Updated NICE guidance 2016. Characteristics:
- random glucose >11,
- polyuria, polydipsia,
- excessive tiredness,
- weight loss.
WHO 1999 criteria – fasting normally <5.6, >7 diagnostic. Random >11 diagnostic (assuming there’s nothing sticky on the finger tested!!!). Glucose tolerance test (starts with fasting level) 2hr level >11.1 diagnostic, 7.8-11.1 is impaired glucose tolerance.
False positives – infection, recent surgery, uncontrolled thyroid disorder, starvation.
Increasing rates in Europe. Scotland rate second only to Scandinavia. Marked increase in under 5s. Aiming for routine pump therapy within a few months.
Type 2 more often in S Asian, Hispanic, Afro-Caribbean. Clue is raised c-peptide – as this is co-produced with insulin, it means there is still endogenous insulin being produced (and cleared at more consistent rate than insulin, so more reliable, esp if on exogenous insulin). C-peptide also used to look for insulinoma or factitious hypoglycaemia. May also predict glycaemia control, complications and response to hypoglycaemic agents.
LADY – latent autoimmune diabetes of the young. More common? Different HLA type. Antibody positive but insulin sensitive and slow progress.
MODY – inability to produce insulin but normal beta cells. Eg KIR 6.2 mutations, within months of birth.
Reduced ideal HbA1c target – 48mmol/l (6.5%).
No DAPHNE for kids.
Multiple daily injections from diagnosis, with level 3 carbohydrate (CHO) counting education, blood ketone testing strips. Other regimens eg BD, TDS only for where problems with compliance. See also pumps.
NICE guidance now includes Type 2 – suspect if strong FH, obesity, black/Asian origin, minimal insulin requirements (<0.5u/kg after “partial remission phase”), evidence of insulin resistance (viz acanthosis nigricans).
Optimal blood glucose range is 4-7 on waking and between meals; 5-9 after meals; 5+ when driving. At least 5 tests per day recommended, more frequently during physical activity and illness.But take into account:
- risk of hypoglycaemia;
- competitive sports;
- need to lose weight;
- life goals (careers, exams, foreign travel);
- any relevant co-morbidity.
Annual thyroid, hypertension, albuminuria checks from diagnosis; retinopathy testing from age 12. Type 2 don’t need thyroid but do need dyslipidaemia.
Most schools happy to give insulin. But no legal requirement. Lancets for school retract into cartridge.
Encourage ownership of meters etc, downloading at home. Over 14 to get access to SCI-DC, as adults.