Diabetes Spectrum 18:14-17, 2005
© American Diabetes Association ®, Inc., 2005
Case Study: Marked Hyperglycemia Followed by Marked Hypoglycemia
Diana W. Guthrie, PhD, FAAN, CDE, BC-ADM
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Introduction
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Family dysfunction leads to a poor quality of life and affects hemoglobin
A1c (A1C), especially in children with type 1
diabetes.1 Choice of
insulins in relation to food absorption, activity level, and stress in the
family may lead to difficulties in developing a successful diabetes regimen.
Lack of education and psychosocial support, especially when the person with
diabetes is an adolescent, affects self-management and the cost-effectiveness
of a program of
care.2 The effect of
emotional situations pitted against the action of various insulins may have
the outcome of "bouncing" blood glucose
levels.3 The
following case demonstrates such a situation.
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Presentation
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R.P. is a 13-year-old Hispanic girl with type 1 diabetes diagnosed a number
of years ago. Her disease was well controlled for at least a year on a
three-injection regimen of 70/30 NPH/regular insulin before breakfast, regular
insulin before supper, and NPH at bedtime. During the following 2 years, her
glucose control deteriorated, and she required hospital admission twice (April
and July of the second year) for re-regulation
(Table 1). After the second
admission, she was referred to a diabetes specialist.
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Table 1. R.P.'s Pre-meal and Bedtime Blood Glucose Testing Results (mg/dl) Before
Two Hospitalizations
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During her hospitalizations, R.P. was evaluated for the Somogyi or rebound
effect (hypoglycemia followed by hyperglycemia due to counterregulatory
hormone release), and she was also assessed for the development of insulin
antibodies, which were not demonstrated. During the second hospital stay, she
was placed on a continuous glucose monitor for 3 days. Her blood glucose
patterns were noted (Table 2)
and reported later to her family at the time of her first outpatient visit to
the specialist.
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Table 2. R.P.'s Continuous Glucose Monitoring Results (mg/dl)
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The patient's medical history revealed that she was the larger of fraternal
twins, weighing 7 lb, 10 oz at birth. The . . . [Full Text of this Article]
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Questions
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Discussion
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Clinical Pearls
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Summary
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Copyright © 2005 by the American Diabetes Association.
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