A 25-year-old man comes to the emergency department because of headache, palpitations, sweating, and irritability. He came directly from the health club, which he joined a few weeks ago. He states that after every exercise session during evening, before dinner, he develops similar symptoms and he gets symptomatic relief by consuming granola bars. He was diagnosed with type 1 diabetes mellitus eight years ago. He takes a combination of NPH and regular insulin before breakfast and supper. He states that he is very compliant with his insulin and meals. He does not have any other symptoms or chronic complications of diabetes. His blood pressure is 110/80 mmHg, pulse is 100/min, temperature is 36.7C (98F) and respirations are 14/min. He is slightly diaphoretic but completely alert and awake. His neurological examination is nonfocal. The rest of the examination is unremarkable.
Hypoglycemia is defined as a plasma glucose level of:

Question

A 25-year-old man comes to the emergency department because of headache, palpitations, sweating, and irritability.  He came directly from the health club, which he joined a few weeks ago.  He states that after every exercise session during evening, before dinner, he develops similar symptoms and he gets symptomatic relief by consuming granola bars.  He was diagnosed with type 1 diabetes mellitus eight years ago.  He takes a combination of NPH and regular insulin before breakfast and supper.  He states that he is very compliant with his insulin and meals.  He does not have any other symptoms or chronic complications of diabetes.  His blood pressure is 110/80 mmHg, pulse is 100/min, temperature is 36.7C (98F) and respirations are 14/min.  He is slightly diaphoretic but completely alert and awake.  His neurological examination is nonfocal.  The rest of the examination is unremarkable.
Hypoglycemia is defined as a plasma glucose level of:

Quizplus · Accepted Answer

Explanation: The normal fasting blood sugar range is 70 to 100 mg/dL. Any individual with a blood sugar level less than 60 mg/dL is suspected to be hypoglycemic. The most important cause of hypoglycemia in type 1 diabetes mellitus is mismatch between insulin dose and insulin requirement. The patient in this case had hypoglycemic episodes during exercise due to a decreased requirement of insulin during exercise. The patient needs to adjust his insulin dosage or consume more carbohydrate. The target pre-meal blood sugar level in patients with diabetes is between 80 and 120 mg/dL. The action is generally necessary if the pre-meal blood sugar is consistently less than 80 or more than 140 mg/dL. Whipple's triad is characterized by a low blood glucose level, symptoms of hypoglycemia, and symptomatic relief with the administration of glucose. Whipple's triad is strongly suggestive of true hypoglycemia. (Choices A and B)Blood sugars below 90 and 120 mg/dL are not within the hypoglycemic range. (Choices D and E)In a non-diabetic normal individual, the prolonged fast blood sugar level can be as low as 45-50 mg/dL without any specific symptoms; therefore, in non-diabetic individuals being tested for hypoglycemia, a blood sugar level less than 50 mg/dL during a prolonged fast is generally considered abnormal if accompanied by hypoglycemic symptoms. Educational Objective: A plasma glucose level of less than 60 mg/dL is suggestive of hypoglycemia. In some normal individuals, the blood glucose level can reach around 45 mg/dL without symptoms. Whipple's triad is suggestive of true hypoglycemia.

A 25-Year-Old Man Comes to the Emergency Department Because of Headache