Clinical Case Database / Category: Clinical Care

Management of newly diagnosed type 1 diabetes

Publication details

Josephine Hutchinson, Julie Tarrant, Kathryn Shevelan, Edward Jude
Foundation Years Journal, volume 4, issue 9, p.5 (123Doc Education, London, December 2010)

Abstract

Type 1 diabetes is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin. Diagnosis is confirmed when a patient presents with hyperglycaemia, polyuria, polydipsia and weight loss and a random laboratory blood glucose concentration of more than 11mmol/L; as is a fasting blood glucose concentration that exceeds 7mmol/L. Management of a newly diagnosed type 1 diabetic patient depends on the severity of the presentation, but all patients need immediate insulin treatment. If a patient presents with diabetic ketoacidosis (DKA), this must first be managed appropriately in a hospital setting and includes commencing the patient on an insulin regime. In a stable diabetic patient the most common regimen includes twice daily insulin or multiple daily injections and some patients might benefit from continuous subcutaneous infusion. Once a patient is established on insulin it is important to educate them on glycaemic control, how to manage hypoglycaemic episodes, complications of diabetes, diet and exercise, and what to do in pregnancy planning. Yearly screening is required to look for any signs of long-term complications of diabetes. The current HbA1c reference method changed in June 2011, to a new reference method, to create a standardised reference method for measuring HbA1c.

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Authors

Josephine Hutchinson

F1 Trainee
Tameside Hospital NHS Foundation Trust
Ashton-under-Lyne

Julie Tarrant

CMT Trainee
Tameside Hospital NHS Foundation Trust
Ashton-under-Lyne

Kathryn Shevelan

Diabetes Specialist Nurse
Tameside Hospital NHS Foundation Trust
Ashton-under-Lyne

Edward Jude

Consultant Physician and Diabetologist, Honorary Senior Lecturer in Medicine
Tameside Hospital NHS Foundation Trust
Ashton-under-Lyne
Lancashire OL6 9RW
Edward.Jude@tgh.nhs.uk

References

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3. National Institute for Health and Clinical Excellence. (2004) Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults [CG15]. London: National Institute for Health and Clinical Excellence.
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7. Schiffrin, A. (2004) Hypoglycaemia in Patients with Type 1 Diabetes. In: H. Lebovitz, (ed.) Diabetes Mellitus and related disorders. Virginia, USA: American Diabetes Association (Chapter 30).
8. DAFNE, 2010. Fact sheet one. (version 3) [Online] Available at: http:// www.dafne.uk.com/downloads/01_fact_sheet_one.pdf [Accessed 14/07/2010].
9. National Institute for Health and Clinical Excellence (2008) Diabetes in Pregnancy: management of diabetes and its complications from preconception to the postnatal period. [CG63]. London: National Institute for Health and Clinical Excellence.
10. ADA, EASD, IFCC Consensus Committee (2007) Consensus statement on the worldwide standardisation of the HbA1c measurement. Diabetologia; 50: 2042–2043
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web_0110.pdf [Accessed 13/09/2010].

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