It is quite complicated to diagnose and treat diabetes mellitus with multiple organ complications, especially in the cases complicated with cardiovascular disease, nephropathy and infection of pacemaker. Here we reported a patient suffering from diabetic nephropathy, but presenting with renal insufficiency, prior myocardial infarction, diabetic foot, further developed sepsis, pacemaker infection, substernal abscess, osteomyelitis and infective endocarditis as well. His condition turned stable after renal replacement therapy, debridement and dressing in his feet, removing pacemaker and full course of antibiotics. The diagnosis and treatment of the case remind us that for the diabetic nephropathy patients complicated with pacemaker infection, it is important to remove the pacemaker in time and prescript full course of antibiotics according to the results of antibiotic sensitivity test. Early renal replacement therapy may be beneficial to the prognosis of such cases.