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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.

Select Relevant Investigations
Iron Studies

Performed

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

Performed

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

Performed

The blood picture appears completely normal.
Hepatitis C screening

Performed

Hepatitis C DNA: negative

Select Relevant Management
Phlebotomy
Start Insulin
Ketoconazole
Dexamethasone