Medical Emergencies · patient case question
Which of the following does NOT occur in a hypoglycaemic patient with type 1 diabetes?
Patient case: A Diabetic Who Does Not Check His Sugar
Patient: 56-year-old male
Chief Complaint: Broken tooth, wants it fixed.
Background: Type 2 diabetes for nine years. When asked about his blood glucose he says he does not test it and has not seen his physician in over a year. Reports increasing thirst and getting up at night to urinate.
Medications: Metformin — admits he is inconsistent with it
Vital Signs: BP 138/86 mmHg · HR 82 bpm · RR 16 · T 98.6°F
Findings: Generalized gingival inflammation with bleeding on probing, multiple 5–6 mm pockets, dry mucosa, and a fractured cusp on #14.
Show answer and explanation
Correct answer: D. Insulin resistance
- A. This DOES occur. Confusion, slurred speech, aggression, drowsiness and eventually seizure and coma are the NEUROGLYCOPENIC symptoms, arising as the brain is starved of its obligate fuel.
- B. This DOES occur, as part of the same adrenergic surge.
- C. This DOES occur. Sweating, tremor, palpitations, hunger and anxiety are the ADRENERGIC warning symptoms, driven by the catecholamine counter-regulatory response.
- D. CORRECT — this is the exception. INSULIN RESISTANCE is the defining pathophysiology of type 2 diabetes: the tissues fail to respond to insulin that is present, often in excess. Type 1 diabetes is an autoimmune destruction of the beta cells producing an absolute insulin DEFICIENCY, and hypoglycaemia in type 1 results from too much exogenous insulin relative to food and activity.
Note: In the chair: if the patient is CONSCIOUS and can swallow, give 15 g of oral carbohydrate and recheck in 15 minutes. If UNCONSCIOUS, give nothing by mouth — intramuscular glucagon 1 mg or intravenous dextrose, and activate EMS. Never assume an unwell diabetic is hyperglycaemic; hypoglycaemia kills far faster.
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