Diabetic kidney disease is the most common cause of hypoglycemia in a previously stable, well-controlled diabetic patient who has not changed their diet or insulin dosage.
Common presentation: A diabetic patient whose been taking insulin for several years to decades starts having episodes of hypoglycemia. His blood sugars have been well controlled for a long time and nothing has changed recently to explain the hypoglycemic episodes.
Suspect Renal disease
Further Reading
Alsahli M, Gerich JE: Hypoglycemia, chronic kidney disease, and diabetes mellitus. Mayo Clin Proc 2014;89(11):1564-1571.