The case of the reluctant patient

Now it is your turn to play doctor. Try your luck solving:

The Case of the reluctant patient...

Mrs. Lester was a seventy-five year old woman who had had diabetes for twenty years. Her blood sugar control had been quite good over the years, but had recently worsened with values now typically ten or higher. She was being treated with glyburide (Diabeta) and metformin (Glucophage). Her health was quite good otherwise, but her doctor had recently noticed that her kidney function was starting to decline. Because of concerns about her worsening sugars, Mrs. Lester's physician referred her to me. I advised Mrs. Lester that she was going to need insulin in the very near future. She protested and said that she was sure that if we added another pill to the two types of diabetes medicines she was currently on, her sugars would certainly improve. I agreed with her, but nonetheless insisted that she would need insulin imminently.

How could I be so sure?

Was it because:

1. her glyburide (Diabeta) needed to be stopped and that would make her sugars go up.

2. her metformin (Glucophage) needed to be stopped and that would make her sugars go up.

3. insulin therapy is always necessary to treat elderly patients with diabetes.

4. I took a wild guess.

So, over to you. What do you think is the correct answer? Once you've decided, then click here.