Diabetes management: a case-based discussion

Date Published: 
Wednesday, September 22, 2021

Dr Rinki Murphy uses a case-based approach to diabetes management incorporating the new Diabetes Management Guidance and discusses where the newly funded dulaglutide fits.



  • 00:00 Intro
  • 01:04 Case intro
  • 01:56 Treating to target to minimise diabetic complications and maximise longevity
  • 02:59  How do we optimise his management?
  • 06:47  If we were to add in a new medication, what would it be and why?
  • 08:53 Do we need to down titrate existing medications and up titrate new ones?
  • 10:57 What monitoring do we need to do?
  • 12:00 What are the expected benefits of this for our case?
  • 12:47 What if our case was already taking insulin? How would this change things? Do we stop insulin?
  • 14:06 Fast forward a decade. What would we need to do now?  
  • 15:58 Special authority criteria
  • 17:14 Take-home messages


Take-home messages

  • Assess all people with T2D for history of HF, and consider prescribing SGLT2i as these reduce hospitalisation and mortality from HF.
  • Lower glucose lowering response expected from SGLT2i with lower eGFR but these still provide cardiorenal benefits.
  • If SGLT2i not indicated (due to eGFR<30, on VLCD/ketogenic diet) or not tolerated (due to recurrent thrush/UTI) then consider switching to GLP1RA.
  • Start Trulicity 1.5mg once fortnightly then after two doses may take 1.5mg weekly and discuss with patients how to minimise nausea with eating less, avoiding fatty foods to increase tolerance and aid weight loss.





Rinki Murphy
Diabetes Physician

Rinki is an Associate Professor in Medicine at the University of Auckland and Principle investigator at the Maurice Wilkins Centre for Biodiscovery.  She is a diabetologist at Auckland and Counties Manukau DHBs.

This podcast episode is supported by Lilly:

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This presentation is intended for qualified health practitioners professional development and should not be relied upon for any other purpose. Any opinions offered are those of the presenter or other speaker and do not necessarily represent the views of Goodfellow Unit.