Me: Your blood sugars of 300’s are very elevated. We need to add a medicine, or else you may have a heart attack or stroke one of these days. Let’s add metformin.
Mr. Adamant: No, I cannot take that because it makes me feel “weird.”
Me: What do you mean “weird”?
Mr. Adamant: I don’t know, I just can’t explain it. I just don’t like it.
Me: Ok, then we can add pioglitazone. It’s more expensive, but we don’t have too many choices at this point.
Mr. Adamant: No, I tried that before and it makes me gain weight.
Me: Did you lose the weight after you stopped it?
Mr. Adamant (while attempting to conceal the soda can clutched in hand): No.
Me: Ok, then the only other choice we have left is insulin.
Mr. Adamant: Oh, no -- I definitely won’t take that! Over my dead body!
Me: There are no other choices. Why won’t you consider insulin?
Mr. Adamant: I tried that before and it didn’t work. In fact, nothing the doctors have given me works to lower my sugars.
Me (while pointing to soda can): But perhaps it’s because you refuse everything we give you!