Return to Scenario ListShow Learning Points most relevant to Phase 1:

Type 1 diabetes mellitus

Clinical Discipline(s)/Organ System(s)
Digestive System, Endocrinology
Progress Test Topic(s)
Digestive, Homeostasis
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.
Progress Test-Type Questions:   Question 1 | Question 2
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
type 1 diabetes mellitus, type 2 diabetes mellitus
Less common but 'important not to miss'
Addison's disease, sepsis, alcohol abuse/dependence, hypopituitarism