Lesson of the Week: Addison's disease presenting as reduced insulin requirement in insulin dependent diabetes

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Abstract
A 43 year old man with a 15 year history of insulin dependent diabetes well controlled with a stable regimen of twice daily injections of human insulin was referred to the diabetic clinic, Royal Victoria Hospital, complaining of increased frequency of hypoglycaemic episodes on waking. On one occasion he required intramuscular glucagon administered by his wife. On a second occasion he collapsed at work and required medical assistance. He also complained of tiredness and nausea. He was advised to reduce his evening dose of long acting insulin and was given an appointment for further review.