1. Thursday 1st February 2018 2pm – 5pm
Lambeth CCG Diabetes Learning Events
Thursday 1st February pm – 5pm
Time
Session
Facilitator
2.00pm
Introduction
2.05pm
When and where to refer cases of hyperglycaemia
Dr Mark Chamley
Clinical Lead -DICT
2.35pm
Freestyle Libre availability
Dr Neel Basudev - Diabetes Lead CCG
3.00pm
Tea and coffee break
3.30pm
The management of diabetic emergencies – case studies
Dr Steve Thomas
Consultant Diabetologist - GSTT
4.30pm
Cambridge Diabetes Education Centre
TBC

3. Random BG > 11.1 in diabetic range

4. Ketones suggest insulin deficiency

5. Symptoms suggest insulin deficiency and in younger patients could be T1DM

6. Case study – early insulin initiation
Mr JA Aged 47 years Portuguese electrician No significant PMH FH = Father has type 2 diabetes BMI Presented with 2 week history of thirst and nocturia x 4 Weight loss 3kg over past 2 months Worried that he may have diabetes
Urine = glucose +++ no ketones
Random blood glucose = HI
Generally well
What would you do?

7. yes no no
yes

8. Case study – early insulin initiation
Lab sample glucose = 32.4mmol/l HbA1c 135mmol/mol – suggests he has had diabetes for some time Normal renal function
Taught home testing and advised to check BG before breakfast and before evening meal Cut out all sugary drinks and food Ensure he drinks lots of water Started on gliclazide 80mg twice a day Safety netting - advised to call SOS if feels more unwell, vomiting or concerned

9. Case study – early insulin initiation
Reviewed after three days: Before breakfast BG 17.5, 19.8 and 16.9mmol/l Before evening meal BG 17.5 and 23.3mmol/l Feels generally better but as BG levels still high arranged to attend Akerman community diabetes clinic the next day
Started on Levemir 6 units twice a day with gliclazide continued Levemir titrated to 14 units BD Diabetes antibodies negative Started on metformin Insulin stopped after 1/12 Lifestyle changes – exercise++ Last HbA1c mmol/mol on metformin only