Clinical case review

Deteriorating glycaemic control in type 2 diabetes

Philip Y Popplewell



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?

Article Extract

Case scenario

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?