A fit 84-year- old woman with type 2 diabetes had been started on gliclazide after strict dietary adherence had failed to control her symptoms. She now presents with persistently high glucose levels (home blood glucose monitoring or HBGM 12–15 mmol/L) and has an elevated HbA1c level (9.0 per cent) despite taking gliclazide, 160 mg in the morning, 80 mg in the evening. She is symptomatic with lethargy, frequency and dysuria. Random fingerstick glucose is 15 mmol/L and urine dipstick shows ++++ glucose, ++ albumin and + haematuria. BP is normal, weight is 67 kg (BMI 24 kg/m 2 ) and she has no evidence of retinopathy.
There is early peripheral neuropathy and foot pulses are absent. What are the treatment options? What would be the preferred choice of treatment? *This case is from the Docplexus Editorial Team and is for educative purpose only.
