A 25years old insulin dependent diabetes mellitus patient develops sweating, anxiety,
palpitations and tremors after performing vigorous exercise. Answer the following:
(a) What is the cause of these symptoms. 1 mark(s)
(b) Would you prescribe beta blockers to this patient if he develops hypertension and why. 2 mark(s)
(c) How will you treat diabetic keto acidosis. 3 mark(s)
Q26 marksEssays
Answer
(a) Cause of symptoms
Hypoglycaemia — vigorous exercise increases insulin sensitivity/glucose utilization by muscle in an insulin-dependent diabetic, precipitating a fall in blood glucose. The symptoms (sweating, anxiety, palpitations, tremors) are due to the resulting sympathetic (adrenergic) counter-regulatory response to hypoglycaemia
(b) Beta blockers in this patient
No, beta blockers should generally be avoided/used with great caution in insulin-dependent diabetics
Why: Beta blockers (especially non-selective agents) mask the adrenergic warning symptoms of hypoglycaemia (tremor, palpitations, tachycardia), delaying recognition and treatment of hypoglycaemia; they can also impair the counter-regulatory response (glycogenolysis) that helps restore blood glucose, prolonging hypoglycaemic episodes. If a beta-blocker is essential, a cardioselective agent (e.g., atenolol) at the lowest effective dose is preferred with careful monitoring
(c) Treatment of diabetic ketoacidosis
IV fluids (normal saline) — first priority, to correct dehydration
IV regular (soluble) insulin infusion — to correct hyperglycaemia and suppress ketogenesis
Potassium replacement (once urine output is confirmed and levels monitored, as insulin therapy drives K⁺ into cells)
Correction of acidosis (usually resolves with fluids and insulin; sodium bicarbonate reserved for severe acidosis)
Identify and treat the precipitating cause (e.g., infection)
Continuous monitoring of blood glucose, electrolytes, and clinical status
