Insulin supersensitivity and normoinsulinaemic hypoglycaemia in uncontrolled type 2 diabetes mellitus: clinical usefulness of 3 h assessment in the 75 g oral glucose tolerance test.

A 60-year-old man with uncontrolled type 2 diabetes mellitus (DM) (glycated haemoglobin 11%) had the unusual symptoms of palpitations and sweating after drinking an excessive amount of soft drinks. Three-hour data in the 75-g oral glucose tolerance test (75g-OGTT) repeatedly showed normoinsulinaemic hypoglycaemia. His diabetic disorder was based on a delayed insulin secretory response to hyperglycaemia and daily excessive intake of glucose from a high caloric diet and soft drinks. However, we paradoxically observed increased insulin sensitivity evaluated by a hyperinsulinaemic-euglycaemic clamp (glucose infusion rate: 64.83 μmol/kg/min). We considered that insulin supersensitivity might be involved in the pathogenic mechanisms of his clinical normoinsulinaemic hypoglycaemia. He was successfully treated by diet and exercise therapy without any hypoglycaemic medications or insulin. Assessment after the 75g-OGTT is useful for investigating the pathogenesis of DM. Insulin supersensitivity and normoinsulinaemic hypoglycaemia might play a role in clinical manifestation and pathogenesis of type 2 DM.