kpmle2
Forum Elite
Topics: 29
Posts: 290
|
A 47-year-old man who has had type 1 diabetes mellitus for more than 20 years that is meticulously controlled by using an insulin pump with no known complications presents with his wife because she is concerned that he has been acting strangely. She believes that her husband is having trouble maintaining attention and has spells of irritability that are unpredictable. He also appears to be having more nightmares and restless sleep. He states that he is feeling and acting fine and that his glucose log looks excellent; he believes that his wife is under stress and is projecting her feelings onto him. He states he has not noted hypoglycemia in his routine self-monitoring of glucose and, although he is under usual stresses caused by work and family, he has not been depressed.
Physical examination and review of symptoms are normal. Laboratory values obtained the previous week are normal.
What is the best next step?
A. Refer to a psychiatrist for marriage counseling
B. Order MRI of the head
C. Rule out adrenal insufficiency
D. Increase the frequency of glucose monitoring
E. Perform electroencephalography
|
| DrVirgo
Forum Hero
Topics: 1042
Posts: 3,344
|
D? Maybe he is getting hypoglycemic at certain times and his Insulin may need to be adjusted.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Adrenal insufficiency doesn't fir into the scenario -- But still, it is a potential complication of Type-I DM resulting in mood changes and it has to be ruled out!
|
| milestogo
Forum Newbie
Topics: 3
Posts: 32
|
only the neurological symptoms seem to be some clue..is the answer mri?.how do you explain night mares... would hypoglycemia during night cause the nightmares.....
pls post correct response with explaination
|
| guangyu
Forum Elite
Topics: 29
Posts: 308
|
I think A B C are wrong. consider D and E
Prefer E.
|
| dr_gladiator
Forum Junior
Topics: 1
Posts: 53
|
D??
|
| cool doctor
Forum Junior
Topics: 1
Posts: 219
|
D?
|
| Ivonne
Forum Guru
Topics: 51
Posts: 1,394
|
I think this is a problem of hypoglycemia unawareness that is frequentely seen in patients with type 1 DM and patients that like tight control of glucose level.
The continuos glucose monitor system can be used for objective detection of hypoglycemia unawareness, not sure if D is saying this...will go with D
___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
|
| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
C
|
| jasmin
Forum Junior
Topics: 7
Posts: 40
|
d
|
| kpmle2
Forum Elite
Topics: 29
Posts: 290
|
The correct answer is D Recognize the subtle presentation of hypoglycemia unawareness and its treatment.
Hypoglycemia unawareness is a common problem in patients with tightly controlled diabetes who are using insulin. It occurs as part of the blunting of adrenergic and related responses to hypoglycemia. The hypoglycemic reaction can be subtle and seem like a behavioral problem. Commonly, the patient denies or rationalizes the problem, and it is those around him who bring it to attention. Hypoglycemic unawareness is often not detected on routine glucose monitoring because the monitoring is usually not done during a period of hypoglycemia. Increasing the frequency of glucose monitoring, especially during the periods of behavioral change, can help to diagnose hypoglycemic unawareness. Decreasing the insulin doses should alter the behavior pattern if hypoglycemia is the cause, after which it will be easier to perform diagnostic self-glucose monitoring and a more critical self-assessment.
There is no evidence that the couple in this case requires psychiatric intervention, whether joint or individual, since the patient is ‘denying” a condition of which he is not aware. Supportive psychotherapy may be helpful if the patient refuses to address the hypoglycemic pattern because of irrational concerns about loosening control. Primary adrenal insufficiency is a related autoimmune disease (Addison disease) that can lead to hypoglycemia, but it is relatively rare. In addition, the patient with Addisons disease typically has dark pigmentation of all skin, including palms and gums, and hyponatremia, hyperkalemia, and an elevated blood urea nitrogen level.
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Thanx for a nice question! U guys rock!
|
|
| |
| | | | | | | | | | | | |
