Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes – A3

ANSWER — Incorrect.

Late one afternoon, the patient's roommate hears a loud noise, finds him unconscious on the floor of his bedroom, and calls 911. The rescue squad, delayed in rush hour traffic, finds the blood glucose level to be 23 mg/dL (1.3 mmol/L) by capillary fingerstick and gives him an ampoule of 50 percent dextrose intravenously. The patient awakens promptly but is left with impaired recent memory and is forced to abandon his graduate studies for several months until his memory returns to normal.

The immediate threat to this patient with hypoglycemia unawareness is a severe insulin reaction with the potential for serious morbidity and mortality. (Severe hypoglycemia is defined as an event requiring the assistance of another person to administer carbohydrate, inject glucagon, or take other resuscitative actions.) He needs revision of his regimen to achieve optimal metabolic control with marked reduction or elimination of hypoglycemic reactions and reversal of hypoglycemia unawareness.

Of course, prevention of cardiovascular disease is always a major goal for the management of any patient with diabetes. However, there is no indication for preventive use of a statin, a beta-adrenergic blocking agent, an angiotensin-converting enzyme (ACE) inhibitor (or an angiotensin receptor antagonist), or aspirin in such a young patient with type 1 diabetes. The patient needs frequent monitoring of the blood pressure, the plasma lipid levels, and the urine microalbumin/creatinine ratio, with appropriate interventions when abnormalities are detected and counseling to assure a healthy lifestyle.

To explore the consequences of the other actions, return to the case at the beginning of this sequence. (See "Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes".)