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Original Question

John Miller is a 55-year-old man who has been admitted to the hospital with worsening symptoms of diabetes mellitus and recent onset of severe abdominal pain. He attributes his recent abdominal pain to indigestion and has been self-medicating with over-the-counter antacids. He lives alone in a rural area and works as a mechanic. He mentions to you that he needs to be able to keep working, or he will fall further behind on his rent. John is a smoker and has a history of hypertension. He reports that he has been feeling increasingly fatigued and has noticed that his legs are swelling. John has been managing his diabetes with oral medication for the past 10 years. He has not been regularly checking his blood glucose levels and admits that he often forgets to take his medication. John’s diet mainly consists of convenience foods and take-out, which are generally high in fat, sodium and sugar. John has a history of ulcers on his feet, which cause him discomfort and make standing in his work boots difficult. John sees his teenage children a couple times a year but has no contact with their mother, his ex-wife. John enjoys the company of his workmates but is somewhat isolated otherwise, relying mainly on occasional visits from a neighbour. Admission Findings: Vital Signs: Temperature 37.9°C, Pulse 88 bpm, Blood Pressure 150/95 mmHg, Respiratory Rate 20 bpm John appears pale and diaphoretic. He has significant abdominal tenderness and distension. He rates his pain an 8 out of 10.

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