2019 Volume 62 Issue 10 Pages 667-673
A 65-year-old man had been diagnosed with type 1 diabetes at 27 years of age and had been on intensive insulin therapy ever since. Throughout his course, he had achieved good blood glucose control through strict lifestyle management and self-regulation of insulin. In August X, he slipped into a hypoglycemic coma and was transported to our emergency room, as he had fallen asleep just after an injection of short-acting insulin without eating anything. His consciousness improved promptly by the administration of glucose. The existence of frequent hypoglycemia was suspected from his medical history and his HbA1c value of 5.9 % at hospitalization. His Mini Mental State Examination score was 25 points, and mild cognitive decline was observed. Importantly, no microvascular complications were observed. Despite a 40-year history of type 1 diabetes, this patient successfully prevented diabetic microvascular complications. However, he developed mild cognitive decline. We report this case as an example suggesting the paradoxical utility and adverse effects of strict blood glucose reduction in elderly diabetic patients.
