Clinical Case Database / Category: Clinical Care

Management of newly diagnosed type 1 diabetes

Publication details

Josephine Hutchinson, Julie Tarrant, Kathryn Shevelan, Edward Jude
Foundation Years Journal, volume 4, issue 9, p.5 (123Doc Education, London, December 2010)


Type 1 diabetes is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin. Diagnosis is confirmed when a patient presents with hyperglycaemia, polyuria, polydipsia and weight loss and a random laboratory blood glucose concentration of more than 11mmol/L; as is a fasting blood glucose concentration that exceeds 7mmol/L. Management of a newly diagnosed type 1 diabetic patient depends on the severity of the presentation, but all patients need immediate insulin treatment. If a patient presents with diabetic ketoacidosis (DKA), this must first be managed appropriately in a hospital setting and includes commencing the patient on an insulin regime. In a stable diabetic patient the most common regimen includes twice daily insulin or multiple daily injections and some patients might benefit from continuous subcutaneous infusion. Once a patient is established on insulin it is important to educate them on glycaemic control, how to manage hypoglycaemic episodes, complications of diabetes, diet and exercise, and what to do in pregnancy planning. Yearly screening is required to look for any signs of long-term complications of diabetes. The current HbA1c reference method changed in June 2011, to a new reference method, to create a standardised reference method for measuring HbA1c.

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Josephine Hutchinson

F1 Trainee
Tameside Hospital NHS Foundation Trust

Julie Tarrant

CMT Trainee
Tameside Hospital NHS Foundation Trust

Kathryn Shevelan

Diabetes Specialist Nurse
Tameside Hospital NHS Foundation Trust

Edward Jude

Consultant Physician and Diabetologist, Honorary Senior Lecturer in Medicine
Tameside Hospital NHS Foundation Trust
Lancashire OL6 9RW


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3. National Institute for Health and Clinical Excellence. (2004) Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults [CG15]. London: National Institute for Health and Clinical Excellence.
4. Kaufman, F. (2004) Diabetic Ketoacidosis in Children. In: H. Lebovitz, (ed.) Diabetes Mellitus and related disorders. Virginia, USA: American Diabetes Association (Chapter 8).
5. Diabetes Control and Complications Trial Research Group (1993) Treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 329: 977–986.
6. Mortensen et al. (2009) New Definition for the Partial Remission Period in Children and Adolescents With Type 1 Diabetes. Diabetes Care; 32 (8): 1384–1390.
7. Schiffrin, A. (2004) Hypoglycaemia in Patients with Type 1 Diabetes. In: H. Lebovitz, (ed.) Diabetes Mellitus and related disorders. Virginia, USA: American Diabetes Association (Chapter 30).
8. DAFNE, 2010. Fact sheet one. (version 3) [Online] Available at: http:// [Accessed 14/07/2010].
9. National Institute for Health and Clinical Excellence (2008) Diabetes in Pregnancy: management of diabetes and its complications from preconception to the postnatal period. [CG63]. London: National Institute for Health and Clinical Excellence.
10. ADA, EASD, IFCC Consensus Committee (2007) Consensus statement on the worldwide standardisation of the HbA1c measurement. Diabetologia; 50: 2042–2043
11. Diabetes UK (2009) HbA1c standardisation for laboratory professionals [Online]. Available at: leaflets/HbA1cLabstaff_
web_0110.pdf [Accessed 13/09/2010].


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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