A 56-Year-Old Man Comes to the Office for Follow-Up of Type

question 67

Multiple Choice

A 56-year-old man comes to the office for follow-up of type 2 diabetes mellitus.  He has an extensive family history of complicated type 2 diabetes, and multiple family members have required lower extremity amputations for nonhealing ulcers.  The patient has tried multiple oral medications and his most recent hemoglobin A1c is 9.6%.  He is now being considered for basal insulin therapy.  After an extended discussion of injection technique, the patient tells the clinician that he does not want to initiate insulin.  He says, "My diabetes is my own fault.  My mother always said I was too fat and was going to get diabetes like my dad.  Maybe if I stop eating too much, I wouldn't have to waste your time giving me insulin."  Which of the following is the most appropriate response to this patient's statement?

• A)"Insulin is the best option for your diabetes right now, and we can work on weight loss later."
• B)"It is common for people with diabetes to eventually need insulin.  That doesn't mean it is your fault."
• C)"It seems you are becoming frustrated with your health.  Do you feel like you may be depressed?"
• D)"You should never feel like you are wasting my time.  Helping patients get better is what makes me happy."
• E)"You shouldn't blame yourself.  Your family history is not something you can control."

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Definitions:

Catabolism

The breakdown of complex molecules in living organisms to form simpler ones, accompanied by the release of energy.

Anaerobic Exercise

Physical activity that increases heart rate and muscle strength through brief, intensive bursts of movement, without relying primarily on oxygen.

Aerobic Endurance

The ability of the cardiovascular and respiratory systems to supply oxygen to muscles during prolonged physical activity.

ATP

Adenosine triphosphate, a molecule that carries energy within cells for metabolism.