Help with patient

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Last week (the 20th) I saw a new patient, the employee of another patient in my practice. She is a simple woman who hasn't seen a doctor in over 10 yrs. 40 yrs old, h/o gestational diabetes. Her chief complaint was bumps in her vagina, becoming painful. My nurse had her give a urine prior to my exam. On exam she had a bartholin's cyst abcess that I I and d'd and some condyloma. Not the hard part. Her urine had sugar in it, and otherwise she seemed like a mildly overweight, smoker who didn't take very good care of herself. I got a metabolic panel and hba1c and lipids. So now I get the lab back (no critical value call over the holiday or anything) and her sugar is 750, (hba1c 16.1!), triglycerides are 3800. Her sodium is 123, K+ 4.4, chloride 88 and co2 21. Her creatinine is 1.1. I think the hyponatremia is compensation of the triglycerides and blood sugar. An apparently successful attempt to keep her from hyperosmolality.Anyway, I called her and asked that she come in right away and she said she has been cutting down on the pop and can't come in to see me until tomorrow. She doesn't think it is necessary. I am a little worried. A part of me thinks she should be admitted to get this under control, but I doubt she would do that. What do you think, would you just start a sliding scale on her? Insist she be admitted? See her tomorrow and have her come in again in a day or two? the holidays are making it very difficult. I have time tomorrow to get her sta

rted on insulin and I hope to teach her how to check her sugars etc...Kris