A 48-Year-Old Woman Who Has Type 2 Diabetes Mellitus Visits

A 48-year-old woman who has type 2 diabetes mellitus visits the office for follow-up care. She has had diabetes for ten years, and despite using numerous oral antidiabetic medications, her glycemic control has gradually gotten worse. The patient stopped taking her oral medications three months ago (with the exception of metformin) and began receiving daily injections of insulin glargine; she has since visited with the diabetes educator several times to go through proper injection technique and titrate up the dosage. However, since initiating insulin, the patient reports gaining 4.5 kg (10 lb) of weight. She claims, "I think I should eat more. I don't want to continue it if that's how insulin will be." Which of the following is the most appropriate response to this patient's statement?

A) "Regular exercise can reduce insulin-induced weight gain.  What are your current exercise habits?"
B) "Some patients eat more after starting insulin because they fear their sugar may drop.  Have you noticed that happening to you?"
C) "Sometimes stress can increase your appetite.  How are things in your life right now?"
D) "Unfortunately, although insulin controls diabetes, it can cause weight gain.  But the benefits outweigh the side effects."