Digging Deeper into Diabetes

September 5, 2014

Truths about necrobiosis lipoidica, advantages of SGLT2 inhibitors, rash in an obese teen, benefits of insulin therapy, knee effusions with diabetes and hypertension-these questions about diabetes put your knowledge to the test.

Question 1:

These yellowish, firm plaques with large telangiectasia coursing over the top with no associated scaling are typical of necrobiosis lipoidica. Here they are shown on the foot of a 34-year-old morbidly obese man. His fasting blood sugar level was 250 mg/dL, and his hemoglobin A1c level was 8.8%.

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Question 2:

The 2013 treatment algorithm from the American Association of Clinical Endocrinologists recommends SGLT2 inhibitors with caution as monotherapy in patients with A1c < 7.5% and as part of dual or triple therapy in patients with A1c 7.5% to 9.0%.

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Question 3:

This obese 18-year-old has had a brown, scaly rash for 4 years. The rash-asymptomatic but of significant concern-has spread from his neck to his chest and back. The teen’s obesity has been an issue since early childhood. He has been well otherwise. He has no family history of similar skin changes or diabetes, which is one of the probable causes of this rash.

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Question 4:

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Question 5:

A 50-year-old African American woman with type 2 diabetes mellitus and hypertension was admitted with constant bilateral knee and thigh pain and swelling of both knees. Bilateral knee effusions were present. The diagnosis was diabetic myonecrosis.

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ANSWER KEY:

Question 1. E

Question 2. E

Question 3. B

Question 4. B

Question 5. B