Clinical Review Lesson of the week

Recurrent hypoglycaemia in a diabetic patient as a result of unexpected renal failure

BMJ 2004; 328 doi: (Published 08 April 2004) Cite this as: BMJ 2004;328:883
  1. Malvinder S Parmar, medical director (
  1. 1Department of Internal Medicine, Timmins and District Hospital, Timmins, ON, Canada P4N 8R1
  1. Correspondence to: M S Parmar, Suite 108, 707 Ross Avenue East, Timmins, ON, Canada P4N 8R1


    Hypoglycaemia is the most frequent complication of diabetes, affecting 10% to 25% of diabetic patients at least once a year and accounting for 3% to 4% of deaths in those treated with insulin.1 Diabetic renal disease is a common complication and is the most prevalent cause of end stage renal disease in the western world.2

    The kidney plays an important role in glucose homoeostasis: in addition to metabolising between30% and 40% of insulin,3 it provides up to 45% of endogenous glucose through gluconeogenesis during a prolonged fast.4 In renal failure, it cannot metabolise insulin or generate glucose, thereby increasing the risk of hypoglycaemia. Hypoglycaemia affects 67% of diabetic patients with renal failure, and in almost half (46%) of patients it is often related to the medication they are taking.5 I present a case where a decline in renal function after treatment with diclofenac resulted in …

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