A 56-Year-Old Man Visits the Office for a Check-Up on His

A 56-year-old man visits the office for a check-up on his type 2 diabetes mellitus. He has a long family history of difficult type 2 diabetes, and several family members have had to have lower extremity amputations due to nonhealing ulcers. The patient has tried many oral drugs, and his most recent hemoglobin A1c level is 9.6%. Basal insulin treatment is currently being investigated for him. After a lengthy discussion on injection technique, the patient informs the clinician that he does not wish to begin insulin administration. He claims, "My diabetes is all my responsibility. My mother constantly thought I was too heavy and would develop diabetes like my father. Maybe if I cut back on my eating, I won't have to spend your time giving me insulin." Which of the following is the most appropriate response to this patient's statement?

A) "Insulin is the best option for your diabetes right now, and we can work on weight loss later."
B) "It is common for people with diabetes to eventually need insulin.  That doesn't mean it is your fault."
C) "It seems you are becoming frustrated with your health.  Do you feel like you may be depressed?"
D) "You should never feel like you are wasting my time.  Helping patients get better is what makes me happy."
E) "You shouldn't blame yourself.  Your family history is not something you can control."