Lesson of the Week: In the Nick of Time!

Management of diabetes lends itself very well to several classical rules of good clinical practice, an elaborationofwhich is out of the scope of this short story. However, a couple of these are noteworthy. “Diagnosis should precede treatment as much as possible except formeasures of resuscitation” applies to diabetes as to all other conditions. In diabetes, diagnosis and classification are the same. Hence, a serious attempt to classify diabetes at the time of diagnosis or as soon as possible after that ismandatory.1 Inparticular,when thepatient’s characteristics are atypical, or events do not follow the expected course, making assumptions under these circumstances can be very dangerous.2 In this vignette, an unusual case of diabetes in a young woman is presented and discussed with an analysis of lessons to be learned. The present case report exemplifies several themes of “not expecting the expected,” “not making unfounded assumptions,” and “ignoring several alert signals.” In theMerriam-Webster dictionary, the idiom “in the nick of time”means just before the last moment when something can be changed or something terrible will happen.3 Many examples are medical, for instance, “The ambulance arrived in the nick of time” or “The doctor arrived in the nick of time. The patient’s life was saved”. Hence, the choice of the title is not for fun, but it is perhaps thebest description of the case as the story unfolds.