A 64-year-old male who is known to have insulin dependent
diabetes mellitus presents with recurrent episodes of hypoglycaemia. This has
necessitated reduction in his daily insulin dosage.
He also has decreased renal function on account of a
combination of diabetic nephropathy and bilateral renal artery stenosis.
In this patient the recurrent hypoglycaemic episodes are
likely to be a consequence of:
Non Alcoholic Fatty Liver Disease resulting in decreased liver glycogen
Autonomic neuropathy resulting in decreased absorption of sugar
Decreased catabolism of insulin by the kidney
Activation of the renin angiotensin system
Decreased insulin resistance