Abstract
Severe hypoglycemia is rare in nateglinide treatment alone. A 50-year-old man admitted for hypoglycemia and treated for diabetes mellitus with nateglinide had been ill for a few days and unable to eat. He was seen for general fatigue, dehydration, and disturbance of consciousness [Japan Coma Scale I-3: Glasgow Coma Scale 14/15 points (E4V4L6)]. His blood glucose could not be measured with a portable blood meter and renal function had deteriorated, due to dehydration. His serum creatinine increased from 1.5 mg/dl to 8.78 mg/dl. Worsened nateglinide and insulin clearance may have raised his serum nateglinide concentration and its metabolic products M1 and M7, derived from nateglinide, higher than usual on admission. Thyroid dysfunction may also have been involved in this metabolism and hypoglycemia.
