Interactive diabetes case 6: Uncontrolled diabetes in a 64-year-old patient treated with insulin – A2

ANSWER — Incorrect.

Approximately 10 percent of adult patients who are initially classified as having type 2 diabetes have type 1 diabetes (latent autoimmune diabetes of the adult) (see "Interactive diabetes case 4: Uncontrolled diabetes in a 51-year-old patient on insulin and two oral agents"). This patient has type 1 diabetes based on the history of diabetic ketoacidosis, the apparent lack of insulin resistance, the absence of other features of the metabolic syndrome (such as obesity, hypertension, and hypercholesterolemia), and the lability of the blood glucose values. When tested, the patient is found to have anti-islet antibodies. She needs a physiologic regimen of insulin replacement.

Metformin is not indicated in a patient with type 1 diabetes. In this patient, by decreasing hepatic glucose output, metformin might reduce peak glucose values but increase the frequency and severity of hypoglycemic events.

Return to the beginning to try again. (See "Interactive diabetes case 6: Uncontrolled diabetes in a 64-year-old patient treated with insulin".)