A 67-year-old man presented with a 1-year history of fatigue, polyuria, polydipsia, blurred vision and 7 kg weight loss.
Physical examination revealed a BMI of 28 kg/m2 and reduced peripheral vibration and monofilament sensation on both feet. Random blood glucose was elevated at 34 mmol/L, and HbA1c was 140 mmol/mol (15.0%), confirming a diagnosis of DM. Basal-bolus insulin was instituted and resulted in the resolution of hyperglycaemia and osmotic symptoms. Insulin was subsequently discontinued, and he was discharged on metformin 1000 mg twice a day, and gliclazide modified release of 30 mg a day.
Three months later, glucose readings were consistently below 6 mmol/L and without documented hypoglycaemia. The patient then complained of a new symptom of severe left-sided groin pain radiating down his left leg. There was associated left leg weakness, such that he walked with a stick. He had lost a further 3 kg in weight despite good glycaemic control. Examination revealed weakness on left hip flexion and left knee extension, an absent left patellar reflex and an atrophied left quadriceps. HbA1c checked 2 months later returned at 42 mmol/mol, indicating excellent glycaemic control.
Nerve conduction studies and electromyography (EMG) were performed.
Like
Answers
Save
Share