Group 3 A.B. is a 72-year-old white

Group 3 A.B. is a 72-year-old white woman who presented to her primary care physician with a 10-year history of episodic confusion and somnolence. The episodes occurred about twice a year, typically in the morning, just after her daily three-mile walk. They lasted minutes and were relieved when she ate her breakfast or had juice. Over the 8-10 months before presentation, the patient noted that the episodes were increasing in frequency as well as occurring throughout the day. When A.B. presented to her primary care doctor with the above complaints, the patient was reassured. As she was waiting for check-out, she developed confusion, a capillary blood glucose test was performed, and she was noted to have a plasma glucose level of 28 mg/dl. She was given juice and her symptoms resolved after a few moments. The patient was subsequently admitted to the hospital for further work up. On exam, A.B.. was found to be a well-nourished woman in no apparent distress. Her vital signs were significant only for mild hypertension. Her physical and neurological exams were unremarkable. Her admission lab values were significant for a glucose level of 36 mg/dl. She was completely asymptomatic upon presentation. What are the clinical signs and symptoms of hypoglycemia? (USLO 1, 6) Explain the risk factors and causes of hypoglycemia. (USLO 2) Identify and prioritize care, weighing consequences to the patient. This includes treatment options/interventions. (USLO 1,6) Discuss the instructions for A.B. regarding her daily exercise. (USLO 5)

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