prasannakumar
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117.A 29-year-old woman has had type 1 diabetes mellitus for 16 years and has been your patient for ten years. During the past three years blood pressure has increased from 110/70 to 135/86 mm Hg; no orthostatic changes have been noted. The patient's hemoglobin A1C level has ranged from 8% to 9% {4.0-6.1}. Today blood pressure is 130/84 mm Hg. The patient routinely monitors her blood glucose level and reports that recently it has fluctuated more than usual, ranging from 60 to 210 mg/dL. She also has had nausea after eating and has required less food than usual to satisfy her appetite. Laboratory studies: Blood urea nitrogen 18 mg/dL Serum creatinine 1.2 mg/dL Serum electrolytes Sodium 136 mEq/L Potassium 4.2 mEq/L Chloride 98 mEq/L Bicarbonate 24 mEq/L Hemoglobin A1C 6% Urinalysis Protein 1+ Which of the following is the most likely cause of this patient's symptoms? (A) Adrenal insufficiency
(B) Incipient renal failure
(C) Impaired epinephrine release
(D) Delayed gastric emptying
(E) Inaccurate insulin administration
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| ssrpk
Forum Fanatic
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D) Delayed gastric emptying
diabetic gastroparesis due to autonomic neuropathy
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| usmlestud
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| Justice
Forum Fanatic
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As for gastric problems, I agree that this is (D).
Does the autonomic neuropathy explain PB increase? Most likely yes, but who knows...
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| dr in trouble
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The increase in BP is most likely d/t renal involvement.
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