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The lecture Insulinoma (Whipple's Triad) with Case by Michael Lazarus, MD is from the course Diabetes Mellitus. It contains the following chapters:
What is most likely the appropriate medical therapy applied in the case described below? A 25-year-old woman presents to the emergency department with palpitations, sweating, and blurry vision after playing volleyball on the beach. She denies chest pain and shortness of breath. She states that these episodes occur often but resolve after eating a meal or drinking a sugary soda. Past medical history is unremarkable, and she takes no medications. Physical examination: Temperature is 37.0°C (98.6°F), blood pressure is 135/80 mm Hg, pulse is 102 beats/min, and respiration rate is 18 breaths/min. Laboratory test results: Fingerstick blood glucose level is 42 mg/dL, electrocardiography shows sinus tachycardia, and urinalysis and toxicology results are noncontributory. Appropriate medical therapy is administered, and she is discharged with an appointment for a fasting blood draw within the week. Laboratory test results: Blood glucose is 45 mg/dL, serum proinsulin is 10 µU/L, C-peptide level is 0.8 nmol/L, results for sulfonylurea are negative, serum insulin level is 20 µU/L, and results for IGF-2 are negative.
Which of the following constellations of laboratory findings is most suggestive of factitious insulin injection when found in a hypoglycemic patient?
What is the most likely diagnosis in the following case? A 25-year-old woman presents to the emergency department with palpitations, sweating, and blurry vision after playing volleyball on the beach. She denies chest pain and shortness of breath. She states that these episodes occur often but resolve after eating a meal or drinking a sugary soda. Past medical history is unremarkable, and she takes no medications. Physical examination: Temperature is 37.0°C (98.6°F), blood pressure is 135/80 mm Hg, pulse is 102 beats/min, and respiration rate is 18 breaths/min. Laboratory test results: Fingerstick blood glucose level is 42 mg/dL, electrocardiography shows sinus tachycardia, and urinalysis and toxicology results are noncontributory. Appropriate medical therapy is administered, and she is discharged with an appointment for a fasting blood draw within the week. Laboratory test results: Blood glucose is 45 mg/dL, serum proinsulin is 10 µU/L, C-peptide level is 0.8 nmol/L, results for sulfonylurea are negative, serum insulin level is 20 µU/L, and results for IGF-2 are negative.
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Case studies helped with a better understanding and linking underpinning theory to clinical practice. Touched on all key aspects of the challenges of diabetes and its short and long term complications.