Diabetic Patient

We report the case of a 47-year-oldwoman who was referred to ourunit for hypoglycemia. She was diagnosed with diabetes at age 30 years and was previously treated with metfor-min, sulfonylureas, and glucagon-like peptide 1 agonists. Despite interruption of her treatments, she had for 1 month clinical features evoking hypoglycemic spells, with adrenergic and neuroglyco-penic symptoms subsiding after glucose administration. Her BMI was 23.8 kg/m2. She had axillary acanthosis nigricans but no lipodystrophy. Continuous glucose monitoring showed hypoglycemia down to 2.1 mmol/L, mostly during fasting pe-riods, and hyperglycemia up to 13.7 mmol/L in the absence of any treatment. HbA1c was 15%. During a fasting test, venous glucose concentration dropped to 2.5 mmol/L with concomitant low se-rum levels of C-peptide, insulinemia, and proinsulinemia:,1.40,,3, and 3.6 pmol/L, respectively (reference ranges i