Correction of Over-Dosed Insulin in a Type-2- Diabetic Led to a Better Control of Glycemia and Arterial Hypertension: A Case Report

Author(s): Abimbola Abobarin-Adeagbo, Torsten Kraya, Matthias Girndt, Rainer Ullrich Pliquett

Introduction: An association between hypoglycemia and arterial hypertension has been proposed. Here, we report a case of an elderly type-2 diabetic presenting with hypertensive crisis, which improved after insulin-dose reduction.

Case Presentation: A 73-year-old, male type-2 diabetic of Caucasian ethnicity was hospitalized for hypertensive crisis and weakness attributed to a diabetic polyneuropathy. Prior to hospitalization, a fixed-dose insulin therapy (160 units per day) and a triple antihypertensive therapy (urapidil, valsartan, bisoprolol) were prescribed. Symptomatic hypoglycemic episodes were not reported. On admission, hyperglycemia from 15-19 mmol/L was present, hemoglobin A1c was 11.2%. On the third day in hospital, the fixed-dose insulin therapy was switched to an intensive insulin therapy with a cumulative daily dose of 46 units. Metformin, empagliflozin, and dulaglutide were added. Despite insulin-dose reduction, intermittent blood-glucose tests showed a considerable decrease of preprandial blood-glucose values to 11-15 mmol/L, antihypertensive medication was reduced by discharge. 22 months later, the diabetes therapy consisted of metformin, liraglutide, and insulin glargine (26 units per day). Antihypertensive medication was further reduced, and hemoglobin A1c was 6.6%. As a likely explanation, undocumented, asymptomatic hypoglycemic events were the cause for post-hypoglycemic, hormonal stimulation determining hyperglycemia and hypertensive crisis at admission. The insulin reduction to a quarter of the initial daily cumulative insulin dose performed at the 3rd day after admission translated into a better glycemic and blood-pressure control.

Conclusions: Here, insulin reduction likely corrected an initial insulin overdose leading to counterregulations facilitating hypertension.

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