[Hypoglycemic comas from multiple sources in a type 1 diabetic]

ABSTRACT

Iterative hypoglycaemic comas in type 1 diabetic patients are a serious problem which may be caused by many factors like educational errors, unawareness of hypoglycaemia and also adrenal insufficiency and diabetic nephropathy while factitious hypoglycaemia is the major diagnostic pitfall. We report an unusual case of a 35-year-old man, who presents a type 1 diabetes for the past 23 years, and who had unexplained hypoglycaemic comas for the past four months even after decreasing his insulin doses. The investigation revealed factitious insulin injections but also the presence of adrenal insufficiency Graves' disease and diabetic nephropathy without renal failure. Psychiatric evaluation showed a depressive state induced by diabetic complications and hyperthyroidism. This case report emphasizes the fact that organic and factitious causes of hypoglycaemia may be present in the same patient that is referred for type 1 diabetic hypoglycaemia