Weng Ning, Luo Yan-Wen, Xu Jian-Dong, Zhang Yue
The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou,Guangdong.
Department of Neurology, Second Affiliated Hospital to Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou.
Medicine (Baltimore). 2019 Feb;98(6):e14405. doi: 10.1097/MD.0000000000014405.
Hypoglycemia, which is characterized mainly by palpitations, dizziness, and sweating, is common and easy to identify. However, some other symptoms, such as mental disorder or abnormal behavior, are atypical, which may lead to a misdiagnosis of epilepsy, sleepwalking, infarction, or mental disorder, among others.
We report a case of a patient with type 2 diabetes who presented with abnormal nocturnal behavior due to hypoglycemia.
Hypoglycemia was diagnosed based on a blood glucose level of 2.1 mmol/L when the patient turned up disoriented unresponsive, unable to understand what was said to him, and producing nonsensical speech. After the patient ate a piece of chocolate, his consciousness returned to normal and all mental symptoms disappeared. Polysomnography (PSG) was synchronously performed. The results of the PSG did not show any signs of abnormality during nonrapid eye movement (NREM) or rapid eye movement (REM) sleep.
We regulated his dose of insulin.
No additional episodes occurred during the 3-month follow-up. Therefore, the abnormal nocturnal behavior of this patient was determined to be due to hypoglycemia, while the cause of the hypoglycemia was insulin overuse.
For physicians, if the cause of abnormal behavior cannot be detected, hypoglycemia should be suspected. Long-term persistent hypoglycemia may cause brain dysfunction and even result in permanent brain damage.
低血糖主要表现为心悸、头晕和出汗，较为常见且易于识别。然而，一些其他症状，如精神障碍或异常行为，则不典型，这可能导致误诊为癫痫、梦游、梗死或精神障碍等。
我们报告一例2型糖尿病患者，因低血糖出现夜间异常行为。
当患者出现定向障碍、无反应、无法理解对其所说内容并胡言乱语时，测得血糖水平为2.1毫摩尔/升，据此诊断为低血糖。患者吃了一块巧克力后，意识恢复正常，所有精神症状消失。同时进行了多导睡眠图（PSG）检查。PSG结果显示在非快速眼动（NREM）或快速眼动（REM）睡眠期间未出现任何异常迹象。
我们调整了他的胰岛素剂量。
在3个月的随访期间未再出现其他发作情况。因此，该患者的夜间异常行为被确定为由低血糖所致，而低血糖的原因是胰岛素使用过量。
对于医生而言，如果无法检测到异常行为的原因，应怀疑低血糖。长期持续性低血糖可能导致脑功能障碍，甚至造成永久性脑损伤。
