Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

We have a new, insulin dependent diabetic with increasing insulin requirement. He had a symptomatically low blood sugar of 42 mg/dL. What are some possible explanations? 

• He can't operate the glucometer and is miscalculating or not administering his insulin properly.
• He isn't storing the insulin properly so it is breaking down, leading to variation in potency.
• He's fiddling with his dose on purpose to get attention.
• He has a lousy diet leading to erratic blood sugars and changing insulin requirement.
• There is some endogenous source of glucose.
• The diagnosis is in error, he never was diabetic.

What can we do to narrow down these possibilities ?              Back