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A 35-year-old man known to have type 1 diabetes for 8 years presented to the emergency department with disturbed conscious level. He gave a history of recurrent similar attacks during the previous 8 months. All of these attacks were proved to be due to hypoglycemia. Some of the episodes were mild and treated by oral glucose only, whereas others were severe, requiring hospital admission and treatment with an intravenous glucose infusion.The patient had been taking human mixed insulin for the past 2 years. His insulin doses were reviewed by his primary care providers and decreased after each episode of hypoglycemia. His total daily insulin dose had been decreased from 70 to 10 units during the previous 8 months.The patient gave a history of darkening of the skin of his face and extremities associated with significant weight loss throughout the previous year. He had no family history of type 1 diabetes or thyroid or adrenal diseases.On admission to the emergency department, the patient had disturbed conscious level with no signs of lateralization. His blood pressure was 70/40 mmHg, …

Polyglandular Dysfunction in Patients With Type 1 Diabetes: Recurrent Hypoglycemia Is an Alarming Symptom