Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: tapazole attending: chief complaint: unresponsive, hypoglycemia major surgical or invasive procedure: intubation for unresponsiveness history of present illness: mr. is a 56 year-old man with dm1, esrd, pvd, dchf, and recurrent admissions for hypoglycemia presents with hypoglycemia requiring intubation for unresponsiveness and is transferred to the micu for further management. . he was recently discharged on after presenting with lethargy and hypoglycemia. his course was complicated by left sided subdural hematoma found in the setting of ams evaluation, and av fistula clot requiring thrombectomy. he was due for dialysis today but missed his session and per report was found at home unresponsive. he was brought be ems to the ed. . in the ed, vital signs were initially: 29c rectal 45 150/palp 20 95%nrb. he had an undetectable glucose level and was intubated for agonal breathing with etomidate 20 mg iv and roc 10 mg iv and was also given 1 amp calcium gluconate, 1 amp d50, vanc/zosyn empirically, levothyroxine 37.5 mcg iv x 1, solumedrol 125 mg iv x 1, and started on glucose drip. a right femoral groin line ws placed semi-sterily. a bear hugger was placed and temp rose to 29.7 after 1.5 hours. his ett was pulled back after a cxr demonstrated partial right main stem intubation and he was transferred to the micu for further evaluation. . in the micu, the patient was extubated and his blood sugars were controlled recommendations. pt was warmed to good effect. vanc and zosyn was discontinued on . he was found to have gram positive rods grow on 0500 in 1 anaerobic bottle dated from . speciation is pending. he also had low grade temperatures (99.5) persistently. he was started on ampicillin 2 g iv q12h, ciprofloxacin 400 mg iv q24h, and clindamycin 600 mg iv q8h. past medical history: 1. type 1 diabetes with insulin autoantibody receptor syndrome -since age 16 on insulin, followed by dr. hypoglycemic episodes, has required intubation for altered ms in the past -high level of anti-insulin ab -complicated by nephropathy -complicated by retinopathy (s/p right eye laser surgery, repeated ) -on immunosuppression ?? no records at 2. end-stage renal disease on dialysis 3. diastolic heart failure 4. hypertension, 5. hyperlipidemia 6. peripheral vascular disease 7. hypothyroidism 8. anemia 9. recent burn on his left upper extremity, now s/p skin graft 10. s/p left first toe distal phalangectomy in 11. pancreatic lesions seen on an abdominal ct done in social history: he states that he currently lives with his parents. several other relatives also live there at different times. he worked in construction but was laid off. he denied alcohol tobacco, or illicit drug use. family history: per omr, history of dm (type 1 and 2), ra and htn. mother - type 2 diabetes , rheumatoid arthritis maternal aunt - type 2 diabetes nephew - type 1 diabetes physical exam: vs: 97.2 141/86 75 20 100%ra general: pleasant middle aged man in nad. aox3. can say all days of the week backwards. heent: perrl, eomi, ett neck: supple heart: rrr, no m/r/g lungs: ctab, no rales, moderately reduced air-movement. abd: +bs, ntnd, no rebound or guarding ext: no edema, no calf ttp neuro: cn 2-12 intact. moves all extremities, no pronator drift, light touch sensation intact throughout msk: r toe s/p amputation, mild ttp, poor wound healing, fibrinous exudate, foul smelling pertinent results: labs on admission: 08:00am blood wbc-5.6 rbc-3.60* hgb-10.3* hct-32.3* mcv-90 mch-28.7 mchc-32.1 rdw-15.0 plt ct-212 11:40am blood neuts-93.4* lymphs-4.2* monos-1.9* eos-0.3 baso-0.1 08:00am blood plt ct-212 08:00am blood urean-28* creat-5.9*# 08:00am blood lipase-44 08:00am blood alt-10 ast-21 ld(ldh)-226 alkphos-56 totbili-0.2 08:00am blood albumin-3.6 08:00am blood tsh-20* 08:00am blood free t4-1.3 06:40am blood cortsol-17.7 08:00am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 11:40am blood ethanol-neg . labs on discharge: . studies: ekg : sinus tachycardia, lad, poor r-wave progression, low voltage. non-specific st-t changes. when compared to prior on , qtc prolongation has improved to normal. nchct (): interval decrease in thin left subdural fluid collection overlying the left cerebral convexity posteriorly as well as an improvement in the local mass effect on subjacent sulci. no new acute intracranial hemorrhage, edema, or mass effect. . nchct (): overall further improvement, with near-complete resolution of the thin subdural fluid collection layering over the posterior left cerebral convexity, and no new acute intracranial process. . cxr findings: in comparison with the study of earlier in this date, the endotracheal tube has been pulled back so that the tip now lies approximately 6 cm above the carina. there is poor definition of the medial aspect of the left hemidiaphragm with increased opacification in the retrocardiac region. this is consistent with volume loss in the left lower lobe, related to the prior low position of the endotracheal tube. there is a suggestion of some patchy opacification in the right mid lung zone, raising the possibility of aspiration pneumonia. . micro blood cultures (): corynebacterium species (diphtheroids) 1/2 bottles. blood culture (): no growth brief hospital course: mr. is a 56 year-old man with dm1, esrd, pvd, dchf, and recurrent admissions for hypoglycemia who presents with hypoglycemia and unresponsiveness, called out from the micu for further management. . # competency: given the large number of life-threatening hypoglycemic episodes, pt was evaluated by psychiatry, social work, the medical team and was deemed to be incompetent in managing his medical illness. the patient's family also satted that they were unable to provide 24 hour supervision for the patient and were no longer able to care for him. therefore, the process of guardianship was pursued. temporary limited guardianship for the purposes of transfer to extended care facility was assigned to the patient's son . the patient's sister remains his health care proxy. . # unresponsiveness: has had these episodes last admission thought to be related to interruption of consciousness syndrome secondary to cerebral edema and frontal lobe dysfunction. this edema was thought to be related to the chronic sdh. seizure was questioned but routine eeg negative. differential diagnosis included cerebral edema/fronal dysfx vs seizure, vs relative hypoglycemia (given drop from 400s overnight to 130). ct head and labs were ordered, neuro was consulted, eeg was scheduled, however, pt refused any further work up, was made aware of risks including death, and still refused. the patient had no further episodes of unresponsivess the rest of this admission. . # recurrent hypoglycemia: thought to be multifactorial etiology with combination of poor medication adherance, including confusing levemer with short-acting, poor po intake. insulin antibody less likely to be a factor as the patient only had several mild hypoglycemic episodes as an inpatient with blood sugars in the 50s range, during which the patient remained asymptomatic. the patient was followed by consult thorughout this admission and long-acting insulin and sliding scale doses were adjusted. the patient still exhibited a wide range of blood sugars ranging from 50s to 400s, but remained asymptomatic throughout. purposely used conservative insulin scale to avoid hypoglycemic episodes. . # history of sdh: found on head ct in for evaluation for agitation/ams, thought to be secondary to a fall. seen by neurosurg and thought to be chronic, not intervened upon. held heparin. ambulation was used for dvt prophylaxis. the patient remained asymptomatic throughout the rest of his hospitalization. . # diabetes i: history of recurrent episodes of hypoglycemia. the patient was continued on prednisone for insulin antibody syndrome. dose of prednisone decreased to 15mg daily. consulted and followed the patient throughout this admission. we continued qid fingerticks and sliding scale. continued lantus (dose increased to 10 units qam and 6 units qpm) as well as humalog sliding scale. the patient will follow up at upon discharge. . # esrd on hd: the patient received dialysis while inpatient on his outpatient schedule every tuesday, thusday, saturday. we continued nephrocaps, calcitriol, and tid calcium carbonate. the patient's medications were adjusted based on his renal function. the patient will resume his outpatient dialysis upon discharge at dialysis center, , , . he will continue to be followed by his outpatient nephrologist dr. . his next outpatient hd session is on saturday, . if the patient is not able to receive hd at on saturday, please page dr. by calling and arrange for hd at . . # left hallux amputation: the patient had a prior amputation of left toe on prior admission and underwent closure pf left hallux during this admissiojn by podiatry. betadine dressing were changed daily and should continue to be changed upon discharge. sutures remain in place upon discharge. the patient may continue to ambulate in his post-surgical shoe essential distances. he will follow up with podiatry upon discharge. . # htn: pt was hypertensive on the floor because all his bp meds were discontinued in the micu. after restarting his home meds, his pressures returned to normotensive. we continued metoprolol 50mg po tid, diltiazem sr 180mg po bid, doxazosin 4mg po hs and minoxidil 5mg po bid . # disease: we continued synthroid . # hyperuricemia: we continued allopurinol . # hyperlipidemia: we continued statin medications on admission: medications at home (per d/c summary): 1. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) 2. rosuvastatin 20 mg tablet sig: one (1) tablet po daily 3. minoxidil 2.5 mg tablet sig: two (2) tablet po bid 4. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. allopurinol 100 mg tablet sig: one (1) tablet po every other day 7. levothyroxine 75 mcg tablet sig: one (1) tablet po daily 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid 9. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h prn 11. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po bid (2 times a day). 12. doxazosin 4 mg tablet sig: one (1) tablet po hs (at bedtime). 13. metoprolol succinate 50 mg tablet sustained release 24 hr qhs 14. metoprolol succinate 100 mg tablet sustained release 24 hr daily 15. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 16. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1)capsule, delayed release(e.c.) po twice a day. 17. insulin: please resume you outpatient diabetes therapy. please administer 3 units levemir under the skin, twice daily. please administer humalog according to the attached sliding scale. 18. levemir 100 unit/ml solution sig: three (3) units subcutaneous twice a day for 2 weeks. 19. tramadol 50 mg tablet sig: one (1) tablet po every six (6) prn discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 5. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 7. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 8. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. metoclopramide 10 mg tablet sig: one (1) tablet po qid (4 times a day) as needed for n/v. 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for bloating. 12. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 13. doxazosin 4 mg tablet sig: one (1) tablet po hs (at bedtime). 14. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po bid (2 times a day). 15. minoxidil 2.5 mg tablet sig: two (2) tablet po bid (2 times a day). 16. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 17. insulin glargine 300 unit/3 ml insulin pen sig: ten (10) subcutaneous qam. 18. insulin glargine 100 unit/ml cartridge sig: six (6) subcutaneous qpm. 19. prednisone 5 mg tablet sig: three (3) tablet po daily (daily). 20. prochlorperazine maleate 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 21. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 22. tramadol 50 mg tablet sig: one (1) tablet po q12h (every 12 hours) as needed for toe pain. 23. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 24. insulin lispro 100 unit/ml cartridge sig: as directed units subcutaneous four times a day: please check fingersticks qid and administer insulin based on the attached sliding scale. . discharge disposition: extended care facility: care and rehabilitation ctr discharge diagnosis: primary: 1. unresponsiveness, likely secondary to hypoglycemic coma 2. hypoglycemia . secondary: 1. chronic kidney disease, stage v 2. type i diabetes, with neuropathy and retinopathy and insulin autoantibodies 3. peripheral vascular disease discharge condition: mental status: clear and coherent level of consciousness: alert and interactive ambulates without assistance discharge instructions: dear mr. , you were admitted to for an episode of unresponsiveness felt to be from low blood sugars. your insulin medications were adjusted with assistance from the doctors. you also had an episode of unresponsiveness with some shaking in the hospital, for which neurology input was requested, but this was not felt to be seizure or other neurologic disease. . while you were here, you continued to receive dialysis per your usual schedule. after discharge, you will continue to receive dialysis at , your usual dialysis site. . your son was chosen to be your legal guardian while you were in the hospital. this is to make sure that you are able to go to the appropriate rehab setting. . new medications/medication changes: - we adjusted your dose of insulin (lantus and sliding scale). - we started you on simethicone qid: prn for gas/bloating - we decreased your doses of prednisone to 15mg daily, prochlorperazine to 5mg every 6 hours as needed for nausea/vomiting, omeprazole to 20mg daily. - we started you on ulltram 50mg every 12 hours as needed for toe pain . please continue your other medications as prescribed. . please keep your appointments below. . please seek medical attention for lightheadedness, dizziness, shaking, low blood sugars with symptoms, chest pain, abdominal pain, shortness of breath, nausea/vomiting, or any other concerning symptoms. please also weigh yourself every morning, and notify your primary care physician if your weight goes up more than 3 lbs. followup instructions: you have the following appointments: . department: podiatry when: friday at 3:40 pm with: , dpm building: ba ( complex) campus: west best parking: garage . name: , when: wednesday, , 8am location: diabetes center address: one place, , phone: please call the above number and ask for if the you need an appointment sooner because of poor blood sugar control. . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis diagnoses: end stage renal disease renal dialysis status anemia, unspecified congestive heart failure, unspecified unspecified acquired hypothyroidism unspecified fall hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia acute respiratory failure cerebral edema toxic diffuse goiter without mention of thyrotoxic crisis or storm diastolic heart failure, unspecified subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled background diabetic retinopathy unspecified disease of pancreas diabetes with other coma, type i [juvenile type], uncontrolled 

Answer: The patient is high likely exposed to