MRCP2-0900

MRCP2-0900

A 67-year-old retired teacher visits the diabetic clinic after her GP discovered a random blood glucose level of 25 mmol/L during a routine check-up. She has been living with diabetes for 25 years and was previously well-controlled on glibenclamide 5 mg bd and metformin 800 mg TDS. She is currently asymptomatic and has no other medical conditions, except for a BMI of 32. On examination, she has symmetrical stocking distribution sensory neuropathy, scattered hard exudates, and dot blot haemorrhages on fundoscopy. Her fasting blood glucose on the day of the clinic is 20 mmol/L (3.0-6.0).

What is the most appropriate approach to managing this patient?