Pranati V (roll no. 129): 55/F with sweating and low sugars

55 year old house wife came to casualty with complaints of:

Sweating and seizure like activity since 1½ hr, after insulin injection

Pt was apparently asymptomatic 10 years back then on routine checkup was told to have Diabetes Mellitus type 2 and advised to use Inj. Human Mixtard 15 units, twice a day. Dosage increased to 20 units one month back.

Pt had C/O polyuria, polydypsia and loose stools 1 month back. stools were watery consistency, non blood stained, 10 episodes per day for 3 days. Watery stools subsided on medication.

Last night pt consumed her meal, followed by s/c insulin injection. ½ hr later pt developed profuse sweating, cold to touch, clenching of fists, uprolling of eyes, frothing at mouth and loss of consciousness.

Seizure like activity lasted ½ hr

Post ictal confusion (+)

Non responsive to verbal commands or touch stimulus

No H/O fever, burning micturition, cold

Pt was administered 2 IVF- 25 D, after that pt regained consciousness and no seizure episodes after that.

K/C/O DM-Type2 since 10 years, on insulin

K/c/o HTN since 3 months, on regular medication

N/K/C/O TB, BA, CAD, CVA, thyroid disorders

Similar complaints, 4 episodes in the last 1 year, most recent being yesterday.

H/o 4 hospital admissions for similar complaints in the past 10 years, duration of 4-10days, latest being 1 year back.

Grbs on presentation- 11mg/dl in both hands

After stabilization- 168mg/dl