Hema Patel is 34. She had gestational diabetes during her first pregnancy. Although initially she managed to control it with diet, she eventually needed to use insulin because she couldn’t tolerate the side effects of metformin. Since the birth of her son three years ago, she has continued to gain weight and her BMI is now 32kg/m2. Hema has been given a new prescription for metformin MR and asks if she can talk to you.

What are the key points that you would discuss with Hema about her medication and lifestyle?

A month later, Hema has a new prescription for gliclazide. She tells you that, despite trying, she could not tolerate the metformin MR. The practice nurse gave her a machine to test her blood sugars and a leaflet about driving. She admits that she was feeling a little overwhelmed and can’t really recall all of the information. She asks if you can help.

What would you discuss with Hema at this stage?

Six months later, Hema is disappointed that despite adherence to her medicines and losing weight, her HbA1c is still raised at 68mmol/mol. She wants to discuss medicine options.

What treatment options are there at this stage?

Three months later, Hema visits you to buy some folic acid, because she is hoping to have a second child. She feels that the new combination of tablets has worked well, and her HbA1c is now 60mmol/mol.

What should you discuss with Hema at this stage?