SAT168 Cholecalciferol - Cause Of Hypoglycemia In Patients With Insulin Dependent Diabetes Mellitus

Abstract

Abstract Disclosure: S. Kalinchenko: None. L. Vorslov: None. T. Sviderskaya: None. S. Timofeeva: None. O. Samburskaya: None. Hypoglycemia is a dangerous complication in patients with diabetes mellitus receiving insulin drugs. We found a previously undescribed cause of hypoglycemia caused by prescription of cholecalciferol. Materials and Methods. Five patients (ages 6, 14, 28, 37, and 45 years) with medically subcompensated insulin-dependent diabetes mellitus (HbA1c > 7%) with vitamin D deficiency (25(OH)D < 30 ng/mL) were under observation. To compensate for vitamin D deficiency, cholecalciferol preparations were prescribed in individually selected doses (2,000 to 20,000 IU), considering age and weight. Findings. As a result of using cholecalciferol (without changing diet and physical activity level) all patients had episodes of hypoglycemia at different terms of treatment - from one to two weeks (younger patients 6 and 14 years old) to 6-8 months (patients of older age groups 28, 37 and 45), which were recorded by the continuous glucose monitoring system FreeStyle Libre: glucose level less than 3.0 mmol/L was accompanied by associated symptoms (tremor, tachycardia, cold clammy sweats, and intense hunger), which necessitated a reduction in the dose of insulin drugs. Interpretation. Vitamin D deficiency is a pandemic of modern society. Overweight, obesity, arterial hypertension, metabolic syndrome, and diabetes mellitus are the clinical manifestations of vitamin D deficiency. Vitamin D regulates the expression of over 5,000 genes, and compensating for its deficiency not only increases the number of insulin receptors, but also increases their sensitivity, leveling out insulin resistance and preventing its development. On achieving an adequate vitamin D level (25(OH)D not less than 65 ng/ml and parathormone levels closer to the lower limit of normal ranges of 16-25 ng/ml) against the background of reduced or completely discontinued insulin drugs, glycated hemoglobin in the blood was determined after three months and its values were within the reference values in all five patients (HbA1c not more than 5.6%). Conclusion. In patients with diabetes receiving insulin therapy, correction of vitamin D deficiency should be accompanied by daily glucose monitoring and under strict medical supervision, with dose adjustment of insulin drugs to prevent the development of hypoglycemia. Presentation: Saturday, June 17, 2023