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

Acute presentation of diabetes mellitus

Clinical Discipline(s)/Organ System(s)
Endocrinology, Emergency Medicine, Digestive System
Progress Test Topic(s)
Seriously ill patient
A 17 year old NZ European man presents to the Emergency department complaining of abdominal pain and passing lots of urine. He has vomited twice and is breathing rapidly with deep sighing breaths. The blood glucose is 27 mmol/L and serum ketones are strongly positive.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Physiology and control of insulin release
   - Cellular regulation and utilisation of energy stores
   - Pathophysiology of autoimmune disease
   - Pathophysiology of ketone production, dehydration and potassium loss in diabetic ketoacidosis
   - Pathophysiology of hyperosmolar non-ketotic syndrome
   - Body's responses to metabolic and respiratory acidosis
Clinical and Communication Skills 
   - Recognise that this is a medical emergency
   - Elicit a history from a patient with acute presentation of type 1 diabetes mellitus (diabetic ketoacidosis); be aware that this could be their first presentation; differentiate diabetic ketoacidosis from hyperosmolar non-ketotic syndrome
   - List the common features of a patient presenting with a new diagnosis of type 1 diabetes mellitus
   - Examine a diabetic patient, recognise manifestations of diabetes and assess fluid balance
   - Perform capillary glucose measurement
   - Management of diabetic ketoacidosis; prescribe intravenous insulin regimen and intravenous fluid and electrolyte (potassium) replacement
   - Management of hyperosmolar non-ketotic syndrome
   - Interpret relevant investigations including an arterial or venous blood gas; blood acid-base balance, blood glucose
   - Causes of diabetic ketoacidosis
   - Complications of diabetic ketoacidosis
   - Educate on daily capillary blood glucose control
   - Role of diabetic nurse and dietitian
Personal and Professional Skills 
   - Breaking bad news, sensitive communication of a chronic, incurable diagnosis with patient and whānau
   - Educating patient and family/whānau about chronic disease that will need lifelong treatment
   - Ethical issues (e.g. genetic research, xenotransplants)
   - Know the obligations of the doctor in relation to the New Zealand Transport Authority guidelines on driving and diabetes
Hauora Māori 
   - Barriers in access to and management of diabetes for Māori
Population Health 
   - Epidemiology of type 1 diabetes mellitus, diabetic ketoacidosis and hyperosmolar nonketotic coma (HONK)
   - Implications for type I diabetes mellitus in certain occupations including commercial driving
   - Use of patient support groups and charities
Conditions to be considered relating to this scenario
diabetic ketoacidosis, type 1 diabetes mellitus, acute kidney injury, hyperosmolar non-ketotic syndrome
Less common but 'important not to miss'
lactic acidosis, severe sepsis, aspirin overdose, massive rhabomyolysis, ethylene glycol poisoning, paraldehyde, methanol or formaldehyde poisoning
renal tubular acidosis types 1 and 2, glue sniffing