HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Unger, J. Search for Related Content PubMed Articles by Unger, J. Social Bookmarking                What's this?

Case Study: A 62-Year-Old Man With "Brittle" Type 1 Diabetes

	Presentation

 
K.A. is a 62-year-old man with a 42-year history of "brittle" type 1 diabetes. When first seen at our office, he complained of erratic and unpredictable blood glucose levels despite adhering to a rigid multiple daily insulin injection protocol. He was taking four insulin injections per day (NPH before breakfast and at bedtime and lispro insulin (Humalog) before each meal) and performing self-monitoring of blood glucose (SMBG) eight times daily, including pre- and postprandially and whenever he felt symptomatic. K.A. injected his morning NPH in the abdomen, his lunch and dinner insulin in the arms, and his bedtime NPH in the buttocks.

He was sedentary and did not exercise. He had been counting carbohydrates to adjust his insulin for only 5 months.

Five years ago, K.A. developed frequent severe hypoglycemia, during which he lost consciousness and presented in the hospital emergency room. His blood glucose levels had been <30 mg/dl on each of his eight emergency room visits. In the ensuing 5 years, he had developed hypoglycemic unawareness.

Because of the frequency of hypoglycemic events with altered levels of consciousness (at least 30 episodes documented per month) the patient’s driver’s license was revoked, and he sought an early retirement from his job as an electrical engineer. He believed that his control might improve if he were placed on an insulin pump.

K.A. is 71 inches tall and weighs 74 kg. His blood pressure at our initial visit was 124/86 mmHg without orthostatic changes. His diabetes-related complications included autoimmune hypothyroidism, microalbuminuria, peripheral sensory neuropathy, and nocturnal diarrhea. His HbA_1c was . . . [Full Text of this Article]

	Questions

 

	Commentary

 

	Clinical Pearls

 

	Footnotes

 

	SUGGESTED READINGS

 

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?