All right, welcome. My name is Divine. This is episode 593 of the Divine Intervention Podcast. In today's podcast, we're going to be continuing the series on the step one free, 120. It's going to be series 10. We're going to be doing questions 91 to 100. All right. Let's get on with question 91. A four-year-old girl with type 1 diabetes is brought to the ED by her father.

Because of a four-hour history of four-hour episode of restlessness, sweating, and confusion that occurred during the night.

Yesterday, he allowed her to eat cupcakes and cotton candy at a county fair.

At her bedtime that evening, he increased her dose of sub-Q, intermediate acting and long-acting insulin.

Her symptoms began six hours later, then resolved spontaneously. After being informed this morning of this nighttime episode, the mother insisted

the father bring the patient to the hospital. On arrival, the patient is alert. Her vital

signs are within normal limits. Examination shows no abnormalities. Her finger stick blood glucose is 72.

Your analysis is negative for glucose and ketones. Which of the following is the most likely explanation for this patient's nighttime symptoms?

Right. So again, let's work this out. This person, the dad kind of bumped up her dose of insulin.

And surprise, surprise, the person is sweating blah blah blah

blah right and confused many people don't think about this but hypoglycemia can actually be pretty

deadly hyperglycemia will kill you but it's kind of a slower process but hypoglycemia can certainly

kind of end you pretty quickly and we see a glucose is low right so this person has hypoglycemia

so you can pretty much get rid of options a through c right we see that all these have symptoms

were preceded by had that just really bumping a dose of insulin that was not maybe not the wisest thing

to do so it has to be a hypoglycemia answer again because that that just gave too much insulin so the

answer is going to be option d again this person literally the labs do not show hyperglycemia, right?

And then option E says hypoglycemia caused by excessive renal glucose loss.

Well, do we see glucose in her urine?

No.

Hypoglycemia caused by increased glucose on secretion.

That would be something that you would have when you're in a state of low insulin. Because remember,

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