UTILITY OF CONTINUOUS GLUCOSE MONITORING TO DETECT SYMPTOMATIC REACTIVE HYPOGLYCEMIA IN DIPEPTIDYL PEPTIDASE-4 INHIBITOR/ METFORMIN COMBINATION THERAPYTREATED T2D INDIVIDUALS

AN ILLUSTRATIVE CASE REPORT

Abstract

CASE
“Relative hypoglycemia” is a phenomenon characterized by an increase in the glycemic threshold for detecting and responding to hypoglycemia. Herein, we illustrated a case of non-insulin requiring well-controlled diabetes presented with postprandial glucose.

A 60-year-old Thai female with well-controlled T2D for 5 years presented with a 6-month history of regularly experiencing symptoms consistent with hypoglycemia without any other alarm symptoms. She is taking a combined tablet of sitagliptin 100 mg/ metformin extendedrelease 1,000 mg and her latest A1C values varied from 6.1- 6.5% in the past 6 months. Continuous glucose monitoring (CGM) revealed postprandial hyperglycemia and subsequent low-normal interstitial glucose levels. Further dietary recall revealed her excessive refined carbohydrate or fruit juices before the onset of hypoglycemic symptoms. Low glycemic index foods and avoiding excessive carbohydrates had been advised. Her symptoms markedly improved, thereafter.

CGM provides important information regarding overall glycemic excursion over time in this patient.