Interactive case study: Managing acute illness in type 2 diabetes

Diabetes & Primary Care’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.

These three scenarios review the management of acute illness in people with type 2 diabetes.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.

Readers are invited to respond to the questions by typing in their answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.

By actively engaging with these case histories, readers will feel more confident and empowered to manage such presentations effectively in the future.

Margaret is a 78-year-old lady with type 2 diabetes. You are called b a neighbour to see her as she appears severely unwell. A capillary blood glucose reading is High (above 30 mmol/L) but blood ketones are negative.
What is your assessment of Margaret and what acute diabetes complication is she likely to have?

Rajeshri, 47 years old and with type 2 diabetes, is diagnosed with acute bronchitis with exacerbation of her asthma. She is prescribed amoxicillin and prednisolone
What is likely to happen to Rajeshri’s blood glucose levels during this acute illness?

Tim, a 63-year-old gentleman with type 2 diabetes, has developed diarrhoea and vomiting after eating out the evening before. He is taking metformin, dapagliflozin, ramipril and atorvastatin. He is diagnosed with mild dehydration but not sufficient to require hospital admission.
What are your concerns and what tests might you check in the surgery?

By working through this interactive case study, we will review the management of acute illness in people with type 2 diabetes, including sick day rules and the prevention and identification of hyperglycaemic emergencies and acute kidney injury.