Seizures as the only clinical manifestation of reactive hypoglycemia: a case report.

A 45-yr old diabetic patient, who had received a diagnosis of grand mal epilepsy, for two episodes of nocturnal tonic-clonic convulsions, underwent continuous glucose monitoring (CGM). During CGM, the patient had an episode of tonic-clonic convulsion, and at the same time a prolonged nocturnal hypoglycemia (<2.2 mmol/l) was observed. CGM revealed that tonic-clonic convulsions, which had been interpreted as a manifestation of epilepsy, were in fact a symptom of severe hypoglycemia. In order to assess the pathogenesis of hypoglycemia, the patient underwent a 75-g oral glucose tolerance test, that was interrupted shortly afterwards for hypoglycemic symptoms (i.e., reactive hypoglycemia). To our knowledge, this is the first case ever reported of reactive hypoglycemia associated with Type 2 diabetes.