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
Pt is conscious
Bp- 180/90mmhg
PR-91 BPM
Rr-20cpm
Temp- afebrile
GRBS- 11mg/dl in both hands (168mg/dl after stabilization)

CVS- S1 S2 heard
Rs- BAE+ve
CNS- NFND
P/a- soft non tender

Rx-
IVF NS @75ml/hr IV/STAT
IVF 25-D bolus IV/STAT
GRBS, BP chatting hrly






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