Interactive diabetes case 4: Uncontrolled diabetes in a 51-year-old patient on insulin and two oral agents – A3

Answer — Incorrect.

The patient increases his caloric intake modestly at lunch but forgets to do so during the afternoon when he is preoccupied by work. He continues to have hypoglycemic reactions in the afternoon. On one occasion, three weeks after the office visit, he has a reaction at work while moving a heavy beam, which falls on his left foot, causing a hematoma. In the emergency department, he is treated for hypoglycemia and referred back to you. Radiographs reveal no evidence of a fracture.

While a redistribution of calories is sometimes effective, it is often difficult to change eating behavior. The patient needed an intervention that is likely to work promptly, such as an adjustment in the distribution of insulin. His potentially hazardous occupation makes any hypoglycemia during work a problem that must be solved quickly.

To explore the consequences of the other responses, return to the case at the beginning of this sequence. (See "Interactive diabetes case 4: Uncontrolled diabetes in a 51-year-old patient on insulin and two oral agents".)