In this next case scenario a diabetic man, who had been under insulin control for many years, is also known with chronic ischaemic heart disease.  He developed septicaemia due to his diabetic foot and dies in hospital. Since the man had died from an expected complication of the diabetes, in this case septicaemia as a result of diabetic foot, the heart condition played only a subsidiary part in the death. 

•Septicaemia, due to diabetic foot, is the immediate cause of death on line A of Part 1.

•Diabetes mellitus is the underlying cause of the diabetic foot, so it is reported on the lowest used line of Part 1.

•In this case chronic ischaemic heart disease is a contributing factor, so it is reported in Part 2. 

•Thus, as a general rule if the patient dies from a complication of diabetes, such as diabetic nephropathy or diabetic foot with sepsis, report diabetes mellitus as the underlying cause of death in Part 1.  

•If the patient dies from a stroke or myocardial infarction, report diabetes in Part 2 as a risk factor.