MSFinals-1052

MSFinals-1052

A 28-year-old woman has been living with type 1 diabetes mellitus for 15 years and has been under your care for the past nine years. During this time, her HbA1c levels have fluctuated between 64 mmol/mol and 75 mmol/mol (20-42).
Today, her blood pressure reads 130/84 mmHg. She has also noticed that her blood glucose levels at home have been fluctuating more than usual over the past three months. Additionally, she reports experiencing nausea after eating and requiring less food than usual to feel full.
Upon conducting investigations, the following results were obtained:
– Urea: 8.1 mmol/L (2.5-7.5)
– Creatinine: 112 µmol/L (60-110)
– Sodium: 138 mmol/L (137-144)
– Potassium: 4.2 mmol/L (3.5-4.9)
– Bicarbonate: 24 mmol/L (20-28)
– HbA1c: 42 mmol/mol (20-42)
– Urinalysis: Protein+
What is the most likely cause of her symptoms?