Cold Truths in a hot land: Hypothermia unmasked by hypoglycemia in an elderly diabetic

Jayavelan J

2nd year MEM, Department of Emergency Medicine, Bangalore

Abstract

Hypothermia is uncommon in tropical regions like South India. Even more unusual is hypothermia caused by hypoglycemia—particularly in a warm environment. We report a rare case of a 72-year-old diabetic female presenting with moderate hypothermia secondary to sulfonylurea-induced hypoglycemia.

Introduction

  • Hypothermia: Core body temperature <35°C
  • Common in cold climates, rare in tropical zones
  • Hypoglycemia impairs thermogenesis, especially in the elderly
  • Delayed recognition can be fatal but is reversible if promptly managed

Case Presentation

A 72-year-old female with type 2 diabetes, on glimepiride, lives alone. She was found unresponsive in home at 5:30 AM; outside temperature was 23°C, in Bengaluru.

On Examination

Temp: 31.6°C

HR: 42 bpm

BP: 90/60 mmHg

GCS: E1V1M1, Pupils: BERL 3mm

Investigations

RBS: 28 mg/dL

ECG: Bradycardia, Osborn (J) waves

Other labs: Mild hyponatremia, normal renal profile.

ECG

Diagnosis

Moderate hypothermia secondary to severe hypoglycemia from sulfonylurea use

Management

  • 100mL 25% dextrose IV bolus
  • Passive external rewarming (warm blankets, heated fluids)
  • Discontinuation of glimepiride
  • Home safety measures implemented, including regular glucose checks and family support

Discussion

  • Elderly patients are more susceptible to both hypoglycemia and hypothermia
  • Sulfonylureas are known to cause prolonged hypoglycemia in older adults
  • Hypothermia can occur even in warm climates if thermoregulation is impaired
  • Early glucose check is critical in any hypothermic patient with altered sensorium

Conclusion

In warm climates, hypothermia is often missed. Hypoglycemia, especially in elderly diabetics on sulfonylureas—is a reversible and critical cause that should always be considered. Temperature and glucose checks must be routine in altered mental status, regardless of geography.

Reference

  • Brown DJA, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med. 2012;367(20):1930–1938.
  • Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med. 1994;331(26):1756–1760.
  • Taylor C, et al. Hypoglycemia-induced hypothermia: a rare presentation in adults. BMJ Case Rep. 2013;2013:bcr2013009755.
  • Cryer PE. Hypoglycemia in Diabetes: Pathophysiology, Prevalence, and Prevention. American Diabetes Association, 2009.

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