Diabetes Complications Management Tutorial

Question 1

47-year-old man presents to his GP with erectile dysfunction. He is obese with a BMI of 33 kg/m2 and blood pressure is 148/99 mmHg. On examination his GP notes darkened areas of skin in his axilla and behind his neck. He has two pale stretch marks on his abdomen. A random capillary blood glucose is 25mmol/L.

Summary of issues:

Obesity
Hypertension
Erectile dysfunction
Hyperglycaemia

What is most likely diagnosis?
What are the darkened areas of skin linked to?
What blood tests could be carried out?

Answer 1

type 2 diabetes mellitus

insulin resistance

• > HbA1c - can be affected by various things
• > lipid profile
• > LH, FSH,
• > testosterone
• > C-peptide along with glucose levels taken at the same time to distinguish between type 1 and type 2
• > Diabetes type 1 would have a high glucose and low C-peptide

Question 2

HbA1c: 75 mmol/mol (20-41)

Total cholesterol: 6.7 mmol/L (<5)

Triglycerides: 3.2 mmol/L (<1.7)

HDL: 0.7 mmol/L (>1.2)

LDL: 5.2 mmol/L (<3)

Creatinine: 98 umol/L (55-110)

eGFR: >90 ml/min/1.73m2 (>89)

Urine albumin: creatinine 6 mg/mmol (>2.9)

Testosterone: 21 nmol/L (10-30)

LH: 7 u/L (2-12)

FSH: 6 u/L( 1.7-8)

What do these blood results show?
How could this patient be treated?

Answer 2

HbA1c is high indicating high blood glucose over the past 3 months. >48 is the cut off.

Total cholesterol is high and lipids high - dyslipidaemia

HDL low, LDL high - associated with cardiovascular mortality and risk whilst high HDL is the opposite. Look at the ratio of HDL to LDL. Suggests type 2 diabetes.

HDL is a marker of good metabolic health.

urine albumin: creatinine 6mg/mmol (<2.9) –> typo so this is the correction

C:A ratio is high

Testosterone, LH and FSH are also within normal range indicating functioning pituitary and gonads

–> statins

–> lifestyle changes

–> anti-hypertensives

–>metformin

–> ACEi can lower BP and preserve renal function

–> Annual retinal screening program and annual foot reviews + education