Gluconeogenesis & Bypass Enzymes | USMLE Step 1
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A 71-year-old woman with stage 5 chronic kidney disease is admitted after two days of nausea and little food intake. She becomes confused overnight, and her plasma glucose is 43 mg/dL. Creatinine is 4.7 mg/dL and estimated glomerular filtration rate is 10 mL/min/1.73 m². During the low glucose measurement, serum insulin is below 1 μU/mL. She has no diabetes, takes no glucose-lowering drugs, and has no urinary glucose. Liver tests and morning cortisol are within their reference intervals.