Do we, primary care physicians, have it right in treating di | Figure 1

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Do we, primary care physicians, have it right in treating diabetes or are we doing a disservice by delaying insulin therapy - clinical scenario - Male patients in early 40’s BMI - 23; BP - 120/70 hr - 75; previously treated by PCP for diabetes type II with metformin 1000 mg BID; he now desires further care - PE essentially within normal limits, ACCUchek - 350; A1c - 13.1; UA - 500 glucoses - Ketones - 40+; ros - negative other than related diabetes uncontrolled; PMH/PSH otherwise negative; health screen labs are pending. How would you treat and how do you counsel patient about his care ?

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Effluent of a peritoneal dialysis patient. What is that in there, and how do we treat it? Students, go!

Patient presented with a scalloped hyper-pigmented area to the right of her right eye. This first appeared about a month ago. Primary care physician treated with topical antibiotic cream. Patient is waiting for an appointment with a dermatologist. Has anybody seen this before? What is it? How do you treat it?

A woman 50 years old, diagnosed with Diabetes mellitus 15 years ago, treated with insulin NPH 5UI in the morning and 15UI in the afternoon, is brought to the unit after presenting diaphoresis, confusion and alteration of the sensory state, reason for which her relatives bring. The patient omits feeding some occasions after the application of insulin. EF is sleepy, irritable, destrostix 30mg / dL, presents 120/80 mmHg arterial pressure, 88 heart rate, 22 respiratory rate, cardiopulmonary without aggregates normoperistaltic abdomen, limbs without compromise. How do you handle this patient? What tests would you ask for? What is your presumptive diagnosis? Do they hospitalize or graduate the patient?