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Teachable Moment
Less Is More
February 2018

Blind Obedience and an Unnecessary Workup for HypoglycemiaA Teachable Moment

Author Affiliations
  • 1School of Medicine, University of California San Francisco, San Francisco
  • 2Department of Neurology, University of California San Francisco, San Francisco
  • 3Department of Medicine, University of California San Francisco, San Francisco
  • 4Division of Hospital Medicine, San Francisco VA Medical Center, San Francisco, California
JAMA Intern Med. 2018;178(2):279-280. doi:10.1001/jamainternmed.2017.7104

A man in his 70s with alcoholic cardiomyopathy with an ejection fraction of 20%, an automatic implantable cardiac defibrillator, and atrial fibrillation was admitted for increasingly frequent episodes of lightheadedness. His fingerstick blood glucose levels (FSBGs) in the hospital were between 60 mg/dL and 70 mg/dL during periods of lightheadedness (to convert to mmol/L, multiply by 0.0555). He was neither diabetic nor taking medications known to cause hypoglycemia. His symptoms did not improve with glucose administration. Aside from lightheadedness, he had no sweating, nausea, or other typical symptoms of hypoglycemia. Repeatedly low FSBGs prompted evaluation for hyperinsulinemia.

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