Objective: To report a case of abnormal sleep behavior associated with hypoglycemia induced by insulin.

Background: Hypoglycemia is a serious condition that can be manifested neurologically by many symptoms like headache, confusion seizures, abnormal movement, and coma. Few cases have been reported to have sleep behavior abnormality due to hypoglycemia.

Method: A 70-year-old male patient diabetic on insulin for 20 years, developed nocturnal attacks of abnormal behaviors and abnormal movements during sleep almost every day for more than 6 months. Patient mainly presented with attacks of sleep talking, walking, shouting, and acting out his dreams, sometimes associated with choric movements and hemiballismus. He seemed unresponsive during the attacks and didn’t recall any of these events upon awakening.

Results: Polysomnography showed atonia during Rapid eye movement (REM) sleep, EEG was normal, his routine labs, thyroid profile, fasting blood glucose were normal, and glycosylated hemoglobin (HA1C) was 5.2%. MRI brain showed diffuse atrophic changes, scattered lacunae and Leukoaraiosis. Parenchymal ultrasound revealed increased echogenicity of the Caudate nucleus on the RT side.
His wife reported that if he missed his evening dose of insulin, these attacks didn’t develop. She was asked to measure his blood glucose once during sleep which was low as 50 mg/dl. The patient was sent for adjustment of his insulin dose with complete resolution of these attacks.

Conclusion: Hypoglycemia can develop at night in diabetic patients on insulin and manifest itself by abnormal sleep behavior and movements.

References: 1- Yang KI, Kim HK, Baek J, et al. Abnormal nocturnal behavior due to hypoglycemia in a patient with type 2 diabetes. J Clin Sleep Med 2016;12:627–9.
2- Weng, Ning, Luo, Yan-Wen, Xu, Jian-dong, Zhang, Yue. Abnormal nocturnal behavior due to hypoglycemia, Medicine 2019: 98 (6) p e14405.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nocturnal-attacks-of-abnormal-sleep-behaviors-and-abnormal-movements-induced-by-insulin-a-case-report/