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  #1  
Old 03-05-2013
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Default DM with decreasing insulin dose!!...i love this

A 72 year old obese woman is evaluated during a follow up visit for Diabetes Mellitus Type II. She had been started on Insulin therapy 5 years ago after several months of oral hypoglycemic drug therapy that failed to improve her glycemic control. Her insulin regimen includes 40 units of Insulin Glargine at bed time and 10 units of Regular insulin 30 minutes before each meal. She has been maintained on this regimen for the past 2 years. She had two recent hypoglycemic episodes for which she was treated in the Emergency Room. She now reports that she had been taking only 5 units of Regular insulin before meals but her post-prandial glucometer reading has usually, been on the lower side of the normal range. At this rate of decreased insulin use, she believes she will be cured of diabetes by the end of the year. She denies any recent weight changes. She denies any depression or drug overdose. Physical examination is consistent with diabetic neuropathy in bilateral lower extremities. The most appropriate next step in managing this patient:

A) Urine Sulfonyl Urea screen

B) C-peptide level

C) Renal Function Tests

D) Stop Insulin therapy

E) Switch to Regular insulin to Lispro
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  #2  
Old 03-06-2013
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Default C) Renal Function Tests

C) Renal Function Tests
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Old 03-06-2013
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Default Renal function test

Quote:
Originally Posted by fadi551 View Post
C) Renal Function Tests
Correct ...insulin is renally cleared...decreasing insulin dose in a DM shd prompt immediate renal evaluation.
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Old 03-06-2013
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Originally Posted by stfidel View Post
Correct ...insulin is renally cleared...decreasing insulin dose in a DM shd prompt immediate renal evaluation.
Great question
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Old 03-07-2013
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C At first I was choosing B then realized that it would be a best choice for other pathologies such as manchausen and not for this case. So to determined the clearance of insulin and help with explaining her current presentations to the ER renal clearance tests is the ideas option.
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Old 03-07-2013
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Quote:
Originally Posted by stfidel View Post
A 72 year old obese woman is evaluated during a follow up visit for Diabetes Mellitus Type II. She had been started on Insulin therapy 5 years ago after several months of oral hypoglycemic drug therapy that failed to improve her glycemic control. Her insulin regimen includes 40 units of Insulin Glargine at bed time and 10 units of Regular insulin 30 minutes before each meal. She has been maintained on this regimen for the past 2 years. She had two recent hypoglycemic episodes for which she was treated in the Emergency Room. She now reports that she had been taking only 5 units of Regular insulin before meals but her post-prandial glucometer reading has usually, been on the lower side of the normal range. At this rate of decreased insulin use, she believes she will be cured of diabetes by the end of the year. She denies any recent weight changes. She denies any depression or drug overdose. Physical examination is consistent with diabetic neuropathy in bilateral lower extremities. The most appropriate next step in managing this patient:

A) Urine Sulfonyl Urea screen

B) C-peptide level

C) Renal Function Tests

D) Stop Insulin therapy

E) Switch to Regular insulin to Lispro
I WOULD AGREE to answer to do renal function tests. but i think self insulin hypoglycemic episodes needs to be ruled out with B.
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Old 03-08-2013
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Originally Posted by doxorubicin View Post
I WOULD AGREE to answer to do renal function tests. but i think self insulin hypoglycemic episodes needs to be ruled out with B.
I would agree if that was one of the choices and not renal. But given that she is presenting neuropathy and the hypoglicemis episodes, I would want to see her current kidney function. If normal then I would ask for C-peptide. She is now reporting that she is taking a decreased dose at 5 units.
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