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?