Clinical and Laboratory ObservationsLoss of hypoglycemia awareness in an adolescent with type 1 diabetes mellitus during treatment with fluoxetine hydrochloride☆
Section snippets
CASE REPORT
Our patient, a 17-year-old boy, was diagnosed with diabetes mellitus at the age of 15 years, when he presented with ketoacidosis. He had no evidence of acanthosis nigricans. Islet cell antibodies, ICA512 antibodies, glutamic acid decarboxylase antibodies, and C peptide were not measured. Although he was mildly obese, his clinical presentation was consistent with type 1 diabetes mellitus, and he was treated with an intensive subcutaneous insulin program (preprandial Lis-pro and evening
DISCUSSION
Glucose fuels the central nervous system. However, the brain is unable to synthesize glucose and is dependent on uptake of glucose from the periphery. Hypoglycemia results in a counterregulatory response involving glucagon, epinephrine, growth hormone, cortisol, and hepatic autoregulation.4 Classic autonomic warning symptoms (including diaphoresis, hunger, anxiety, and palpitations) typically occur at a blood glucose level of ~3.3 mmol/L (60 mg/dL). Symptoms of neuroglycopenia (confusion,
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