Question of the Week # 83, 84, 85

Q83) 35-year-old man with a 10-year history of type 1 diabetes mellitus is evaluated because of recent onset of morning hyperglycemia. His home blood sugar logs over the last 10 days have consistently been showing elevated sugars in the range of 220 to 300 mg% in the early morning ( pre-breakfast).  He has also experienced nightmares recently. He has been compliant with his diet instructions and has  not changed his dinner potions recently.  He takes mixed insulin regimen :  NPH/Regular  insulin 70/30 mix at  30 units in the AM before breakfast and 20 units in PM 30 minutes before dinner. Which of the following best explains this patient’s morning hyperglycemia?

( A ) Diabetic nephropathy

( B ) Undertreatment with insulin

( C ) Overtreatment with insulin

( D ) Insulinoma

(E) Non compliance with Insulin

Q84) The best diagnostic study in establishing the diagnosis in this patient :

A) C-Peptide level

B) Urine 24 hour catecholamines

C) Check pre-dinner blood sugar level

D) Check blood sugar level 30 minutes post – dinner

E) Check blood sugar level between 2:00 AM and 3:00 AM

Q85) Next best step in managing this patient’s pre-breakfast hyperglycemia :

A) Increase pre-breakfast regular insulin dosage in AM

B) Increase pre-dinner regular insulin dose

C) Reduce pre-dinner NPH insulin dose

D) Decrease the carbohydrate consumption in the night

E) Discontinue Pre-dinner insulin

2 Responses

  1. C,E,C

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