Case Study: Seizures and Hypoglycemia

Abstract

A.S. is a 64-year-old man admitted to the nephrology service for dizziness and hypotension after dialysis. During his hospital stay, he experienced labile blood glucose levels and had a suspected hypoglycemic seizure. The endocrine service was consulted to assist with these findings. The patient has a history of previous stroke, remote alcohol abuse, and end-stage renal disease requiring hemodialysis 3 days/week and is awaiting a kidney transplant. He has had type 2 diabetes for 25 years and has been treated with insulin for 10 years. During the past year and a half, he reports having had two seizures. His family witnessed the first seizure and reports that he was hyperglycemic at that time. Additionally, the patient reports an event during which he suddenly “passed out” and was “out of it” for the rest of the day. At home, he takes 6 units of aspart insulin with meals and 12 units of glargine insulin in the morning. He weighs 84 kg, and his last A1C result was 6.7%. During the hospitalization, he was placed on his home insulin regimen plus a hospital preprandial correction dose of insulin. The correction dose was 2 units of aspart for blood glucose readings that were 151–200 mg/dl, increasing by 2 units of aspart for every 50 mg/dl increase in blood glucose. While in the hospital, he felt nauseated and did not eat. That afternoon, he had a witnessed seizure. He was stabilized, and routine laboratory testing was performed. His blood glucose measured …