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• Case Study 21-1, p. 768 • Case Study 21-2, p. 769

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Because abnormal thyroid function can affect weight and anxiety, a thyroid-stimulating hormone reading TSH was ordered, with results in the normal range. A fructosamine measurement, which reflects glycemic control over the previous 3—4 weeks, was also in the normal range. Fasting C-peptide, which is a measure of insulin secretion, was 2.

The basic metabolic profile results were within normal range. 21-2 a follow-up visit 4 months after insulin initiation, W. Based on his SMBG results showing p769 hyperglycemia, his insulin was increased to 11 units of glargine at He was advised to continue following a 3,calorie daily meal plan, adjusted with exercise. 21-2 research has identified a slowly progressive autoimmune diabetes in adult patients.

Known as latent autoimmune diabetes of adulthood LADA or study 1. This type of diabetes could be the explanation for W. He may have been preventing more severe hyperglycemia by exercising and restricting calories, but this also resulted in weight loss.

His A1C and fructosamine results may have been surprisingly low because of his frequent hypoglycemic episodes. Clinical Pearls Diabetes management should be based on more than A1C results if the results do not fit with the rest of the clinical picture. In the presence of frequent hypoglycemia, A1C levels may not accurately reflect the level of hyperglycemia present.

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