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Old 09-01-2012
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Question Diabetic Morning Hyperglycemia

A 35-year-old man with a 10-year history of type 1 diabetes mellitus is evaluated because of recent onset of morning hyperglycemia. For the past 10 days, his morning blood glucose levels ranged from 220 to 300 mg/dL. He has also experienced nightmares recently.

Which of the following best explains this patient's morning hyperglycemia?

A- Diabetic nephropathy
B- Undertreatment with insulin
C- Overtreatment with insulin
D- Recent infection
E- High carbohydrate meal
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Old 09-01-2012
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C...Overtreatment with Insulin ??????????
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Old 09-01-2012
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B or E?


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Old 09-01-2012
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Default C

Quote:
Originally Posted by imgchuchu View Post
A 35-year-old man with a 10-year history of type 1 diabetes mellitus is evaluated because of recent onset of morning hyperglycemia. For the past 10 days, his morning blood glucose levels ranged from 220 to 300 mg/dL. He has also experienced nightmares recently.

Which of the following best explains this patient's morning hyperglycemia?

A- Diabetic nephropathy
B- Undertreatment with insulin
C- Overtreatment with insulin
D- Recent infection
E- High carbohydrate meal
Would go with C, as itīs because somogyi phenomenon.
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Old 09-01-2012
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Default C- Overtreatment with insulin

Ya exactly it would be Chronic somogyi effect. Andes thanks for reminding.
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Old 09-01-2012
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ya, like all posted.....C is my answer
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Old 09-02-2012
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Quote:
Originally Posted by koolkiller88 View Post
Ya exactly it would be Chronic somogyi effect. Andes thanks for reminding.
cud u pls explain wats dat!!
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Old 09-02-2012
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Originally Posted by sruthi View Post
cud u pls explain wats dat!!
generally, insulin doses in diabetes is given in split doses.(twice daily---AM and PM) but, sometimes a problem may occur of increased early morning glucose level(means--evening insulin dose was insufficient)...
to know the cause of hyperglycemia------a 3AM glucose is useful....
-if both,3AM and 7AM glucose levels are increased----more insulin dose is required at evening.......called as waning effect
-if 3AM glucose is decreased and 7AM glucose is increased.......then,less insulin is given at evening-------called as somogyi effect
-if 3AM glucose is normal but 7 AM glucose level is increased------then,divide the dose of insulin between dinner time and bed time------called as dawn effect

-usually somogyi effect is caused by-----counterregulatory hormones----glucagon ,catecholamines----released at 3 AM (causes hyperglycemia in response to hypoglycemia at 3AM)
Dawn effect is caused by release of growth hormone(has antiinsulin effect) at 5AM..so,it increase glucose level


in this question..the pt. has increased morning hyperglycemia,it means his evening dose of insulin is high...so, we treat it by decreasing evening insulin doses.....
hope it understands.....
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