Presentation of Type 1 Diabetes
- The ‘classic’ patient will show the following features:
- More likely to be <40 y/o (although can affect at any age)
- 2 peaks of presentation: one in preschool and one in teenagers
- Acute onset of symptoms developing over weeks/days
- Long-term complications are unlikely at presentation in these patients due to the rapid onset of symptoms
- Related autoimmune conditions (TAP CV)
- Thyroid Disease (either hypo-thyroidism or hyper-thyroidism)
- Addison Disease
- Pernicious anaemia
- Coeliac Disease
- Vitiligo
- More likely to be <40 y/o (although can affect at any age)
- T1DM patients typically present in one of three ways
- Symptoms of hyperglycaemia
- NB these are often more prominent in Type 1 patients due to the more acute onset making them more noticeable
- Symptoms of gluconeogenesis
- Acute decompensation (this is also due to gluconeogenesis)
- DKA is the main presentation of acute decompensation in undiagnosed patients
- Symptoms of hyperglycaemia
Hyperglycaemic symptoms
- Increased systemic infection risk
- These patients may present with boils
- Osmotic symptoms
- Osmotic diuresis:
- Polyuria + Nocturnal enuresis (nocturia)
- Dehydration and polydipsia
- Genital candidiasis and UTIs
- Weight loss also occurs in part due to this
- CNS symptoms
- Blurred vision – develops as glucose enters into the lens and pulls water in with it
- Tiredness, fatigue, stupor and lethargy
- Headache
- Psychiatric – Mood changes and irritability
- Osmotic diuresis:
Gluconeogenesis
-
- NB these are rare in T2DM
- Rapid weight loss
- Rapid muscle wasting
- DKA occurs with acute decompensation (See separate for more detail)
- N&V and abdominal pain
- Weakness and fatigue
- Kussmaul respiration to blow off CO2 and compensate acidosis
- Characteristic breath smell
- Can ultimately lead to death
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