Severe Hypoglycemia in a Patient With Type 1 Diabetes Mellitus Recently Started on Sacubitril/Valsartan: A Case Report

This report describes an episode of severe hypoglycemia in a 55-year-old woman with type 1 diabetes mellitus approximately 2 weeks after initiating sacubitril/valsartan for heart failure. She was receiving a continuous subcutaneous insulin infusion and denied any severe hypoglycemic events in the prior 13 years. She experienced a second hypoglycemic episode 1 week later. She subsequently reduced her insulin dose and continued on sacubitril/valsartan. Eight months later, she did not have any recurrent hypoglycemic episodes. Clinicians should be aware of this potential adverse effect and educate patients on concomitant insulin therapy to monitor for symptoms of hypoglycemia when initiating sacubitril/valsartan.