When the Treatment Becomes the Problem

A 47-year-old white male with a 5-year history of type 2 diabetes mellitus presented to clinic with uncontrolled hyperglycemia, weight loss, and body aches that impeded his ability to work and sleep. He had initially controlled his diabetes successfully with weight loss and exercise. However, in the previous 6 months he had noticed unintentional weight loss. He was evaluated at another clinic where he was prescribed sitagliptin/metformin (Janumet) for his uncontrolled hyperglycemia. After 6 weeks his blood glucose had not significantly improved, and an endocrinologist prescribed insulin glargine (Lantus) and insulin aspart (NovoLog). About 3 days later he developed migratory joint pains and myalgias. After some weeks his insulin regimen was changed to insulin detemir (Levemir), and his myalgia symptoms briefly improved but then worsened. He experienced tingling of his feet that caused increasing difficulty sleeping. His review of systems was remarkable for fatigue, weight loss, polydipsia, polyphagia, polyuria, myalgias and arthralgias, numbness and tingling of both feet, and difficulty sleeping.