BOF:
36
A 23
year old male who is known to have insulin dependent diabetes mellitus is
brought into casualty with a hypoglycaemic episode. He is treated with
intravenous dextrose and glucagons and makes a satisfactory recovery.
He
admits to having several such episodes over the preceding months.
Which
of the following is most likely to enable you to determine the cause of the
hypoglycaemic episodes?
a)
Detailed family history
b)
Careful auscultation of the heart
c)
Careful examination of the skin
d)
Detailed neurological examination
e)
Examination of the thyroid gland
Answer: c)
Examination of the skin with special emphasis on the insulin injection sites
is important in patients with hypoglycaemic episodes
If the
patient has injected insulin into an area of lipodystrophy this could cause
either enhanced or delayed absorption of insulin and interfere with glycaemic
control
To
maintain normoglycaemia there must be a balance between food intake, energy
expenditure and insulin dosage and absorption
In
analysing hypoglycaemia the important features are:
ü
Dietary history
ü
Exercise history
ü
Timing
of insulin injections
ü
IS
Lipodystrophy
ü
E&M
Addison’s disease
ü
GIT
Liver
failure
ü
KUS
Renal
failure (kidneys break down insulin)
Revision Tip
Revise
type I diabetes mellitus KEYS to SUCCESS in Medicine
page 35-37
