An elderly woman has had type 2 diabetes for 10 years, controlled by diet and oral hypoglycaemic agents. In the last year, her blood glucose levels have risen gradually. How should her diabetes be managed?
A 60-year-old woman has had non-insulin-dependent diabetes mellitus for 10 years. She is otherwise well but for mild hypertension. She is not overweight. Well controlled by diet and a standard dose of combined oral hypoglycaemic agents for some years, her blood glucose levels have risen gradually over the last year and are now hovering around 13 mmol/L. How should I manage her diabetes? How far can I push up the dose of hypoglycaemic agents? When should I start insulin, and what is the cut-off level for failure of oral hypoglycaemic agents?