We report diagnostic difficulties in a case of diabetes mellitus presenting as acute on chronic renal failure with normoglycaemia. A renal biopsy indicated diabetic nephropathy; she developed hyperglycaemia following the institution of haemodialysis. It is important to remember that diabetic patients may have normal blood glucose concentrations in renal failure. In a patient with undiagnosed diabetes mellitus presenting with acute on chronic renal failure, choice of diagnostic biochemical test for diabetes may be difficult.
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