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Over the next ten years, B’s insulin therapy was stepped
up to multiple injections to keep her HbA1c less than 7%,
but this was at the expense of weight gain. She was also
started on statins for her hyperlipidaemia. She required
increasing doses of antihypertensive drugs including diuretics
for blood pressure control. Despite the intensification of
therapy and good self care in terms of adhering to dietary
advice and monitoring her blood glucose regularly, she eventually
developed end stage renal disease (ESRD) ten years after
her initial presentation. During these ten years of follow-up,
her mother died of combined heart and kidney failure at the
age of 53 years. B suffered from severe depression with her
ESRD and at one stage refused dialysis, but subsequently
accepted the therapeutic decision after intensive counselling
of both B and her family by the medical team. She remained
gainfully employed throughout this period of time.
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