DrVirgo
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11. A 36 year old man with a long history of Type I DM comes to the physician for routine health maintenance. His diabetic complications include blindness and painful peripheral neuropathy. He performs finger sticks and reports that recently he requires less insulin to remain euglycemic. His blood work shows
sodium 139 mEq/L,
Potasium is 3.9 mEq/L,
Creatinine is 6.2 mg/dL,
Htc is 43%
Which of the following is the most likely esplanation for his lower insulin requirement?
A. Decreased insulin clearance
B. Increased islet cell production of insulin
C. Increased peripheral insulin sensitivity
D. Induction of glucagon autoimmunity
E. Supression of anti-islet cell autoimmunity
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| Aashi
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A...the only explanation can be given is with developing nephropathy in type1 DM,there is decreased clearence of insulin by kidneys,some ppl do c/o of hypoglycemia thou,and some dont recongnize this at all due to neuropathy..with dialysis,when kidney function improves,insulin requirement may come to a baseline like before..
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| DrVirgo
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I agree... Creatinine is increased, so this means renal problems... nephropathy....so decreased insluin clearance... this explains why he would need less insulin to remain euglycemic.
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| alpha12
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so he should not be be jumping thinking that his diabetes is being cured. ACEIs could have slowed that down. BTW can you prescribe ACEIs when BP is normal? If not, what would you use to prevent nephropathy in a diabetic patient?
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| aml
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