Management of Diabetes Mellitus Dr Esther Tsang August 2011 Case 1 50 year old lady presents to you with polyuria, polydipsia. You do a reflomet and it was 13.0mmol/L. Can you diagnose diabetes mellitus? How do you diagnose diabetes mellitus? She complains of blurring of vision and cramping sensations in her legs whenever she walks. What are these symptoms of? What other questions do you ask to screen the patient for end-organ damage? She weighs 80kgs and is 145cm tall. What is her BMI? What is the waist-hip ratio? How would you advise her with regards to her weight? What is the recommended amount of weight loss and how can this be achieved? What is the metabolic syndrome? What particular physical signs do you want to look for in her physical examination? When should you examine her fundus? When should you refer her to the ophthalmologist? What blood tests do you want to send? How would you screen for diabetic nephropathy? Her HbA1c was 11.0% FBS was 14.6 mmol/L Renal function was normal. Which OHA would you start and why? What are the side effects of metformin? What are the contraindications of metformin. Name the classes of OHAs. You start her on Metformin 1g BD and Gliclazide 160mg BD. 1 month later, she is here to see you. She has a FBS of 8.0mmol/L; BP of 140/90 mm Hg; and HbA1c of 10.9%. Her FLP is as follows : TC 7.0 mmol/L LDL 4.0mmol/L TG 2.0 mmol/L Is she adequately managed? What should be the targets? How do you interpret the HbA1c now? Can you continue her tablets and see her 4 months later with a repeat blood test? How would you then treat her diabetes mellitus? She comes back during her next follow up with a fasting blood sugar of 15.0mmol/L despite your treatment. HbA1c 10.0%. She confesses that she did not take her metformin at all due to severe diarrhoea. What can you offer her? What is a diabetic diet? How would you treat her dyslipidaemia? How would you treat her blood pressure? Then she complains of severe pains over her lower limbs, so much so that she is unable to tolerate blankets over her legs. What can you offer? Finally during her next visit, she has reduced her weight to 75kgs, FBS of 7.5mmol/L and HbA1c of 8.0%. Are you satisfied? She says that she has a niece aged 21 whom she thinks should be screened for diabetes mellitus. Do you agree? Who should be screened for diabetes mellitus?