Question of the Week # 196

196)  A 72 year old obese woman is evaluated during a follow up visit for Diabetes Mellitus Type II. She had been started on Insulin therapy 5 years ago after several months of oral hypoglycemic drug therapy that failed to improve her glycemic control. Her insulin regimen includes 40 units of Insulin Glargine at bed time and 10 units of Regular insulin 30 minutes before each meal.  She has been maintained on this regimen for the past 2 years. She had two recent hypoglycemic episodes for which she was treated in the Emergency Room. She now reports that she had been taking only 5 units of Regular insulin before meals but her post-prandial glucometer reading has usually, been on the lower side of the normal range. At this rate of decreased insulin use, she believes she will be cured of diabetes by the end of the year. She denies any recent weight changes. She denies any depression or drug overdose. Physical examination is consistent with diabetic neuropathy in bilateral lower extremities.  The most appropriate next step in managing this patient:

A)     Urine Sulfonyl Urea screen

B)      C-peptide level

C)      Renal Function Tests

D)     Stop Insulin therapy

E)      Switch to Regular insulin to Lispro

5 Responses

  1. Renal Function Tests.

  2. C

    • Since oral hypoglycemics were not effective it’s unlikely to be A ,but c peptide can be considered for possible insulinoma.could you please explain why u choose ranal function test ?I am thinking on the line of uncontrolled type 2 Dm so concisering she still has beta cells.

      • agree
        i think of insulinoma too

  3. renal impairment reduce insulin clearance and she get the hypoglycemia.

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