Rationale of the Week | What is the cause of this emergency room visit?
For last week’s practice question, we quizzed participants on what is the cause of LS’ ER visit based on lab results. 61% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: LS is a 29-year-old who arrives in the emergency room with known history of type 2 diabetes. BMI is 23.9 and they are on basal insulin therapy and an oral medication to help “clear extra sugar”. On admission, their blood glucose is 189, pH is 7.2 and LS has 3+ betahydroxybyturate.
What is the most likely cause of these lab results?
Answer Choices:
- LS is omitting insulin to lose weight.
- There is a lab error in the glucose reading.
- LS is taking a SGLT-2 Inhibitor
- New onset gastroparesis.
Getting to the Best Answer
Answer 1 is incorrect. 18.63% chose this answer. “LS is omitting insulin to lose weight.” Although this answer is tempting since LS has ketosis and acidosis, it doesn’t explain why the glucose level is so low. With insulin omission, the person would present in ketoacidosis with a blood sugar of 200 or greater. In addition, the question mentions that LS is taking a diabetes pill to help release the sugar through her urine. This is an important clue to get to the best answer.
Answer 2 is incorrect. 4.98% of you chose this answer. “There is a lab error in the glucose reading.” Since LS has ketosis and acidosis, it is confusing as to why the glucose level is so low. With insulin omission, the person would present in ketoacidosis with a blood sugar of 200 or greater. The question also mentions that LS is taking a diabetes pill to help release the sugar through her urine. This is an important clue to get to the best answer.
Answer 3 is correct. About 61.44% of respondents chose this. “LS is taking a SGLT-2 Inhibitor.” GREAT JOB. This is the best answer. LS has ketosis and acidosis, with a glucose level less than 200. Given her history, this meets the criteria for euglycemic DKA. Since the question mentions that LS is taking a diabetes pill to help release the sugar through her urine, this important clue gets us to the best answer. LS is taking a SGLT-2 inhibitor, which can lead to euglycemic DKA, especially during periods of illness or if they are not taking adequate insulin.
Finally, Answer 4 is incorrect. 14.94% chose this answer. “New onset gastroparesis.” This answer doesn’t really explain why LS is experiencing acidosis and ketosis. Many people with new onset gastroparesis struggle with post meal hypoglycemia and erratic blood sugar levels, but they do not generally struggle with euglycemic DKA. The question also mentions that LS is taking a diabetes pill to help release the sugar through her urine. This is an important clue to get to the best answer.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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