Secondary Diabetes

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Step 1: View clinicals

A 54 year old caucasian male who was diagnosed with type II diabetes mellitus 2 years ago presents with persistently poor glycemic control. His HbA1c was 8.5% while on maximum doses of Metformin and Glipizide, with good dietary and drug compliance. A recent renal profile, serum electrolyte assay and full blood count were completely normal.


Step 2: Order all relevant investigations

Iron Studies

Serum iron: 306 ug/dl (< 155) Total Iron Binding Capacity: 315 ug/dl (< 400) Transferrin saturation: 97% (< 50%) Serum Ferritin: 2,920 ug/l (< 160)

Endocrine Panel

Morning cortisol: 20 ug/dl (5 - 25) Urinary free cortisol: 70 ug/24 hr (10 - 110)

Blood Picture (Film)

The blood picture appears completely normal.

Hepatitis C screening

Hepatitis C DNA: negative


Step 3: Select appropriate management

Phlebotomy
Start Insulin
Ketoconazole
Dexamethasone


Score: ★★☆