Severe hypoglycemic coma with radiological evidence of hypoglycemic encephalopathy due to impaired awareness to hypoglycemia: a case report

Adults with diabetes are at a higher risk of recurrent hypoglycemia, a condition linked to morbidity and mortality. This is due to their diminished counter-regulatory response to hypoglycemia, which can lead to impaired awareness to hypoglycemia (IAH). The brain relies on circulating glucose as its primary energy source, so hypoglycemia impairs central nervous system function. Clinical manifestations vary depending on severity, duration, and serum glucose responsiveness to treatment. Hypoglycemic encephalopathy (HE) is characterized by coma or stupor in patients with glucose levels below 50 mg/dL, despite normalization. Early recognition of symptoms is crucial to prevent irreversible brain cell death and timely intervention to restore blood glucose levels and minimize complications. We report a case of a 42-year-old man with type 1 diabetes who presented in hypoglycemic coma (GCS 3). Neuroimaging confirmed hypoglycemic encephalopathy, and the patient improved after intravenous dextrose and supportive care. The current case showed that IAH causes severe sequelae due to the progression of the hypoglycemia affecting the brain and leading to impaired quality of life associated with bed-ridden outcomes and inability to work.