A N S W E R S
HM has multiple risk factors for diabetes. Her risk factors include the following: age >45 years, body mass index >25 kg/m2, family history of diabetes, African-American race, hypertension, and dyslipidemia (particularly if her high-density lipoprotein cholesterol is <35 mg/dL or her triglyceride level is >250 mg/dL).
When mixing regular (or other rapid-acting) insulin with NPH (or other longer-acting) insulin, the clear regular insulin should be drawn into the syringe before the cloudy NPH insulin.
Unfortunately, DR cannot believe the pharmacist. First, the pharmacist exhibits the classic symptoms of opiate use, including pinpoint pupils, drowsiness, and itching. Second, the amount of codeine and morphine found in poppy-seed bagels is not enough to cause symptoms of intoxication. Third, morphine typically predominates over codeine when poppy seeds are ingested. The pharmacist's drug screen shows a predominance of codeine, as would be seen after codeine ingestion.
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