A 19-year-old man with a history of type 1 diabetes presents to the emergency department for the evaluation of a blood glucose level of 492 mg/dL. Laboratory examination revealed a serum bicarbonate level of 13 mEq/L, serum sodium level of 122 mEq/L, and ketonuria. Arterial blood gas demonstrated a pH of 6.9. He is admitted to the hospital and given bicarbonate and then started on an insulin drip and intravenous fluid. Seven hours later when his nurse is making rounds, he is confused and complaining of a severe headache. Repeat sodium levels are unchanged, although his glucose level has improved. His vital signs include a temperature of 36.6°C (98.0°F), pulse 50/min, respiratory rate 13/min and irregular, and blood pressure 177/95 mm Hg. What other examination findings would be expected in this patient?
AHypoglycemia
BPupillary constriction
CPapilledema
DPancreatitis
EPeripheral edema
A 54-year-old woman presents for follow-up care for her type 2 diabetes mellitus. She was diagnosed approximately 2 years ago and was treated with dietary modifications, an exercise regimen, metformin, and glipizide. She reports that her increased thirst and urinary frequency has not improved with her current treatment regimen. Her hemoglobin A1c is 8.5% at this visit. She is started on a medication that will result in weight loss but places her at increased risk of developing urinary tract infections and vulvovaginal candidiasis. Which of the following is the mechanism of action of the prescribed medication?
APeroxisome proliferator-activated receptor activator
BGlucagon-like protein-1 receptor agonist
CSodium-glucose co-transporter-2 inhibitor
DAlpha-glucosidase inhibitor
EDipeptidyl peptidase-4 inhibitor
A 58-year-old male presents to the clinic for a follow-up visit. He takes metformin every day and says that he is compliant with his medication but can not control his diet. Three months prior, his HbA1c was 8.2% when he was started on metformin. He does not have any complaints on this visit. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min and blood pressure is 122/88 mm Hg. His BMI is 33. Physical examination is within normal limits. Blood is drawn for laboratory tests and the results are given below: Fasting blood glucose 150 mg/dL Glycated hemoglobin (HbA1c) 7.2 % Serum Creatinine 1.1 mg/dL BUN 12 mg/dL The physician wants to initiate another medication for his blood glucose control, specifically one that does not carry a risk of weight gain. Addition of which of the following drugs would be most suitable for this patient?
ASitagliptin
BGlimepiride
CRosiglitazone
DGlyburide
EPioglitazone
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