Correction of over-dosed insulin in a type-2- diabetic led to a better control of glycemia and arterial hypertension: a case report

Abstract Background:An association between hypoglycemia and arterial hypertension has been proposed. Here, for the first time, we report a case of a chronically over-dosed insulin therapy with uncontrolled hypertension, which improved after insulin-dose reduction.Case Presentation: A 73-year-old, male type-2 diabetic of Caucasian ethnicity was hospitalized for uncontrolled arterial hypertension and weakness. Prior to hospitalization, a fixed-dose insulin therapy (160 units per day) and antihypertensive medication with urapidile, valsartan and bisoprolol were prescribed. Hemoglobin A1c was 11.2%, symptomatic hypoglycemic episodes were not reported. During hospitalization, metformin, empagliflozin, and dulaglutide (1.5 mg per week) were added to insulin. Conventional insulin therapy was switched to an intensified insulin therapy with a cumulative daily dose of 46 units. 22 months after discharge, the medical therapy consisted of metformin, liraglutide, and insulin glargine (26 units per day), antihypertensive medication was reduced to bisoprolol and valsartan. Blood pressure was well controlled, hemoglobin A1c was 6.6%. As a likely explanation, undocumented, asymptomatic hypoglycemic events with a post-hypoglycemic hormonal stimulation were the cause for the poor glycemic and blood-pressure control. A step-wise reduction of insulin translated into a better glycemic and blood-pressure control. Conclusions: Undocumented, asymptomatic hypoglycemic events and post-hypoglycemic hormonal stimulation were the likely cause for the poor glycemic and blood-pressure control prior to index hospitalization. A step-wise reduction of insulin concurrently translated into a better glycemic and blood-pressure control.