单选题 In a poor, inland, gang-infested part of Los Angeles, there is a clinic for people with type I diabetes. As part of the country health care system, it serves persons who have fallen through all other safety-net options, the poorest of the poor. Although type II diabetes is rampant in this part of town, type I diabetes exists as well. Yet these latter individuals generally lack access to any specialty care—a type of treatment they desperately need due to a complexity of dealing with type 1 diabetes in the setting of poverty and psychosocial stress. The Type I Clinic meets one morning per week and is staffed by four endocrinology fellows and a diabetologist, often me. I have the unique perspective of working part of the time in a county setting and the other part of the time in a clinic for people with health insurance, in Beverly Hills. I know what is possible in the treatment of type 1 diabetes. East Los Angeles teaches me what happens when access to care is not available. Most of our patients, in their 20s and 30s and 40s, already have complications of their diabetes; many near end stage. Concepts about maintaining near-normal blood glucose levels often miss their mark—lack of education or money or motivation or factors I can't even imagine make the necessity of a patient acting as his or her own exogenous pancreas nearly impossible, especially when there are acute consequences to hypoglycemia and few to moderate hyperglycemia. Historically, in spite of these barriers, we persisted and thought we made a difference. Often, teaching simple carbohydrate counting or switching therapy to long-acting insulin improved patients control and their quality of life. The fellows felt they made a positive impact in the health of their patients. Driving home I would be encouraged by what we had accomplished, although saddened by the severity of the complications suffered by many of our patients. Yet everything changed with the recession of 2008. In Beverly Hills I heard a lot about the demise of the financial markets. Patients of mine had invested with Bermie Madoff. Some, once billionaires, were now millionaires. Personal assistants and housekeepers were laid off, vacation homes were put on the market, and parties became less lavish. But all still live in safe, clean homes, wear designer clothes, and eat high-quality food. The landscape is very different for many of my East LA patterns. The temporary, part-time jobs they had cobbled together to keep food on the table and pay for housing are gone. I — naively — didn't realize how much worse poverty could get. But now many of our patients are young without food and are becoming homeless. One young man, a college student trying to work his way out of poverty by going to school, lost his job and is living in his car. He is still taking classes but is unable to afford more than a dollar meal from a fast-food restaurant once every day or two. Management of his diabetes involves simply keeping him alive with his erratic, poor eating habit.

单选题 At the beginning, the author describes the patients with an emphasis on______.

单选题 As a diabetologist working for the Type I Clinic, the author is quite concerned about those who ______.

单选题 Not until the recession of 2008 did the medical staff______.

单选题 As witnessed by the dialectologist during the recession of 2008, many poor patients______.

单选题 Which of the following tones does the passage most probably carry?