Abstract
Hypoglycemia is a major side effect of insulin treatment in diabetic patients. However, warning symptoms generally prevent neuroglycopenia severe enough to cause coma or death. We report here a hypoglycemia-induced cardiorespiratory arrest in a patient with severe diabetic autonomic neuropathy. After successful resuscitation, he required artificial respiration for 6 hours and was confused for the 2 following days. He had severe autonomic neuropathy which manifested as orthostatic hypotension (80 mmHg decrease in systolic blood pressure upon standing), and no blood pressure and heart rate responses to the valsalva maneuver, deep breathing, cold stimuli and atropine infusion, i. e. his heart was almost totally denervated. We tested his counterregulatory hormonal responses to hypoglycemia using an insulin-glucose clamp technique. He suddenly lost consciousness at a 45mg/dl blood glucose level without any prior warning symptoms and adrenaline and glucagon did not increase in response to the hypoglycemia. These data strongly suggest that his cardiorespiratory arrest and severe hypoglycemia were closely related to his endocrine and neurogenic impairment. Cardiorespiratory arrests have been reported in the patients with severe diabetic autonomic neuropathy, usually in the status of respiratory restriction. This is one of two cases of hypoglycemia-induced cardiorespiratory arrest in severe diabetic autonomic neuropathy reported in Japan. However, such patients may increase in number with longer durations of insulin treatment.This case reminds us that hypoglycemia could easily be fatal in diabetic patients with severe autonomic neuropathy.
