What are the possible causes of persistently high blood glucose, >20 mmol/l, in a dm2 patient with esrf, despite doubling dosage of nph within a week?

Diabetes: Most common reason for high blood sugar is poor diet. Sorry but it's true. In other words, my patients can always out eat any amount of Insulin i prescribe. So it's very important to eat low glycemic foods as suggested by your diabetic education/nutritionist. Next most common cause is an underlying infection. Always check bottom of your feet for nails, objects, etc. Most important, follow up w/doc.