Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 1 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]. 2