Case Study 1

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You are asked to see Joan, a 62 year old woman who is on a disability pension and lives alone. She has Type 2 Diabetes which began 12 years ago and she is on maximum oral therapy with Metformin and Glibenclamide. 
She has chronic back pain and major depression and is reviewed at your surgery regularly. She has had recurrent urinary tract infections over the past year. 

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Her recent random BSLs were in the low 20s and her HbA1c, performed 1 month ago was 10.5 . Joan has symptoms of polyuria and polydipsia associated with her hyperglycaemia. She has nocturia x4.

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Current Medication List:
metformin extended release 1gm BD
Gliclazide MR 30 mg mane
Simvastatin 80mg nocte
Escitalopram 20 mg mane

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Current Medical Problems: 
Ischaemic Heart Disease
Major Depression
Chronic low back pain
Recurrent Urinary Tract Infections with stress incontinence
Obesity 

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On examination:
BP 155/72, P 70 and regular. BSL 21.5, BMI 35 ​