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Background: Hypoglycemia is a common complication in pregnant patients with Type 1 diabetes, often exacerbated by hormonal changes and intensive insulin therapy. While mifepristone has been associated with hypoglycemia due to anti-glucocorticoid effects, the role of misoprostol, a prostaglandin E1 analog used in medical abortions, remains unclear.
Case Presentation: We describe a 28-year-old woman with well-controlled Type 1 diabetes who experienced recurrent severe hypoglycemia following misoprostol administration for medical termination of pregnancy. She had no history of hypoglycemia unawareness or adrenal insufficiency. Glycemic instability persisted for several days post-administration and required significant insulin dose reductions.
Discussion: This case highlights a possible association between misoprostol and hypoglycemia in patients with Type 1 diabetes. Proposed mechanisms include prostaglandin-mediated alterations in glucose metabolism or impairment of counterregulatory hormonal responses. A review of the literature revealed limited data on this phenomenon, underscoring the need for further investigation and to develop guidelines for managing glycemic control in similar clinical scenarios.
Conclusion: Clinicians should be aware of the potential for misoprostol-induced hypoglycemia in individuals with Type 1 diabetes. Preemptive insulin adjustments and close glucose monitoring are advised during medical management of pregnancy in this population.
