Alondra A.

Sagario BSMedtch 3C

CASE 1
A 25-year-old healthy female patient complained of dizziness and
shaking 1 hour after eating a large, heavy-carbohydrate meal. The result
of a random glucose test performed via fingerstick was 60 mg/dL.

Questions
1. Identify the characteristics of hypoglycemia in this case study
 Due to the patient's large, high-carbohydrate lunch and lowered
plasma glucose, the symptoms of hypoglycemia in this case study are
trembling and dizziness, as well as polyphagia.

2.What test(s) should be performed next to determine this young

woman’s problem?
 Suppresion Test
 A 72-hour fast can be used as part of a suppression test to
check for the presence of an insulin-secreting tumor if insulin
levels do not suppress, which is typically monitored in a
hospital setting. The patient is allowed to drink calorie- and
caffeine-free drinks throughout the exam. A reflectance meter
is used to measure capillary blood sugar every 4 hours until
values of 60 mg/dL (3.3 mmol/L) are reached. Once results
are below 49 mg/dL (2.7 mmol/L), the frequency of blood
glucose measurements is increased to every hour. The fast is
subsequently broken, and the hypoglycemia is treated with
intravenous dextrose or carbohydrate-containing food or
drink. At that point, or whenever the patient exhibits signs of
hypoglycemia, a blood sample is taken to measure serum
glucose, insulin, proinsulin, and C-peptide levels.

3. To which category of hypoglycemia would this individual belong?

 Mild hypoglycemia
 Blood glucose is less than 70 mg/dL but is 54 mg/dL or higher.

4. What criteria would be used to diagnose a potential insulinoma?

 The blood tests required to detect insulinoma are glucose, insulin, C-
peptide, and if a proinsulin level is available, it may also be helpful.
CASE 2
A 13-year-old girl collapsed on a playground at school. When her mother
was contacted, she mentioned
that her daughter had been losing weight and making frequent trips to the
bathroom in the night. The emergency squad noticed a fruity breath. On
entrance to the emergency department, her vital signs were as follows:

Blood pressure 98/50 mm Hg

Respirations Rapid
Temperature 99°F

Stat lab results included:

RANDOM URINE SERUM CHEMISTRIES

pH 5.5 Glucose 500 mg/dL

Protein Negative Ketones Positive
Glucose 4+ BUN 6 mg/dL
Ketones Moderate Creatinine 0.4 mg/dl

Questions
1. Identify this patient’s most likely type of diabetes.
 The patient’s most likely to have Type 1 diabetes.
 Type 1 diabetes, once known as juvenile diabetes or insulin-
dependent diabetes, is a chronic condition. In this condition, the
pancreas makes little or no insulin. Insulin is a hormone the body
uses to allow sugar (glucose) to enter cells to produce energy.
2. Based on your identification, circle the common characteristics
associated with that type of diabetes in the case study above.
 This include loss weight, frequent urination at night, and fruity breath
due to the presence of ketones in moderate level.
3. What is the cause of the fruity breath?
 The fruity breath smell is an indication of ketoacidosis. When the
body cannot utilise glucose as a fuel source because there is no insulin
or not enough insulin, diabetic ketoacidosis occurs. Instead, fats is
used as fuel. Acids known as ketones accumulate in the blood and
urine as fats are broken down. High concentrations of ketones are
lethal. This condition is called ketoacidosis.