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Diabetes7-Managing Diabetes Dilemmas- red
flags and urgent pathways, Miranda Rosenthal
Speaker key
IV
MR
Interviewer
Miranda Rosenthal
MR
My name is Miranda Rosenthal. I’m a consultant in Diabetes at the Royal Free.
IV
What was your talk about today?
MR
My talk today is about diagnostic dilemmas in Type 1 and Type 2 diabetes.
IV
What are the red flags in diagnosis and management of diabetes?
MR I think the most important thing is to remember that there are always exceptions to the
rule. So when you have a young patient with Type 1 diabetes who presents with weight loss
and presents with clinical diabetic ketoacidosis, it’s quite easy to make the diagnosis. Type 1
diabetes in adults is not always the same. Patients don’t present acutely and often they don’t
present with a severe acidosis. The reason why it’s important to know this is that they can
require insulin and they may require insulin quite quickly to prevent them from deteriorating.
So when that patient who is middle-aged and turns up with hyperglycaemia, it’s quite
important to understand that although it’s most likely they’ve got Type 2 diabetes, there’s a
possibility that they could have Type 1 diabetes and to think about that and how you’re going
to manage them in the next couple of weeks to keep that situation safe.
IV
Are there any common pitfalls either in diagnosis or treatment to try and avoid?
MR My talk today is really about the diagnosis of Type 1 and Type 2 diabetes. So to think
about Type 1 diabetes, it’s to bear in mind that older patients do get Type 1 diabetes and that
you need to think and be sure that your patient definitely has Type 2 diabetes because if you
miss the fact that they require insulin, the patient can deteriorate and become unwell quite
quickly. And in the diagnosis of Type 2 diabetes it’s important to remember that 2-3% of
patients diagnosed with Type 2 diabetes actually have maturity onset diabetes of the young.
This is a monogenic diabetes that is strongly inherited within families so you’ll be able to
elicit a very strong family history. And also to remember that haemochromatosis is also
familial and can be a cause of Type 2 diabetes.
IV
When and how should a GP refer on?
MR A GP should refer on a patient who does not fulfil the diagnostic criteria of Type 2
diabetes easily, so that’s particularly if they have unusual aspects to their presentation such as
that they’re younger, there’s weight loss or they are not responding to oral medication. And
in the case of a strong family history, if that’s been elicited, they should refer that on so that
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they can be assessed as to whether or not they should be screened for haemochromatosis or
MODY.
My contact detail is via email at [email protected].
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