Hypoglycemia-associated In-stent Thrombosis: Are We Doing Too Much?

Diabetes mellitus is one of the most common modifiable risk factors for coronary artery disease, and its prevalence is rising globally. Persistent hyperglycemia has a well-established cardiovascular risk, and its treatment plays an important role in the prevention of future cardiovascular events. While we improved microvascular complications such as retinopathy, nephropathy, and neuropathy by stringent blood glucose control, the cardiovascular morbidity and mortality in diabetics remain high. Hypoglycemia, on the other hand, is an important side effect of pharmaceutical blood glucose control, especially those who are treated with insulin. Here, we report the case of a 38-year-old man with type 1 diabetes presenting twice with acute ST-elevation myocardial infarction, both in the setting of documented hypoglycemia. There are reported cases of acute cardiovascular events or silent myocardial ischemia associated with hypoglycemia, and we wish to raise awareness for clinicians who treat this special population of patients.