Practice 10-Minute Consultation


BMJ 2011; 342 doi: (Published 16 February 2011) Cite this as: BMJ 2011;342:d567

Alarm bells

The patient described is, in reality, rather unusual given his age,
BMI, his treatment regimen and the diagnosis of type 2 diabetes. He also
appears to be very insulin sensitive. The sudden onset of probable
recurrent hypoglycemia raises alarm bells about serious underlying new
conditions including failure of normal glucose counter-regulation.

He also needs advice about doing structured self-monitoring of blood
glucose to check out if damage is being done by Gliclazide and/or once
daily Glargine (many patients need a split dose). Carbohydrate (and
Gliclazide) free meal frequent SMBG testing will sort it out. If you have
the money continuous interstitial glucose monitoring (sensing) could also
add value.

Basically he needs specialist input (ouch!!!)

Competing interests: No competing interests

18 February 2011
David Kerr
Diabetes Technology Society