j*****o
发帖数: 137 | 1 65yo woman comes to the office for a follow-up examination. She has an 18y
history of Dm and 2y history of diabetic nephropathy. She had laser
treatments 1 y ago for proliferative retinitis with some loss of vision. She
currently takes intermediate and short-acting insulin before breakfast and
dinner. She also takes enalapril for HTN. She does home glucose monitoring
three times daily. her blood glucose concentrations usally range bw 70-130
mg/dl, but several readings every week are < 60m/dl at various time of the
day. She was asymptomatic at the time monitoring showed hypoglycemia. She
eats three meals a day and a snack before bedtime. Pulse 74 bpm sitting and
94 bmp standing. BP 142/84 sitting and 118/76 standing. Sensation is
decreased over her feet. Creatinine increased from 2.4 from 1.8 1y ago.
HbA1c last week decreased to 5.9% from 6.7% 6 mos ago. Which of the
following is the most likely explanation for the discrepancy bw the
glucometer readings and the patient symptoms?
a False indication of hypoglycemia from defective glucose monitor
b Inaccurate reading of hypoglycemia on monitor from her vision deficit
c Lack of hypoglycemic symptoms
d Lack of knowledge of typical symptoms associated with hypoglycemia
e,Masking of hypoglycemic symptoms by enalapril therapy |
s*******w
发帖数: 1879 | 2 C?
orthostatic HoTN --> diabetic autonomic neuropathy --> impaired autonomic
response to hypoglycemia (aka lack of sweating, etc) --> masks hypoglycemia
episodes |
s******m
发帖数: 44 | 3 C
low Ha1c rule out A B
18yrs Dm hx rule out D, she should fully aware the hypoglycemic symptoms
E doesnt make any sense though
diabetic neuropathy... |
T****g
发帖数: 705 | 4 E
hypoglycemia (tremors, sweating, palpitations)=sympathetic system mediated.
b-blockers block catecholamine actions, so it masks the hypoglycemic
symptoms. |
s******m
发帖数: 44 | 5 Enalapril is ACEi, right?
【在 T****g 的大作中提到】
: E
: hypoglycemia (tremors, sweating, palpitations)=sympathetic system mediated.
: b-blockers block catecholamine actions, so it masks the hypoglycemic
: symptoms.
|
J*********4
发帖数: 1274 | 6 Pt has DM complicated with microvascular complications, evident by presence
of retinopathy and nephropathy. Also pt is orthostatic, manifesting
autonomic neuropathy. Likely, pt has neuropathy that makes her not able to
properly responding to changes in serum glucose level.
Many long term DM pts, because of neuropathy, may feel only SOB but no chest
pain when they have MI. |
T****g
发帖数: 705 | 7 Ha，you are all right.
Enalapril is ACEi
Thanks JennyGao for explaining the question. |
