EMQs in Clinical Medicine.pdf - Peshawar Medical College

210 Metabolic and endocrine disturbances
they will have significant potassium depletion. As soon as insulin therapy
has commenced, potassium levels will rapidly fall. Hence, patients will
need regular potassium supplements in the intravenous fluids.
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A 25-year-old athlete with type I diabetes is brought to A&E. He is
unconscious with a blood glucose level of 1.0 mmol/l.
This is presentation of hypoglycaemic coma requiring immediate delivery
of glucose. Oral glucose preparations are inappropriate in this acute
situation as a result of risk of aspiration and should be given once the
patient is conscious. In circumstances where intravenous glucose is
difficult to administer, e.g. out of hospital, glucagon can be administered
(subcutaneously, intramuscularly or intravenously).
A 21-year-old man with type 1 diabetes presents with dizziness. On
examination he is alert and no abnormalities are detected. Blood
glucose 2 mmol/l.
This patient has documented hypoglycaemia. Unlike the previous case he
is conscious and relatively well. In this situation oral glucose solution is
appropriate.
A 50-year-old man presents with symptoms of tiredness. Fasting glucose
6.8 mmol/l which rises to 10.7 mmol/l after oral glucose tolerance test.
This patient’s test results suggest impaired glucose tolerance rather than
frank diabetes. In both cases, lifestyle measures, e.g. diet control and
weight reduction, are important.