BACKGROUND: Multi-drug resistant tuberculosis and diabetes mellitus form a lethal partnership, with each multiplying the morbidity associated with the other. AIM: This is to report a case of multi-drug resistance tuberculosis with background uncontrolled diabetes mellitus in a patient with below knee amputation for diabetic foot gangrene. CONCLUSION: A good glycaemic control is crucial in preventing immunosuppression which is a precursor to MDR-TB especially in the background of default from anti-tuberculous therapy. Additionally, poor glycaemic control leads to diabetic complications which can result in non-healing ulcers and gangrene necessitating limb amputation as in the index patient.