Question of the Week # 159, 160

159) A 65 year old man with history of Diabetes Mellitus Type II and Hypertension is evaluated for a one month history of numbness in bilateral hands and feet. He has been feeling excessively tired lately. His medications include Glyburide, Metformin and Enalapril for the past 5 years. Physical examination reveals loss of position sensation in bilateral lower extremities.  He reports good control of blood pressure and Diabetes. His recent HgBA1C was 6.0% 1 month ago. His laboratory tests reveal a Hemoglobin of 9.0gm%; WBC of 8.0k/µl, MCV of 103 and Platelets of 200k/µl. Once the diagnosis is confirmed, the most important therapeutic step in addressing this patient’s presentation:

A) Stop Metformin

B) Switch to insulin

C) Vitamin b12 and Calcium supplementation

D) Start Gabapentin

E) Start Thyroid Supplements

160) In Question above, the most likely underlying cause of this patient’s presentation:

A) Diabetes related complications

B) Chronic Metformin Use

C) Poor Glycemic Control

D) Myelodysplastic Syndrome

E) Hypothyroidism 

8 Responses

  1. 159. C

    160. A

  2. start gabapentin bc B12 def doesnt menifest so early,D ,,A

  3. in 160,whats diffrence in A and C?

  4. c,b

  5. Myelodysplastic syndrome may suffer from Vit B12 deficiency——***********——–

  6. C and B

    Higher doses and prolonged useof metformin is associated with increased incidence of vitamin B12 deficiency

  7. C,B
    Side effects of Metformin:
    >10%: Gastrointestinal: Diarrhea (IR tablet: 53%; ER tablet: 10%), nausea and vomiting (IR tablet: 26%; ER tablet: 7%), flatulence (12%)
    1% to 10%.
    Cardiovascular: Chest discomfort (1% to 5%), flushing (1% to 5%), palpitations (1% to 5%)
    Central nervous system: Headache (6%), chills (1% to 5%), dizziness (1% to 5%), taste disorder (1% to 5%)
    Dermatologic: Diaphoresis (1% to 5%), nail disease (1% to 5%), skin rash (1% to 5%)
    Endocrine & metabolic: Decreased vitamin B12 serum concentrate (7%), hypoglycemia (1% to 5%)
    Gastrointestinal: Dyspepsia (≤1% to 7%), abdominal distress (6%), abdominal distention (1% to 5%), abdominal pain (1% to 5%), abnormal stools (1% to 5%), constipation (1% to 5%), heartburn (≤1% to 5%)
    Neuromuscular & skeletal: Weakness (9%), myalgia (1% to 5%)
    Respiratory: Dyspnea (1% to 5%), flu-like symptoms (1% to 5%), upper respiratory tract infection (1% to 5%)
    <1%, postmarketing and/or case reports: Lactic acidosis, megaloblastic anemia.

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