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: penicillins / watermelon / almond oil / hydralazine attending: chief complaint: high blood sugar, abdominal pain major surgical or invasive procedure: none history of present illness: presented with additional episode c/w gastroparesis and dka; states that he is compliant with his dm regimen and does well for awhile until he has another hurdle. last a1c was > 9 which is not consistent with the glycemic control stated by the patient. has been having nausea and vomiting over the past days and continued to feel worse until he knew he had to come to the ed for additional evaluation and treatment. denies any fevers/chills/sweats but has been having abdominal pain, nausea, and vomiting. past medical history: -dm type i since age 19, followed at . complicated by nephropathy, neuropathy, gastroparesis, retionpathy. prior episodes of dka and hospitalization. -esrd on hd t/th/s: right arm fistula, , dry weight 73kg -hypertension -nonischemic cardiomyopathy with ef 30-35% -anemia: felt to be due to both iron deficiency and advanced ckd -depression -pulmonary hypertension -migraines social history: -home: lives with his gf. mother lives in the area as well. -tobacco: trying to quit; has relapsed and smokes 1 pack per week or week and a half -etoh: previously drank heavily (30-40 drinks/week) but has not used alcohol since -illicits: denies other drugs. family history: paternal gf had dm2 but nobody with dm1. hypertension in a few family members. physical exam: admission physical exam: vitals: 98.7 160/100 94 12 97% general: alert, oriented, in mild-moderate distress d/t abdominal pain heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, ttp in mid-epigastrum, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. functioning av fistula in r arm. neuro: awake and alert. oriented. moving all extremities. . discharge physical exam: vitals: 97.7 125/85 72 18 100% general: alert, oriented, no apparent distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no r/r/w cv: regular rate and rhythm, normal s1 + s2, 2/6 sem, no gallops abdomen: soft, slightly distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. functioning av fistula in r arm with +thrill. neuro: awake and alert. oriented. pertinent results: admission labs: 08:05am blood wbc-8.9 rbc-3.75* hgb-11.8* hct-34.4* mcv-92 mch-31.4 mchc-34.3 rdw-14.2 plt ct-278 08:05am blood neuts-85.8* bands-0 lymphs-8.2* monos-5.6 eos-0.2 baso-0.3 08:05am blood plt ct-278 08:05am blood glucose-397* urean-39* creat-9.1*# na-136 k-5.9* cl-88* hco3-26 angap-28* 08:05am blood alt-24 ast-34 alkphos-146* amylase-139* totbili-1.2 11:25am blood ck(cpk)-145 08:05am blood ck-mb-3 ctropnt-0.27* 11:25am blood ck-mb-3 ctropnt-0.25* 06:36pm blood ck-mb-3 ctropnt-0.24* 08:05am blood lipase-62* 08:05am blood albumin-4.6 calcium-10.1 phos-6.5* mg-1.9 10:14am blood lactate-2.0 01:03pm blood k-5.2* . discharge labs: 03:12am blood wbc-6.1 rbc-3.15* hgb-9.8* hct-29.5* mcv-94 mch-31.2 mchc-33.3 rdw-14.1 plt ct-182 03:12am blood plt ct-182 03:12am blood glucose-160* urean-52* creat-10.8* na-135 k-5.9* cl-92* hco3-29 angap-20 03:12am blood calcium-8.7 phos-7.0* mg-1.7 . imaging: cxr: impression: no acute cardiopulmonary process. stable mild-moderate cardiomegaly. brief hospital course: dc summaries: brief course: dm1 c/b gastroparesis, esrd on hd, neuropathy, htn who is admitted with 2 days of nausea and vomiting and found to have hyperglycemia and gap acidosis most likely due to dka, gap has closed glycemic control regained, abdominal pain resolved. . active issues: # dka: the patient has a h/o of recurrent episodes of dka and presents now with similar sx to prior admissions. unknown exacerbating factor although may be related to the patient's chronic gastroparesis and his n/v over the past 2 days. also consider viral uri vs. pna given the patient's recent productive cough which has since resolved. the patient reports good compliance with medications although has been non-compliant in the past. other forms of gap acidosis less likely as lactate is normal and patient was dialyzed yesterday. is 2 kilos below dry weight on admission. pt had insulin gtt in micu, with subsequent hypoglycemia. ag closed. he was transitioned to sc insulin with normalization of blood sugars. - fs qid, diabetic diet - iss - sw consult given concern for repeated episodes and medication non-compliance - saw the patient and made minor adjustments to his sliding scale, will follow him as an outpatient . # uncontrolled hypertension: the patient was hypertensive on arrival with bps up to 200 systolic while here. most likely etiology is poor compliance/absorption of home medications given recent n/v. also started on a patch recently but does not have on here which may lead to rebound htn. bp improved in micu and continued to have good pressure control on the floor. - continue home anti-hypertensives amlodipine, carvedilol, , lisinopril, stable . #. elevated troponin - patient with troponin elevated to 0.27 (0.25 on repeat). has been elevated to these levels on prior admission in early . most likely due to renal failure and inability to clear trops. less likely acs as no ischemic changes on ecg or active cp. -baseline, no need to cycle enzymes . # end stage renal disease: renal failure to dm. hd schedule on , , sat. last dialyzed today in micu. will have regular dialysis tomorrow. - continue hd per schedule - appreciate renal recs - continue home sevelamer and nephrocaps. . transitional care: 1. code: full 2. medication changes: , no other changes or additions 3. follow-up: with pcp and 4. pending studies/labs: blood cultures drawn ; ngtd medications on admission: medications - prescription amlodipine - 5 mg tablet - 1 tablet(s) by mouth daily b complex-vitamin c-folic acid - 1 mg capsule - one capsule(s) by mouth once a day carvedilol - 25 mg tablet - 2 tablet(s) by mouth twice a day - 0.2 mg/24 hour patch weekly - apply as directed weekly glucagon (human recombinant) - 1 mg kit - use as directed for low blood sugar or passing out hydromorphone - 4 mg tablet - 1 tablet(s) by mouth twice a day as needed for severe pain 28 day supply insulin glargine - (prescribed by other provider) - 100 unit/ml solution - 18 units every morning daily insulin lispro - (prescribed by other provider) - 100 unit/ml insulin pen - sliding scale lidocaine-prilocaine - 2.5 %-2.5 % cream - use as directed one hour prior to dialysis three times a week lisinopril - 40 mg tablet - one tablet(s) by mouth once a day metoclopramide - 5 mg tablet - 1 tablet(s) by mouth three times a day as needed for abdominal discomfort please take 30 minutes before meals. omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth daily ondansetron - 4 mg tablet, rapid dissolve - 1 tablet(s) by mouth every eight (8) hours as needed for nausea sevelamer carbonate - 800 mg tablet - 1 tablet(s) by mouth tid with meals sildenafil - 100 mg tablet - 0.5 (one half) tablet(s) by mouth daily as needed for sexual activity take tablet 1 hour before sexual activity. sumatriptan succinate - 25 mg tablet - 1 tablet(s) by mouth once repeat in 2 hours if no effect. aspirin - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth daily blood sugar diagnostic - strip - to be used four times daily dextrose - 40 % gel - gel(s) by mouth for blood sugar < 60 if blood sugar < 60, take gels and recheck blood sugar in 30 minutes to one hour. docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day insulin syringe-needle u-100 - 30 gauge x " syringe - use up to four times daily as directed lancets - misc - 1 misc(s) four times a day or as directed discharge medications: 1. amlodipine 5 mg tablet : one (1) tablet po daily (daily). 2. 0.2 mg/24 hr patch weekly : one (1) patch weekly transdermal qwed (every wednesday). 3. sevelamer carbonate 800 mg tablet : one (1) tablet po tid w/meals (3 times a day with meals). 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. ondansetron 4 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. disp:*15 tablet, rapid dissolve(s)* refills:*0* 6. insulin glargine 100 unit/ml (3 ml) insulin pen : eighteen (18) units subcutaneous with breakfast. 7. insulin lispro 100 unit/ml solution : per sliding scale units subcutaneous with meals: please follow your sliding scale. 8. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 9. glucagon emergency 1 mg kit : one (1) kit injection once as needed for hypoglycemia. 10. hydromorphone 4 mg tablet : one (1) tablet po twice a day as needed for severe pain. 11. lidocaine-prilocaine 2.5-2.5 % cream : as directed topical one hour prior to dialysis three times a week. 12. metoclopramide 5 mg tablet : one (1) tablet po three times a day as needed for abdominal discomfort: take 30 minutes prior to meals. 13. carvedilol 25 mg tablet : two (2) tablet po twice a day. 14. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day: 30 minutes before a meal. 15. lisinopril 40 mg tablet : one (1) tablet po once a day. 16. viagra 100 mg tablet : 0.5 tablet po once a day as needed for sexual activity: take 1 hour before sexual activity. 17. sumatriptan succinate 25 mg tablet : one (1) tablet po once as needed for headache: may repeat x1 in 2 hours if no effect. 18. docusate sodium 100 mg capsule : one (1) capsule po twice a day. 19. dextrose 40 % gel : gels po blood sugar < 60: if blood sugar less than 60, take gels and repeat blood sugar in 30 minutes. discharge disposition: home discharge diagnosis: primary diagnoses: diabetic ketoacidosis gastroparesis secondary diagnoses: diabetes hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr , it was a pleasure taking care of you. you were admitted for elevated blood sugars and abdominal pain - in your case you were in diabetic ketoacidosis and required admission to the intensive care unit. your blood sugars were controlled in the hospital and you were seen by the diabetes center staff who adjusted your insulin regimen. . weigh yourself every morning, md if weight goes up more than 3 lbs. . the following medications were changed during this admission: you have no new medications we are not stopping any medications change your insulin regimen as directed by diabetes center . please continue all other medications you were taking prior to this admission. followup instructions: name: , md specialty: endocrinology when: wednesday at 3pm location: diabetes center address: one place, , phone: department: when: friday at 9:00 am with: , np building: sc ctr campus: east best parking: garage this appointment is with a nurse practioner as part of your transition from the hospital back to your primary care provider, . . after this visit, you will see dr. in follow up. md, procedure: hemodialysis diagnoses: other primary cardiomyopathies hyperpotassemia anemia in chronic kidney disease end stage renal disease renal dialysis status other chronic pulmonary heart diseases polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin iron deficiency anemia, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled other nonspecific abnormal serum enzyme levels background diabetic retinopathy gastroparesis adjustment disorder with depressed mood 

Answer: The patient is high likely exposed to