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Beta blocker masking hypoglycemia — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Beta blocker masking hypoglycemiaUSMLE Step 3

A 70-year-old man with insulin-treated diabetes and coronary disease takes metoprolol. He reports several episodes of confusion and sweating before lunch but no palpitations or tremor. Fingerstick glucose during an episode is 48 mg/dL. Which of the following is the most likely explanation for this patient's findings?

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Reveal the answer and explanation

Correct answer: E — Blunting of adrenergic warning symptoms by beta blockade

Beta blockers can mask adrenergic symptoms of hypoglycemia, while neuroglycopenic symptoms and sweating may still occur.

Reference: ADA Standards of Care in Diabetes