In both conditions, patients may have symptoms suggestive of hyperglycaemia and metabolic syndrome. Patients with late-onset type 1 diabetes may be overweight, but could be losing significant amounts of weight unintentionally.
This weight loss may represent ketogenesis. The presence of ketones on urinalysis could indicate beta-cell failure in the pancreas and the requirement for insulin replacement. NICE previously suggested using ketonuria as a marker for the need for insulin.
Other investigations occasionally performed in a hospital setting aim to look at how much insulin is being produced by the pancreas, including C-peptide levels and glutamic acid decarboxylase GAD antibodies. These investigations are not routinely used in primary care and need to be interpreted with caution. This case study highlights the importance of ensuring that patients are reviewed regularly following a diagnosis of diabetes where you suspect the patient may not typically be a type 2 diabetic.
Do not be afraid to question the diagnosis at any point. If your patient has been newly diagnosed with diabetes, is not unwell but does not fit the typical criteria for type 2, then it is entirely reasonable to try a course of metformin with regular assessment of symptoms, weight and urine testing for glucose and ketones.modernpsychtraining.com/cache/kids/jazew-oppo-rx17-software.php
OTC Case Studies: Self-Care for Treating Diabetes
If the patient has osmotic symptoms you may consider gliclazide and titrate this to maximum dose over a period of a few weeks, assessing response. Review the patient every two weeks and have a low threshold for referring to your diabetes service if their condition does not behave as typical type 2 diabetes, despite good concordance with medication. If you are unsure what type of diabetes the patient has, let them know what symptoms may suggest diabetic ketoacidosis so that they can look out for these and are empowered to manage any complications. Explain that you are not sure what type of diabetes they have and that there may be a need for insulin in the future.
Network-Based Analysis of Comorbidities: Case Study of Diabetes Mellitus
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Figure 2: Acanthosis Nigricans
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In addition, all faculty are required to openly disclose any off-label, experimental, or investigational use of drugs or devices discussed in this activity. The faculty and planning committee have been advised that this activity must be free from commercial bias, and based upon all the available scientifically rigorous data from research that conforms to accepted standards of experimental design, data collection, and analysis.
The members of the Planning Committee have no relevant relationships to disclose.
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Release date: December 19, Expiration date: December 19, For Practicing Clinicians Exchange general information, contact pce practicingclinicians. Format Case studies with interactive benchmarking. Goal To improve primary care management of patients with type 2 diabetes in order to ensure optimal control of hyperglycemia, minimize long-term complications, and reduce hypoglycemia risk through appropriate use of basal insulin.
Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes
Learning Objectives After completing this activity, participants should be better able to: Assess the clinical characteristics of basal insulins and basal insulin analogues Select appropriate patients for treatment with basal insulin therapy based on treatment risks and benefits, guideline recommendations, and patient factors Implement strategies for achieving glycemic goals in patients with T2DM, while minimizing the risk of hypoglycemia Target Audience NPs and PAs.
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