Ms. K, aged 58 years, presented with a 45-year history of maturity onset diabetes of the young. She was initially diagnosed with type 1 diabetes and was started on insulin therapy.

Ms. K recalled periods of her life where she did not require insulin therapy. Eventually, the patient had genetic testing performed, and a diagnosis of maturity onset diabetes of the young (MODY) was confirmed. Ms. K required insulin at different stages of her life: after initial diagnosis and during pregnancies. After each of her pregnancies, she came off insulin therapy. The disease was well controlled with metformin for many years.

In the previous 1 year, Ms. K experienced an episode of renal failure that required dialysis. Since that time, she followed-up with a nephrologist and endocrinologist as an outpatient every three months.

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Metformin was discontinued after the episode of renal failure, with noted elevation in creatinine. Mild renal insufficiency continued after this episode, and she was started on low dose sulfonylurea therapy for safety. Her creatinine level was 1.3 mg/dL.

Ms. K’s diabetes therapy included glimepiride (Amaryl) 0.5 mg in the morning and 1 mg in the afternoon. The patient’s hemoglobin A1C was 6.2%. It was obtained just prior to admission. The patient had several complications and comorbidities affecting diabetes management: renal insufficiency following episode of renal failure, gastroparesis, and retinopathy.