A 56-year-old Caucasian man presents with intermittent nausea, abdominal distension, erectile dysfunction, and arthralgia of the small joints of both hands for 6 months.

He has been on treatment for diabetes mellitus for 2 years now. Despite good dietary compliance, he displayed a poor response to oral hypoglycemics, but achieved satisfactory control with insulin therapy.

His family history is significant for diabetes in his mother, at the age of 50. He does not smoke or drink.

A CBC is within normal parameters, with a Hb of 13.5 mg/dl. A blood film is also normal.