hey guys,

i recently had a pt in the hospital who claims to have been dx w/ DMII a year ago. she tells me she was placed on insulin the first time she got really sick and then went home on glipizide (this is an outside hospital so i had no records). then she got admitted again a few months ago @ our hospital when she was c/o intractable N/V. so they initially thought she had diabetic gastroparesis but when they checked her sugars, they were perfectly normal during her entire stay. Hgba1c was 4.4! so they stopped her glipizide and told her to f/u w/ a pcp and that she did not have diabetes. well, she returns to the hospital c/o n/v now and tells me her sugars go anywhere from 50s-300 @ home...not sure if i believe her b/c her sugars have been fine here. her Hgba1c is 5.5 this time. i did an OGTT and @ 3 hours, her BS was in the 40s! so i've ordered a bunch of labs like c-peptide, proinsulin, etc. i even wonder if she's injecting herself w/ insulin (but she's an inpatient so i don't see how she could do it). she is about to become and RN so i was thinking about surreptitious insulin use. she's thin so i even wondered about anorexia, etc. do you guys have any idea of this hypoglycemic rxn and how normal it is after an OGTT?? and how common is it to have hyperglycemia (enough to require an insulin gtt like she did in the past but NOT related to gestational DM) and then become euglycemic??

would appreciate any help. i'm about to do some studying on this topic since i've never actually done an ogtt w/ hypoglycmic results before.

thanks!