Clinical Case Scenario
A 19-year-old male with a known history of Type 1 Diabetes Mellitus (T1DM) is brought to the emergency department by his family. He has a 2-day history of nausea, vomiting, diffuse abdominal pain, and frequent urination. On examination, he is lethargic, dehydrated, and breathing deeply and rapidly (Kussmaul breathing) with a fruity odor on his breath.
• Blood Glucose: 450 mg/dL
• Serum Bicarbonate (HCO₃⁻): 12 mEq/L (Low)
• Arterial Blood Gas (ABG): pH 7.28
• Serum Ketones: Strongly positive
A 19-year-old male with a known history of Type 1 Diabetes Mellitus (T1DM) is brought to the emergency department by his family. He has a 2-day history of nausea, vomiting, diffuse abdominal pain, and frequent urination. On examination, he is lethargic, dehydrated, and breathing deeply and rapidly (Kussmaul breathing) with a fruity odor on his breath.
• Blood Glucose: 450 mg/dL
• Serum Bicarbonate (HCO₃⁻): 12 mEq/L (Low)
• Arterial Blood Gas (ABG): pH 7.28
• Serum Ketones: Strongly positive
Question:
What is the primary acid-base disorder and underlying diagnosis in this patient?
What is the primary acid-base disorder and underlying diagnosis in this patient?
Anonymous Quiz
11%
A Metabolic alkalosis due to severe vomiting
44%
B. High anion gap metabolic acidosis
28%
C. Respiratory acidosis secondary to hypoventilation
11%
D. Normal anion gap (hyperchloremic) metabolic acidosis
6%
E. Non of the above
A 52-year-old man is diagnosed with type 2 diabetes. His HbA1c is 7.8%. He is overweight, has normal renal function, and no cardiovascular disease. He has no contraindications to metformin.
What is the most appropriate initial pharmacological treatment?
Anonymous Quiz
0%
A. Insulin glargine
75%
B. Metformin
18%
C. Glimepiride
4%
D. Pioglitazone
4%
E. Sitagliptin
A 62-year-old man with T2DM presents for routine follow-up. He has been taking metformin 1 g twice daily for 8 months. His HbA1c is 9.4%. He has a BMI of 34 kg/m², eGFR of 78 mL/min/1.73 m², and a previous myocardial infarction 2 years ago. He has no symptoms of hyperglycaemia.
Which of the following is the most appropriate next step in management?
A. Add glibenclamide
B. Start basal insulin immediately
C. Add a GLP-1 receptor agonist with cardiovascular benefit
D. Add pioglitazone
E. Continue metformin alone and repeat HbA1c after 12 months
Which of the following is the most appropriate next step in management?
A. Add glibenclamide
B. Start basal insulin immediately
C. Add a GLP-1 receptor agonist with cardiovascular benefit
D. Add pioglitazone
E. Continue metformin alone and repeat HbA1c after 12 months
MEDICINEnotes
What is the most appropriate initial pharmacological treatment?
Metformin first choice to treatment type 2 DM
#Metformin
First-line treatment.
1. Rule out renal failure (RF) before starting Metformin.
2. Reassess HbA1c after 3 months.
If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug.
#Dual_therapy
اختار واحد من الاثنين اهما
Metformin + Gliptin.
Metformin + Sulfonylurea.
Metformin + Pioglitazone.
Metformin + SGLT-2 inhibitor.
Reassess HbA1c after 3 months.
If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy.
#Triple_therapy
اختار واحد من الثلاثة اهما
Metformin + Gliptin + Sulfonylurea.
Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor.
Metformin + Pioglitazone + SGLT-2 inhibitor.
If HbA1c remains above 7.5% despite triple therapy → Insulin therapy.
لو كانت Triple therapy:
Not effective.
Not tolerated.
Contraindicated.
AND BMI greater than 35.
نستخدموا:
Metformin + Sulfonylurea + GLP-1 mimetic.
First-line treatment.
1. Rule out renal failure (RF) before starting Metformin.
2. Reassess HbA1c after 3 months.
If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug.
#Dual_therapy
اختار واحد من الاثنين اهما
Metformin + Gliptin.
Metformin + Sulfonylurea.
Metformin + Pioglitazone.
Metformin + SGLT-2 inhibitor.
Reassess HbA1c after 3 months.
If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy.
#Triple_therapy
اختار واحد من الثلاثة اهما
Metformin + Gliptin + Sulfonylurea.
Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor.
Metformin + Pioglitazone + SGLT-2 inhibitor.
If HbA1c remains above 7.5% despite triple therapy → Insulin therapy.
لو كانت Triple therapy:
Not effective.
Not tolerated.
Contraindicated.
AND BMI greater than 35.
نستخدموا:
Metformin + Sulfonylurea + GLP-1 mimetic.