A 68-year-old man with a 12-year history of type 2 diabetes mellitus and stage 3 chronic kidney disease is found unresponsive by his wife at home in the early morning. Emergency medical services arrive and measure a capillary blood glucose of 32 mg/dL. His blood pressure is 98/60 mmHg, heart rate is 112 beats/min, respiratory rate is 18 breaths/min, and temperature is 36.8°C. His wife reports that he skipped dinner the previous evening and that his physician had added a new oral diabetes medication to his regimen three weeks ago, replacing his previous agent due to suboptimal glycemic control. She denies any insulin use. The new medication works by closing ATP-sensitive potassium channels in pancreatic beta cells, leading to membrane depolarization and subsequent calcium influx that triggers insulin secretion independent of ambient glucose levels. Which of the following drugs most likely caused his severe hypoglycemia?

  1. A)Metformin
  2. B)GlyburideGABARITO
  3. C)Pioglitazone
  4. D)Canagliflozin
  5. E)Acarbose

Explicação

Sulfonylureas such as glyburide stimulate insulin release by closing ATP-sensitive potassium channels in pancreatic beta cells. This increases depolarization, opens voltage-gated calcium channels, and promotes insulin exocytosis. Because insulin release is not... Ver explicação completa e trilha adaptativa →

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