Mr. T was in his late 50s and being treated for schizophrenia, noninsulin-dependent diabetes, and hypertension. He had lived in the same assisted-living facility for the past four years and had expressed satisfaction with the arrangements. He spent most of his time at the home resting, smoking, and walking to the local store. He attended adult day care briefly, but had not enjoyed the activity, preferring to remain alone during the day.

Mr. T was alert and oriented, and cooperative and responsive to questioning, but offered little information voluntarily. He reported no hallucinations but could sometimes be seen responding to internal stimuli and would occasionally complain of having unusual thoughts that disturbed him.

1. History and Physical Examination

After Mr. T was diagnosed with noninsulin-dependent diabetes mellitus in 2003, medications were added and titrated in a sequential manner, beginning with metformin (Fortamet, Glucophage, Glumetza, Riomet) and followed by glyburide (Diabeta, Glycron, Glynase, Micronase), acarbose (Precose), and isophane insulin (Humulin).

The patient received counseling regarding the diabetic diet but expressed little interest. The caretakers at his residence were asked to provide the patient with a diabetic diet, which they did, but Mr. T still had access to snacks that he would purchase on his own. When waiting in the clinic area, he would regularly be seen consuming candy and soda. He was polite when listening to suggestions that he avoid candy and drink diet sodas but never made any commitment to change behavior.

This article originally appeared on Clinical Advisor