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Acta Diabetologica

, Volume 55, Issue 8, pp 873–875 | Cite as

Permanent brain damage following parasuicide with severe insulin-induced hypoglycaemia

  • Andreas Holstein
  • Markus Zimmer
  • Mathias Rohde
  • Brian M. Frier
Case Report
  • 100 Downloads

Dear Editor,

The brain is continuously dependent on glucose as its energy substrate. When vulnerable areas (hippocampus, cerebral cortex, basal ganglia, caudoputamen) are exposed to protracted neuroglycopenia, irreversible neuronal necrosis with permanent cerebral damage or brain death may result [1, 2, 3].

We present a case of parasuicide with an overdose of insulin that caused protracted hypoglycaemia with permanent brain damage. We propose that the acute inflammatory and rheological response to hypoglycaemia with subsequent intravascular thrombosis provoked multi-territorial cerebral infarctions, therefore, representing an atypical pathogenesis of hypoglycaemic brain damage.

A 68-year-old woman with a 40-year history of type 1 diabetes and a history of depression and chronic alcohol abuse was found at home in a deeply comatose state. Her blood glucose concentration was too low to be estimated. Verifiably, approximately 6 h earlier, she was observed by her relatives to be conscious...

Keywords

Diabetes Hypoglycaemia Brain damage Cerebral imaging Parasuicide 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

As the patient deemed unfit, the husband gave his signed consent for the material presented in the publication.

References

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    Kahn KJ, Myers RE (1971) Insulin-induced hypoglycaemia in the non-human primate. I. Clinical consequences. In: Brierly JB, Meldrum BS (eds) Brain hypoxia. William Heinemann Medical Books ltd, London, pp 185–194Google Scholar
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    Kang EG, Jeon SJ, Choi SS, Song CJ, Yu IK (2010) Diffusion MR imaging of hypoglycemic encephalopathy. Am J Neuroradiol 31:559–564CrossRefPubMedGoogle Scholar
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    Arky BI, Veverbrants E, Abramson EA (1968) Irreversible hypoglycaemia. A complication of alcohol and insulin. J Am Med Assoc 206:575–578CrossRefGoogle Scholar
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    Frier BM, Schernthaner G, Heller SR (2011) Hypoglycemia and cardiovascular risks. Diabetes Care 34(Suppl. 2):S132–S137CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Crown 2018

Authors and Affiliations

  1. 1.First Department of MedicineLippe-Detmold HospitalDetmoldGermany
  2. 2.Department of RadiologyLippe-Detmold HospitalDetmoldGermany
  3. 3.Department of NeurologyLippe-Detmold HospitalDetmoldGermany
  4. 4.The Queen’s Medical Research InstituteUniversity of EdinburghEdinburghUK

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