INS and hypothyroidism: Moreover, thyreotoxi-cosis may worsen the metabolic control of diabetes and increase the need for increased insulin dosage, and hypothyroidism can lead to increased frequency of hypoglycemic episodes in diabetic patients.22,23 Metwalley KA et al. in their study in Egypt showed that Diabetic patients with hypothyroidism had higher HbA1c than those without hypothyroidism.24