A 59-year-old man with a 13-year history of type 2 diabetes mellitus presented with  recurrent hypoglycemic episodes  over 4 months, including nocturnal hypoglycemia, accompanied by sweating, palpitations, and confusion. Episodes occurred predominantly during fasting and persisted despite discontinuation of insulin and oral antidiabetic medications for approximately 2 months.

Medical history  T2DM treated with sitagliptin-metformin 50/1000 mg twice daily, dapagliflozin 10 mg once daily, insulin glargine U300 at 20 IU/day, and insulin aspart 10 IU 3 times daily  No history of bariatric surgery  No chronic systemic disease, including renal failure or malignancy  No significant weight gain  No history of macrovascular and microvascular complications  Physical examination: Unremarkable  Laboratory findings  HbA1c:  5.6%  Fasting glucose:  106 mg/dL  Renal and thyroid function: Within…