Short of Breath and Diabetes

pregnant

25 years later at age 53 Emma complains to her GP that she feels short of breath on exertion for the last 6 months

She has attended for regular complication screening

Which is the most likely diagnosis? Select from the list below.

Breathlessness due to diabetic ketoacidosis    
Breathlessness due to acute renal failure    
Breathlessness due to COPD    
Breathlessness due to ischaemic heart disease     green tick

Well done, correct.