Question of the Week

For August 16, 2022

An 18-year-old young woman with long-standing type 1 diabetes and Hashimoto thyroiditis presents for routine follow-up. Her glycated hemoglobin level has ranged from 7.2% to 8.4% during the past 3 years. She is currently prescribed multiple daily injections of insulin for diabetes management, including insulin glargine once daily for basal insulin and insulin lispro for prandial insulin before meals. She also takes levothyroxine to treat her hypothyroidism.

The patient started college 3 months ago in a new city and is currently home on break. She reports that she has lost 3.6 kg of body weight at college despite an increase in appetite. She has also had dry mouth, which has prompted her to drink throughout the day and night. The increased thirst is accompanied by increased urination and fatigue.

She forgot to bring her glucometer to the appointment today but reports that her blood glucose level was 90 mg/dL this morning before breakfast.

Which one of the following laboratory results is most likely to explain this patient’s symptoms?

Gross proteinuria
Low morning cortisol level
Elevated glycated hemoglobin level
Elevated tissue transglutaminase immunoglobulin A antibody level
Elevated thyroid-stimulating hormone level

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