A54-year-old insulin-dependent diabetic notes that her insulin requirements have gone up dramatically in the past year (from 50 U to nearly 200 U of recombinant human insulin) and her blood glucose is still poorly controlled. A possible explanation for the worsening of her diabetes includes which of the following?
(A) a high titer of anti-insulin antibodies
(B) an improved diet
© an improved exercise program
(D) progression of macrovascular disease
(E) weight loss
(A) The patient clearly has an increase in her state of insulin resistance. Given the magnitude of her increased insulin requirements, she most likely developed a high titer of antiinsulin antibodies that are preventing the injected insulin from lowering blood glucose effectively. Agood choice of lifestyle, including an improved diet (choice B), an improved exercise program (choice C), or weight loss (choice E) each are shown to beneficially affect her insulin requirements. Progression of macrovascular disease (choice D) is largely irrelevant to her insulin requirements, except to the extent that it might decrease her ability to exercise.