Type 1 Diagnosis

WHO Criteria for Diagnosis

Symptoms of diabetes plus random plasma glucose concentration

of > 11.1 mmol/l

fasting plasma glucose concentration of > 7.0 mmol/l

People with newly diagnosed type 1 diabetes are of any age, but usually younger. They will almost certainly have a short history of symptoms (<2 months). They will have glycosuria and probably ketones. They do not need to have ketones to make the diganosis

Note: If you suspect diabetes in a child refer urgently do not wait for test results.

If the patient has developed newly diagnosed type 1 (insulin dependent diabetes), they should be referred to the hospital on the day of diagnosis, especially if urinary ketones are present in moderate to large amounts. This should be through the diabetes team directly,(Endocrine Registrars carry bleep 7018 or 7021, or bleep 7221 diabetes liaison nurse, RUH). The object is to reduce the need for hospital admission. On weekends this facility will not be available and therefore direct referral to the on call team is appropriate (on call Registrar should be available, and able to start insulin). The diabetes team must endeavour to move to a 24 hour 7 day availability to service primary care needs and to minimise secondary care resource use.
If there is doubt about need for insulin then a specialist referral to the diabetes team should be made. It is easier psychologically to introduce insulin therapy after failure of tablets, than stop it, and then have to re- introduce.
Treat with insulin
Options for different insulin regimens can be discussed with the patient following a period of stability on diabetologist recommended regimen
Give basic life style advice such as diet, physical activity and smoking
People with type 1 will be afforded more confidence if they are supported to test glucose levels several times a day. They can be given confidence to test less frequently as their condition stabilises
The purpose of the monitoring is to maintain glucose levels at or near the non-diabetic value
Agree a target blood range with the patient
Patients must be made aware of possible short and long term complications of diabetes
Agree regular review and checks throughout year to provide screening for complications and opportunities to discuss matters
Follow guidelines laid out in annual review
Ensure referral is made to type one structured education programme, education to commence no sooner than 6 months following diagnosis and no later than 12 months

Type 1 diabetes mellitus (ß-cell destruction, usually leading to absolute insulin deficiency)

Immunie mediated
Idiopathic

Type 1 Diagnosis

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