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  • 62-year-old male
  • Body weight 90 kg
  • Body mass index (BMI) 30.1 kg/m2
Photo posed by model/courtesy of stock.adobe.com
  • ST elevation myocardial infarction (STEMI) with coronary artery bypass graft (CABG) 8 years ago, treated with aspirin 100 mg daily
  • Hypertension, treated with an angiotensin-converting enzyme (ACE) inhibitor and a calcium channel blocker (CCB)
  • Also taking a statin (HMG-CoA reductase inhibitor)
  • Former smoker
Photo posed by model/courtesy of stock.adobe.com
  • The patient consulted his primary healthcare provider for a routine examination
  • The laboratory workout was normal except:
    • Fasting plasma glucose: 156 mg/dl
    • HbA1c: 7.2% (55mmol/mol)
    • Estimated glomerular filtration rate (eGFR): 85 ml/min/1.73 m2
  • Echocardiogram (ECG) shows mild left ventricular systolic dysfunction (LVSD), known since the STEMI; ophthalmic examination is within normal limits
  • The patient is given lifestyle recommendations and is started on a sulfonylurea on top of metformin (500 mg twice daily) with the aim of an HbA1c reduction to ≤6% (42mmol/mol)
  • He was sent home with a scheduled follow-up 6 months later
  • 6 months later, the patient presents with an HbA1c of 6.6% (49mmol/mol)
  • The patient admits to random late-night hypoglycemic events and high levels of fasting blood sugar in the early morning, which are not acted upon and the patient is advised to continue the same medication
  • One month later, the patient collapses while sleeping at 03:00 am; his spouse calls the ambulance
  • His ECG shows ventricular fibrillation (VF); blood glucose is 36 mg/dl
  • Resuscitation attempts were unsuccessful and the patient died

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Please note:
This case study is a fictitious teaching example. Any resemblance to the case history of a real person with diabetes is purely coincidental.