HHS in type 1 diabetes associated with medication overdose : can counter-regulatory hormone suppression prevent diabetic ketoacidosis?

In states of insulopaenic hyperglycaemia, counter-regulatory hormone (CRH) excess is a driver of ketogenesis and thus diabetic ketoacidosis. We present a case of hyperglycaemic hyperosmolar state in a patient with type 1 diabetes mellitus, associated with a mixed drug overdose including agents with documented CRH suppressive effects. We postulate that the drugs taken in overdose protected against diabetic ketoacidosis, and suggest further investigation of pharmacological therapies aimed at inhibiting CRH responses which may protect against this life-threatening complication in patients with type 1 diabetes.