A 16-year-old man comes to the office due to frequent episodes of disorientation, palpitations, tremulousness, and excessive sweating over the past 3 months. He says the symptoms resolve quickly after drinking some juice or a carbonated beverage. The patient was diagnosed with type 1 diabetes mellitus at age 12 and takes short- and long-acting insulin. He has had no dose changes in the past 2 years or diabetic complications and follows up with an ophthalmologist frequently. The patient is a college student and reports some stress due to an upcoming midterm examination. He does not use tobacco, alcohol, or illicit drugs. Vital signs and physical examination are within normal limits. Laboratory results show a hemoglobin A1c of 6.8% and no proteinuria. Which of the following factors most likely precipitated this patient's current symptoms?

Question

A 16-year-old man comes to the office due to frequent episodes of disorientation, palpitations, tremulousness, and excessive sweating over the past 3 months.  He says the symptoms resolve quickly after drinking some juice or a carbonated beverage.  The patient was diagnosed with type 1 diabetes mellitus at age 12 and takes short- and long-acting insulin.  He has had no dose changes in the past 2 years or diabetic complications and follows up with an ophthalmologist frequently.  The patient is a college student and reports some stress due to an upcoming midterm examination.  He does not use tobacco, alcohol, or illicit drugs.  Vital signs and physical examination are within normal limits.  Laboratory results show a hemoglobin A1c of 6.8% and no proteinuria.  Which of the following factors most likely precipitated this patient's current symptoms?

Quizplus · Accepted Answer

Eductional Objective: Uptake of glucose by skeletal muscle is mediated by the glucose transporter type 4, which is translocated to the cell membrane in response to insulin and muscle contraction.  Hypoglycemia can be precipitated by exercise in patients with insulin-treated diabetes due to the persistent effects of exogenous insulin.

A 16-Year-Old Man Comes to the Office Due to Frequent