Autoimmune β-cell destruction with absolute insulin deficiency; lifelong insulin required.
History taking
- • Polyuria, polydipsia, weight loss
- • DKA episodes, hypoglycaemia awareness
- • Injection technique, glucose log
Examination
- • Weight, BMI, BP
- • Injection sites for lipohypertrophy
- • Fundi, feet, peripheral pulses
Red flags
- • DKA: vomiting, abdominal pain, Kussmaul breathing
- • Severe hypoglycaemia
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • HbA1c 3-monthly
- • Annual lipids, eGFR, urine ACR
- • Annual retinal screening
- • TSH, coeliac screen
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Basal-bolus or pump therapy
- • Carbohydrate counting
- • CGM where available
Drug therapy
- • Basal: glargine/degludec 0.3–0.5 U/kg OD
- • Bolus: aspart/lispro with meals (ICR 1U:10g)
- • Glucagon kit for severe hypoglycaemia
Lifestyle advice
- • Consistent meal timing
- • Exercise with carb adjustment
- • Sick-day rules
Follow-up advice
- • 3-monthly HbA1c (target <7%)
- • Annual complication screen
Patient counselling
- • Sick-day rules
- • Hypoglycaemia recognition + 15-15 rule
- • Driving and DKA prevention
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Never stop basal insulin even if not eating — risk of DKA
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
