MIGRAINE AS A CONSEQUENCE OF EUGLYCEMIA DIABETIC CONTROL

Abstract

Euglycemia in insulin dependent diabetes mellitus (IDDM) is possible with intensive insulin treatment. Though control may be improved, the risks of hypoglycemia are increased. We have encountered a patient with IDDM who attempted intensive insuiin treatment only to experience debilitating migraine attacks in association with insulin induced hypoglycemia.Seven year-old boy developed IDDM and managed by conventional insulin therapy (2 injections mixed insulin/day, uriae glucose monitoring) for two years. On occasion he experienced early AM headaches with vomiting in association with hypoglycemia. Neurologic evaluations indicated that he was experiencing migraine attacks. At the same time he was enrolled in an adult diabetic clinic which had the goal of maintaining his blood glucose between 100-160 mg/dl. Frequent severe usually early AM headaches with prolonged vomiting triggered by hypoglycemia led to metabolic derangement and many hospitalizations. Over the next 18 months. Maintenance propranolol started for migraine prevention; intensity and frequency of hypoglycemia and migraine attacks increased. Conventional diabetic management resumed with lessening of frequency and severity of hypoglycemia and migraine episodes. Then propranolol discontinued, and no symptomatic hypoglycemia, migraine or hospitalization for past year.Counter regulatory mechanisms to prevent insulin induced hypoglycemia are usually intact in the young diabetic, and migraine is an unexpected complication of hypoglycemia, particularly in a child. This boy showed symptoms of hypoglycemia, that had a unique and repetitive expression. He also showed that children may not tolerate an adult oriented intensive insulin management plan.