sclerosis

Abstract

Artifactual hypoglycemia, defined as a discrepancy between different laboratory measurements and actual blood glucose levels, can occur due to clinical conditions affecting the capillary microcirculation leading to falsely low blood glucose assessment. Systemic sclerosis, hallmarked by auto-immunity, fibrosis of the skin and/or internal organs and small vessel vasculopathy, can interfere with capillary point-of-care (POC) glycemia measurements, leading to the misdiagnosis of hypoglycemia. We report an 87-year-old woman with recurrent, asymptomatic hypoglycemia of unknown cause. Clinical examination revealed multiple features of limited cutaneous systemic sclerosis causing microvascular damage leading to artifactual hypoglycemia. Artifactual hypoglycemia is rarely considered by physicians and knowledge of its causes is generally lacking. Early identification of causes of inaccurate glycemia assessment can prevent unnecessary investigations and treatment. In the future, continuous glucose monitoring (CGM) could become a reliable alternative for inpatient glucose monitoring.

Keywords: Diabetes mellitus; Raynaud’s phenomenon; artifactual hypoglycemia; hypoglycemia; systemic sclerosis.