Page 1 of 52
Discussion | Jonah Helmer Hypoglycemia
vs Hyperglycemia Case Study | 2026
Update with complete solutions.
Question 1
A patient with blood glucose <70 mg/dL accompanied by
autonomic or neuroglycopenic symptoms is defined as:
A) Hyperglycemia
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemia (Level 1)
D) Hyperosmolar hyperglycemic state (HHS)
Answer: C
Rationale: The American Diabetes Association (ADA) 2026
defines Level 1 hypoglycemia as glucose <70 mg/dL but ≥54
mg/dL. Level 2 is <54 mg/dL. Level 3 is severe hypoglycemia
with altered mental status.
,Page 2 of 52
Question 2
Which of the following is the PRIMARY counterregulatory
hormone that raises blood glucose during hypoglycemia?
A) Insulin
B) Amylin
C) Glucagon
D) C-peptide
Answer: C
Rationale: Glucagon, secreted by pancreatic alpha cells,
stimulates glycogenolysis and gluconeogenesis. Insulin is lowered
during hypoglycemia. Amylin slows gastric emptying. C-peptide
is a byproduct of insulin production.
Question 3
Jonah’s symptoms of profuse sweating and confusion are most
characteristic of:
A) Hyperglycemia only
,Page 3 of 52
B) Hypoglycemia (autonomic and neuroglycopenic)
C) Euglycemic DKA
D) Somogyi effect
Answer: B
Rationale: Sweating (autonomic/adrenergic) and confusion
(neuroglycopenic) are hallmark signs of moderate to severe
hypoglycemia.
Question 4
The "Rule of 15" for treating mild hypoglycemia in a conscious
patient includes:
A) 15g of fast-acting carbohydrate, wait 15 minutes, recheck
B) 15 units of insulin, wait 15 minutes
C) 15 mL of water, wait 15 minutes
D) 15g of protein, recheck in 15 hours
, Page 4 of 52
Answer: A
Rationale: 15g rapid-acting carb (e.g., 4 oz juice, 3 glucose tabs)
→ wait 15 min → recheck glucose. Repeat if still <70 mg/dL.
Question 5
Which medication class is MOST associated with causing
hypoglycemia?
A) SGLT2 inhibitors (e.g., empagliflozin)
B) Biguanides (e.g., metformin)
C) Sulfonylureas (e.g., glipizide)
D) DPP-4 inhibitors (e.g., sitagliptin)
Answer: C
Rationale: Sulfonylureas increase insulin secretion independent of
glucose level. Metformin and SGLT2 inhibitors rarely cause
hypoglycemia as monotherapy.
Question 6 (2026 Update)
Jonah uses an automated insulin delivery (AID) system.
Discussion | Jonah Helmer Hypoglycemia
vs Hyperglycemia Case Study | 2026
Update with complete solutions.
Question 1
A patient with blood glucose <70 mg/dL accompanied by
autonomic or neuroglycopenic symptoms is defined as:
A) Hyperglycemia
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemia (Level 1)
D) Hyperosmolar hyperglycemic state (HHS)
Answer: C
Rationale: The American Diabetes Association (ADA) 2026
defines Level 1 hypoglycemia as glucose <70 mg/dL but ≥54
mg/dL. Level 2 is <54 mg/dL. Level 3 is severe hypoglycemia
with altered mental status.
,Page 2 of 52
Question 2
Which of the following is the PRIMARY counterregulatory
hormone that raises blood glucose during hypoglycemia?
A) Insulin
B) Amylin
C) Glucagon
D) C-peptide
Answer: C
Rationale: Glucagon, secreted by pancreatic alpha cells,
stimulates glycogenolysis and gluconeogenesis. Insulin is lowered
during hypoglycemia. Amylin slows gastric emptying. C-peptide
is a byproduct of insulin production.
Question 3
Jonah’s symptoms of profuse sweating and confusion are most
characteristic of:
A) Hyperglycemia only
,Page 3 of 52
B) Hypoglycemia (autonomic and neuroglycopenic)
C) Euglycemic DKA
D) Somogyi effect
Answer: B
Rationale: Sweating (autonomic/adrenergic) and confusion
(neuroglycopenic) are hallmark signs of moderate to severe
hypoglycemia.
Question 4
The "Rule of 15" for treating mild hypoglycemia in a conscious
patient includes:
A) 15g of fast-acting carbohydrate, wait 15 minutes, recheck
B) 15 units of insulin, wait 15 minutes
C) 15 mL of water, wait 15 minutes
D) 15g of protein, recheck in 15 hours
, Page 4 of 52
Answer: A
Rationale: 15g rapid-acting carb (e.g., 4 oz juice, 3 glucose tabs)
→ wait 15 min → recheck glucose. Repeat if still <70 mg/dL.
Question 5
Which medication class is MOST associated with causing
hypoglycemia?
A) SGLT2 inhibitors (e.g., empagliflozin)
B) Biguanides (e.g., metformin)
C) Sulfonylureas (e.g., glipizide)
D) DPP-4 inhibitors (e.g., sitagliptin)
Answer: C
Rationale: Sulfonylureas increase insulin secretion independent of
glucose level. Metformin and SGLT2 inhibitors rarely cause
hypoglycemia as monotherapy.
Question 6 (2026 Update)
Jonah uses an automated insulin delivery (AID) system.
