Interactive diabetes case 4: Uncontrolled diabetes in a 51-year-old patient on insulin and two oral agents – B1

Answer — Incorrect.

Highly variable blood glucose levels not related to variations in diet and physical activity are atypical for type 2 diabetes and raise the possibility of latent autoimmune diabetes in adults (LADA).

Frequent or recurrent episodes of hypoglycemia are not acceptable, even when the glycated hemoglobin (A1C) value is within the desired range. The goal always is to achieve the best overall control that can be attained, based on the A1C values, without hypoglycemia (or, at worst, with infrequent and sporadic hypoglycemic events not related to correctable factors, such as insulin regimen, diet, and physical activity). Hypoglycemia is particularly worrisome in patients with hazardous occupations. Of course, it is always appropriate to review the symptoms of hypoglycemia and the response to hypoglycemic episodes, emphasizing the need to avoid overtreatment of hypoglycemia.

Return to the previous choice to try again. (See "Interactive diabetes case 4: Uncontrolled diabetes in a 51-year-old patient on insulin and two oral agents – A1".)