Hypoglycemic Encephalopathy in a Patient With Diabetes Mellitus: A Case Report

Hypoglycemic encephalopathy (HE) is a rare yet critical consequence of extended low blood sugar, often resulting in altered mental status, seizures, and coma. Because its presentation mirrors various other neurological disorders, prompt recognition is difficult, and treatment delays risk permanent brain damage. This report describes a 56-year-old Black man with Type 1 diabetes mellitus (DM) on Neutral Protamine Hagedorn (NPH) insulin who discovered nonresponsiveness roughly eight hours post insulin injection. Upon admission, he was presented with a blood glucose of 43 mg/dL and a Glasgow Coma Scale (GCS) score of 7/15, with brain magnetic resonance imaging (MRI) findings consistent with HE. Despite immediate treatment with intravenous (IV) 40% dextrose (50 mL), a continuous dextrose-saline infusion, and antiepileptic medication to control seizures, his neurological function stabilized without further improvement, leaving his GCS score between 8 and 10. Following a four-month period of stabilization during home care the patient developed pneumonia and septicemia in the fifth month. This complication triggered progressive neurological deterioration, ultimately resulting in death at five months postevent. This case underscores the importance of timely detection and treatment of hypoglycemia in diabetic patients, particularly those receiving insulin. Regular glucose monitoring, patient education, and careful insulin adjustment are essential to prevent HE and its devastating outcomes.