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What do new doctors need to know about Type 1?

As medical student they are soon to be doctors so the most relevant information for them in a hospital setting is
The difference between type one and type two
How to treat hypos
How to correct hyperglycaemia in a hospital setting- many hcp's are afraid of hypos and therefore will happily let people's sugars run high for 'fear' of going too low
That if a patients sugars are very high ( late teens, and twenties), check for ketones in the urine and blood, and I positive, need to do a VBG to check if they are acidotic ( dka)
The protocol for treating DKA in your hospital

Never stop a type 1's basal insulin- ever. Just because they've had a hypo, is not an indication to stop the lantus or levemir, treat the hypo and give the basal when it is due.

If you have a diabetic patient in hospital and their sugars are all out of range, and you don't know why, the diabetic specialist nurse will probably have a better idea. Don't be afraid to ask her/ his help- they are called specialist nurses for a reason

Hospital food is ******** and will cause anyone's blood sugars to soar

This is the kind of stuff that will crop up for them as junior doctors on a. Daily basis. The ins and outs of our condition, it would be nice for them to know but unlikely you'd cover it in 25 minutes
 
Hi, I have been following this thread's development with keen interest... I don't feel personal individual accounts regarding misdiagnosis, naff hospital food & neglect help "the cause" with the "bigger picture"... (Though I do personally empathise with these accounts.)

There isn't a lot you can do in 25 minutes.. I would "waffle" the D basics & weed out the yawners the hangover merchiants & the arrogance...
Then point who is left to this site to glean knowledge from the likes of @Spiker ... ;)
 
I'd have to echo spiker, smidge and donellysdogs.

The best MDs I have dealt with relating to Diabetes have been open minded about how to manage it and accepted that it is, in general, a very individually managed condition with a common initial set of symptoms. They have also accepted that well controlled diabetics know what they are doing and have learned how to manage their bodies and minds.

I think what hasn't been mentioned is that they shouldn't assume that all diabetics don't know what they are doing. If they meet a diabetic with a low hba1c, then this is likely to be intentional. It's hard to get to that level and be there consistently. Just because received knowledge is that low hba1cs mean more Hypos, that generally isn't how the majority with low hba1c manage it. They do it through a lot of management.
 
Jaylee said:
There isn't a lot you can do in 25 minutes.. I would "waffle" the D basics & weed out the yawners the hangover merchiants & the arrogance...
Then point who is left to this site to glean knowledge from the likes of @Spiker ... ;)
Click to expand...
Yes. You can get two messages across in 25 mins. Perhaps even just one.

That diabetics can and some do manage their own condition, and how. That all patients are not fools.

And that there is new clinical experience and new patient experience, and that they need to keep up to date.
 
The difference between t1 & t2.

That diabetes is a disease not a symptom (t2) - i.e. being overweight may not necessarily be the cause of diabetes but in fact it could be the other way round!

The importance of regular check ups with a specialist diabetes consultant.

The role of carbohydrates and its effects on metabolism. What a healthy diabetic diet is, why we should consider lowering carbohydrate intake if struggling with BG and or weight control.

To understand that a patient might actually know more than you and to work with them/be willing to listen and take on board information.
 
That's all been really helpful guys and has given me a clearer idea of where I'm going with this. I'm watching the thread with interest. Funny how lots of the posts seem to be echoing the things I was originally thinking
 
Daibell said:
Hi. I agree with Spiker and. Smidge. T1 can come on at any age and many HCPs don't know this and just assume T2 if older. The latest NICE Draft DEC 2014 Diabetes Guidelines now, sensibly, suggest the GP assumes T1 as a possibility if the patient presents as slim and having had weight loss as I did. It also says that the two tests GAD and c-peptide need to be used with care (if used) as GAD is only reliable at or near the time of diagnosis and c-peptide becomes more relibale as the condtion progresses. Note that GAD antibodies are not the only cause of T1 things like viruses, pancreatitis and so on can cause iselt cell damage. To me one of the important differences between a typical T2 and a typical T1 is that aT2 will have too much insulin whereas a T1 will have too little. This means the tablets and insulin if needed need to be chsoen with that in mind.
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Does that mean that my GAD test won't be reliable as I've had diabetes for around 10 years?
 
Not sure I would launch into the clinical stuff. As medical undergrads I would expect that they should have convered the clinical aspects already.
I would tend to agree with getting it through to them they they do need to be open minded and treat each person individually.
As has already been stated not all patients are idiots.

That's just my thoughts though since there have already been plenty of great suggestions.
 
rowan said:
Does that mean that my GAD test won't be reliable as I've had diabetes for around 10 years?
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Good question. This point has appeared in the latest NICE Draft DEC 2014 Diabetes guidleines. I had my GAD and c-peptide done privately 8 years after diagnosis as my GP wouldn't accept I was anything other than a T2 despite never having been overweight in my life and all tablets failing. My GAD was negative but my c-peptide showed I had very little insulin; indicative of failing islet cells. GAD isn't the only cause of islet cell death and I'm suspicious I may have had a virus. At the end of the day the c-peptide test indicates the right treatment needed whereas GAD shows the possible cause not the right treatment? The new guidelines sensibly say being slim is a strong indicator of LADA at diagnosis.
 
Daibell said:
Good question. This point has appeared in the latest NICE Draft DEC 2014 Diabetes guidleines. I had my GAD and c-peptide done privately 8 years after diagnosis as my GP wouldn't accept I was anything other than a T2 despite never having been overweight in my life and all tablets failing. My GAD was negative but my c-peptide showed I had very little insulin; indicative of failing islet cells. GAD isn't the only cause of islet cell death and I'm suspicious I may have had a virus. At the end of the day the c-peptide test indicates the right treatment needed whereas GAD shows the possible cause not the right treatment? The new guidelines sensibly say being slim is a strong indicator of LADA at diagnosis.
Click to expand...

I was slim when first diagnosed but had been overweight beforehand, spent most of my adult life fighting the flab.
When I had my blood taken this morning I checked with the nurse that she had the right tests, I'd originally booked just for the AC1, and she said the GAD test, nothing about c-peptide! I had to get her to look it up to see that both were needed, there was nothing on my notes about it but luckily she was able to add it at the last minute.
I don't have a lot of faith in the surgery at the moment but being in a village there isn't another surgery I can go to - the nearest town surgery also runs my village one so it has the same doctors!
 
Tell them that terrorism doesn't work. I lost count of the number of doctors who "threatened" me with limb loss and blindness, etc when I was an uncontrolled twenty-something. Not one of them ever asked me what my carb to insulin ratio was, what my insulin resistance was, how much exercise I took, etc. Nothing. They never taught me how to control my diabetes because I'd had it since I was a child. I was thoroughly neglected by my parents. I didn't know what I didn't know. I think they need to look at older diabetics with "new eyes". I only found out all this after moving to Turkey, getting a private endocrinologist who really pursued me in terms of treatment, and we worked out together that only a pump would do it. The NHS was all, "No glucose records? Next?" But I gave up on BG records because I didn't know how to use them, and I saw a specialist once a year, which is useless.

You might also tell them that the children of diabetics have a higher rate of psychotic disorders than the average. If the NHS looked out for that, they could catch people in the prodromal stage and maybe head it off, instead of fobbing them off and letting them suffer for ten years like my son did.
 
T2's have hypos and hypers.
 
rowan said:
Does that mean that my GAD test won't be reliable as I've had diabetes for around 10 years?
Click to expand...

GAD tests are pretty reliable, but they are only a one-way diagnostic tool i.e. a positive GAD test is indicative of an auto-immune form of diabetes, but a negative one tells you nothing except that there are no GAD antibodies visible at that moment - that's what confuses people and why medics don't like the test. Incidentally, they rarely just test for GAD antibodies; they test for 3 or 4 different islet cells and antibodies - people just refer to the test as GAD for short.
C-peptide is OK as a test to see if you need insulin treatment - but it is not a diagnostic test. It cannot differentiate between different types of diabetes - it just indicates the level of insulin you are producing. In the early stages of Type 2 you are likely to be producing too much insulin so you would have a high c- peptide and high BG; in the early stages of LADA you are likely to be producing insulin at the low end of normal - they will often use that difference to diagnose, but as we never know what stage Type 2s and LADAs are at, it's all a bit hit and miss. As the illnesses progress unchecked, both groups will produce progressively less insulin because high BG is toxic to beta cells. That doesn't mean Type 2s have become LADAs or vice versa, but both will have the same symptoms.

GAD and c-peptide tests should be done and the results interpreted together to get a clearer picture. However, personally I had to plump for one test so it was the GAD as I wanted a proper diagnosis - by then, I could already tell I wasn't producing enough insulin and needed to inject, so the c-peptide test would have done nothing except confirm that.

Smidge
 
Unique pixie said:
I have a teaching session with medical students in a couple of weeks. I have 25 minutes to talk to them about type 1 and living with it. What would you like your Dr's to know? What should I cover?
Many confuse Type 1 and 2 so I thought I'd cover the difference and awareness of hypos but any ideas otherwise?
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Yes, the DAFNE course should be a MUST for all type 1s. Also please treat everyone as an individual as insulins all react differently in us all. Don't rush to put people onto Levemir and Lantus as some diabetics cannot tolerate these insulins.....they almost did me in and I suffered like hell for 3 years until I began treating myself using my daughter's Insulatard.
 
smidge said:
GAD tests are pretty reliable, but they are only a one-way diagnostic tool i.e. a positive GAD test is indicative of an auto-immune form of diabetes, but a negative one tells you nothing except that there are no GAD antibodies visible at that moment - that's what confuses people and why medics don't like the test. Incidentally, they rarely just test for GAD antibodies; they test for 3 or 4 different islet cells and antibodies - people just refer to the test as GAD for short.
C-peptide is OK as a test to see if you need insulin treatment - but it is not a diagnostic test. It cannot differentiate between different types of diabetes - it just indicates the level of insulin you are producing. In the early stages of Type 2 you are likely to be producing too much insulin so you would have a high c- peptide and high BG; in the early stages of LADA you are likely to be producing insulin at the low end of normal - they will often use that difference to diagnose, but as we never know what stage Type 2s and LADAs are at, it's all a bit hit and miss. As the illnesses progress unchecked, both groups will produce progressively less insulin because high BG is toxic to beta cells. That doesn't mean Type 2s have become LADAs or vice versa, but both will have the same symptoms.

GAD and c-peptide tests should be done and the results interpreted together to get a clearer picture. However, personally I had to plump for one test so it was the GAD as I wanted a proper diagnosis - by then, I could already tell I wasn't producing enough insulin and needed to inject, so the c-peptide test would have done nothing except confirm that.

Smidge
Click to expand...

Thank you for the explanation, very helpful. Nothing is straightforward is it?
 
rowan said:
I was slim when first diagnosed but had been overweight beforehand, spent most of my adult life fighting the flab.
When I had my blood taken this morning I checked with the nurse that she had the right tests, I'd originally booked just for the AC1, and she said the GAD test, nothing about c-peptide! I had to get her to look it up to see that both were needed, there was nothing on my notes about it but luckily she was able to add it at the last minute.
I don't have a lot of faith in the surgery at the moment but being in a village there isn't another surgery I can go to - the nearest town surgery also runs my village one so it has the same doctors!
Click to expand...
Thanks. Interestingly there is another thread running about users of these forums not being experts whereas GPs and DNs are. I think the fact that your DN needed to lookup c-peptide doesn't show she/he is not a good DN but they have to handle so much information on every aspect of medicine that they are not always experts but sometimes we are.
 
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