After 6 months a patient came for a follow-up visit. He indicates that his blood sugars have been around 100 to 120 mg/dL, and he has been fully participating in the other aspects of his diabetes management plan. Which would lead you to believe that he has not been in tight control of his diabetes?

A. Pain at the site of injury, such as a paper cut, is often due to the release of chemical mediators like prostaglandins, bradykinin, and histamines, which are part of the inflammatory response. These mediators increase blood flow and sensitivity in the affected area, contributing to pain. Exudate (fluid containing white blood cells and proteins) also forms at the site to aid in healing, and this can increase sensitivity.

B. Increased perfusion (blood flow) is part of the inflammatory response, but it is not the direct cause of pain. While increased blood flow helps deliver nutrients and immune cells to the site, it is the chemical mediators that cause pain.

C. Bacteria entering the wound could cause infection, but pain from a paper cut is typically related to the inflammatory response rather than infection. If infection were present, pain would usually be accompanied by other signs like redness, heat, and pus.

D. Vasoconstriction is the opposite of what happens at the site of an injury. Inflammation causes vasodilation, not vasoconstriction, to increase blood flow to the area.

A. A random blood sugar of 150 mg/dL is within an acceptable range for someone with diabetes, though it may suggest some fluctuation in blood glucose levels. It does not definitively indicate poor control of diabetes.

B. There are multiple methods to determine if diabetes is under tight control, including blood glucose monitoring and glycosylated hemoglobin (HbA1c) testing.

C. A reduced glycosylated hemoglobin level would indicate that blood glucose levels have been well-controlled over the past few months, suggesting that the patient is in tight control.

D. An elevated glycosylated hemoglobin level indicates that the patient's average blood glucose levels have been higher than recommended over the past 2-3 months, suggesting poor control of diabetes despite the patient's reported blood sugar levels. HbA1c is a key indicator of long-term glucose control.