Last updated on 22 Oct 2014 at 2:30 PM (Endo10)

Type 1 diabetes mellitus
A 35 year old NZ European male with a 15 year history of type 1 diabetes mellitus presents with repeated low blood glucose levels. In the past he felt sweaty and irritable when his glucose was low, but these symptoms seem to have stopped. He has nearly lost consciousness on a couple of occasions and is worried that this might happen when driving.

 

Applied Science for Medicine
Endocrine and exocrine functions of pancreas
Pathophysiology of type 1 diabetes mellitus
Pathology of microvascular and macrovascular complications of diabetes mellitus
Role of diabetes in the development of atherosclerosis
Pharmacology of short acting and long acting insulin, glucagon

Clinical and Communication Skills
Elicit a history from a patient with type 1 diabetes mellitus; enquire about problems with management and disease complications
Examine a patient with diabetes mellitus; recognise complications and cutaneous manifestations, especially associated with injection sites
Differential diagnosis of type 1 diabetes mellitus and hypoglycaemia
Perform a capillary blood glucose measurement and urine dipstick
Interpret blood glucose levels, ketones, urine dipstick, HbA1c; know how to use and interrogate blood glucose meter
Management strategies for type 1 diabetes mellitus, including indications and training for use of an insulin pump
Management of hypoglycaemic episode including nonpharmacologic (e.g. eating) and pharmacologic (glucagon injection) methods
Recognition of factors that contribute to hypoglycaemia: complication of aggressive glycaemic control, incorrect insulin dosing, not eating or excessive exercise, alcohol or drug consumption
Role of the diabetic nurse specialist, dietitian, GP and diabetes specialist

Personal and Professional Skills
Confidentiality and respect for autonomy
Empathy for people with chronic disease
Assess social factors that may be affecting disease control
Tailor management to patient's individual circumstances
Encourage patients to take ownership of their chronic disease
Understand the role of patient support groups eg. Diabetes New Zealand
Know the obligations of the doctor in relation to New Zealand Transport Authority guidelines

Hauora Māori
Unequal access to and quality of diabetes care for Māori compared with non-Māori
Understanding of the role of kaupapa Māori health services, particularly diabetes programmes

Population Health
Epidemiology of type 1 diabetes mellitus: change over time, including management
Lifestyle/behaviours that may impact the progression of diabetes related complications

 

Conditions to be considered relating to this scenario

Common

type 1 diabetes mellitus, type 2 diabetes mellitus

Less common but 'important not to miss'

Addison's disease, sepsis, alcohol abuse/dependence, hypopituitarism