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One of your patients presents with the complaint of increasing fatigue. He is a 42-year-old white man whose primary diagnosis is diabetes mellitus of 20 years' duration. Long-term control of his blood sugar has been generally satisfactory on stable doses of NPH insulin. Vascular complications are evident, however, including retinopathy and nephropathy. In addition to fatigue, the patient has intermittent episodes of epigastric distress between meals and at night, which are readily relieved by milk. On further questioning, he indicates that he has had dark stools (perhaps black) on three or four occasions in recent
III. Application of Principles of Test Selection and Interpretation: A. Diagnostic Exercises. Ann Intern Med. ;94:571–587. doi: 10.7326/0003-4819-94-4-571
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Published: Ann Intern Med. 1981;94(4_Part_2):571-587.
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