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Q1: What test may be used to confirm a diagnosis of type 1 (as opposed to type 2) diabetes mellitus?
The intravenous glucagon stimulated C-terminal peptide test is considered the gold standard in confirming that a patient has type 1 (insulin dependent) diabetes mellitus. The insulin precursor proinsulin is released from the pancreas and then broken down into insulin and C-peptide. One milligram of glucagon is given intravenously, the subsequent rise in blood glucose stimulates the pancreas to release proinsulin, and thus pancreatic reserve can be measured by assaying C-peptide levels. In this patient type 1 diabetes was confirmed by a maximal response of 127 pmol/l at five minutes (adequate insulin reserve: >500 pmol/l, borderline insulin reserve: 200–500 pmol/l).
Q2: Given this patient's history before this admission; what other condition are the urea and electrolytes results in box 1 (see p 734) consistent with and how is the diagnosis confirmed?
Addison's disease is a deficiency in both glucocorticoids and mineralcorticoids. Glucocorticoid deficiency may lead to hypoglycaemia, while mineralcorticoid deficiency leads to …
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