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Case Report
Correction of Over-Dosed Insulin in a Type-2-Diabetic Associates With a Better Control of Glycemia and Arterial Hypertension: A Case Report
Rainer U. Pliquett
Martin-Luther-Universitat Halle-Wittenberg Naturwissenschaftliche Fakultat II Chemie Physik und Mathematik
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9684-0618
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: An association between hypoglycemia and arterial hypertension is unknown. Here, we report a case of a chronically over-dosed insulin therapy in conjunction with uncontrolled hypertension.
Case Presentation: A 73-year-old, male diabetic of Caucasian ethnicity was admitted to a neurological intermediate-care unit of a university hospital for progressive weakness due to diabetic polyneuropathy. Besides obesity (body-mass index: 31 kg/m²) and type-2 diabetes, an uncontrolled arterial hypertension was present. Diabetes therapy consisted of fixed-dose insulin (160 units QD). Symptomatic or documented hypoglycemic episodes were not reported. Hemoglobin A1c was 11.2%. Prior to hospitalization, a urapidil (60 mg thrice a day), was added to his antihypertensive medication with valsartan (160 mg BID) and bisoprolol (5mg BID). During hospitalization, metformin, empagliflozin, and dulaglutide (1.5 mg per week) were added to insulin. An intensified conventional therapy with a cumulative daily dose of 46 units was introduced. 22 months after discharge, the medical therapy consisted of metformin (1 g BID), liraglutide (1.8 mg QD), and insulin glargine (26 units QD). The antihypertensive medication was reduced to bisoprolol and valsartan, urapidil was discontinued. The follow-up visit showed Hemoglobin A1c of 6.6%, and a well-controlled blood pressure. The patient’s physical activity improved with the patient being able to leave his flat alone for the first time within 6 years.
Conclusions: Undocumented, asymptomatic hypoglycemic events and post-hypoglycemic hormonal stimulation were the likely cause for the poor glycemic and blood-pressure control. A step-wise reduction of insulin concurrently translated into a better glycemic and blood-pressure control.
Keywords
case report, insulin, Type-2 Diabetes, Hypoglycemia, Hypertension
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Case Report
Correction of Over-Dosed Insulin in a Type-2-Diabetic Associates With a Better Control of Glycemia and Arterial Hypertension: A Case Report
Rainer U. Pliquett
Martin-Luther-Universitat Halle-Wittenberg Naturwissenschaftliche Fakultat II Chemie Physik und Mathematik
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9684-0618
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 25 Sep, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: An association between hypoglycemia and arterial hypertension is unknown. Here, we report a case of a chronically over-dosed insulin therapy in conjunction with uncontrolled hypertension.
Case Presentation: A 73-year-old, male diabetic of Caucasian ethnicity was admitted to a neurological intermediate-care unit of a university hospital for progressive weakness due to diabetic polyneuropathy. Besides obesity (body-mass index: 31 kg/m²) and type-2 diabetes, an uncontrolled arterial hypertension was present. Diabetes therapy consisted of fixed-dose insulin (160 units QD). Symptomatic or documented hypoglycemic episodes were not reported. Hemoglobin A1c was 11.2%. Prior to hospitalization, a urapidil (60 mg thrice a day), was added to his antihypertensive medication with valsartan (160 mg BID) and bisoprolol (5mg BID). During hospitalization, metformin, empagliflozin, and dulaglutide (1.5 mg per week) were added to insulin. An intensified conventional therapy with a cumulative daily dose of 46 units was introduced. 22 months after discharge, the medical therapy consisted of metformin (1 g BID), liraglutide (1.8 mg QD), and insulin glargine (26 units QD). The antihypertensive medication was reduced to bisoprolol and valsartan, urapidil was discontinued. The follow-up visit showed Hemoglobin A1c of 6.6%, and a well-controlled blood pressure. The patient’s physical activity improved with the patient being able to leave his flat alone for the first time within 6 years.
Conclusions: Undocumented, asymptomatic hypoglycemic events and post-hypoglycemic hormonal stimulation were the likely cause for the poor glycemic and blood-pressure control. A step-wise reduction of insulin concurrently translated into a better glycemic and blood-pressure control.
Figure 1