March 11, 2023
Three years ago, a 48-year-old female patient was diagnosed with her diabetes as part of an anemia evaluation. She has been taking oral medications ever since. She takes metformin 1000 mg twice daily (bid), pioglitazone 30 mg daily, and glipizide 5 mg bid. She reports that the medications worked at first but they no longer seem to work. Her morning glucose readings vary between 130 and 180 mg/dL, but rise steeply to 200-300 mg/dL anytime she eats. She has stopped eating carbohydrates to limit this.