Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• He can't operate the glucometer: Studies have shown the most important factor in correct operation of the glucometer is experience with it, not level of education. He's actually doing a great job. 
• He isn't storing the insulin properly: Not a chance, this guy's as sharp as a tack, you can tell it by just looking at him.
• He's fiddling with his dose on purpose to get attention: A remote possibility, but he's been stable in every other way.
• He has a lousy diet leading to erratic blood sugars: Again a remote possibility, but he was the star of his diabetes education class. Besides, his insulin requirement has gone steadily up, not bounced around.
• There is some endogenous source of glucose: True, the liver makes it, but are there conditions that could lead to excessive production? If so, why at this time in his life?
• The diagnosis is in error, he never was diabetic: Not a chance, his glucose tolerance values included a 30 minute value of 400 mg/dL and 2 hour level of 230 mg/dL.