Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.