Station 91
Sadiq Mohammed
Age: 40 year old male
Examiner
Marking Scheme
Data Gathering and Diagnosis
- Ask about the onset and duration of increased urination and thirst
- Ask about associated urinary symptoms to rule out UTI, including pain when passing urine, blood in the urine, lower abdominal or suprapubic pain, and fever
- Ask about any weight changes, including unintentional weight loss, and quantify how much weight he has lost and over what period.
- Ask about symptoms suggestive of diabetic complications, including blurred vision, tingling or numbness in the hands or feet, and any history of slow-healing wounds or frequent infections.
- Ask whether he has experienced any symptoms that could indicate diabetic ketoacidosis, such as, abdominal pain, nausea or vomiting, diarrhoea, deep or rapid breathing, or a fruity odour on his breath.
- Ask about family history of diabetes, including age at diagnosis and type if known.
- Ask about social and lifestyle factors, including diet, physical activity, smoking, alcohol intake, and occupation.
- Ask if how his symptoms have affected his daily life, including mood, energy levels, sleep, or ability to manage his work and responsibilities.
- Explore his ideas, concerns, and expectations.
- Give a diagnosis of suspected Type 1 diabetes.
Example of explanation to patient
Thank you for explaining everything so clearly, Sadiq. I completely understand why you and your wife have been concerned, and I agree with both of you. Based on the symptoms you have described, feeling unusually tired, drinking more than usual, going to the toilet a lot, and the weight loss, as well as the blood sugar reading of 11.5 that your wife took with her blood sugar machine, this does raise the possibility of diabetes.
Before we go ahead, can I just check, what do you already know about diabetes?
Diabetes is a condition where the level of sugar in the blood is too high. This happens because your body is not making enough of something called insulin, which helps control sugar levels. In your case, I think it might be type 1 diabetes, which can come on suddenly. It means your body has stopped making insulin.
When this happens, sugar builds up in the blood and can start to make people feel very unwell, quite fast. That is what I think is happening now.
I completely understand that you are keen to get back to the shop and help your wife, but the fact that your symptoms are getting worse is a sign that your body is struggling to cope. That is why the safest thing to do now is to get you into hospital today.
At the hospital, they can confirm the diagnosis with some tests and, if needed, start treatment straightaway with insulin and fluids through your vein. This will help bring your blood sugar down safely, help you feel better, and stop things from getting worse. Waiting even one more day could be risky, so it is important we act now.
Do you understand everything I have explained so far?
Would you be okay with going to hospital now so we can get ahead of this? Please do not drive yourself, it would be safest if your wife or someone else takes you. If you start to feel worse on the way, for example, very dizzy, sick, or struggling to breathe, please ask them to call 999 immediately.
Once you are back home, I would like you to book a follow-up appointment with me so we can talk about everything that happened, and I can support you with your diet, lifestyle, and long-term blood sugar control.
Management
Management
- Offer to arrange immediate same-day hospital admission via the Acute Medical Unit (AMU) for suspected type 1 diabetes.
- Instruct the patient not to drive and advise that he should ask his wife or someone else to take him safely to the hospital if possible.
- Advise the patient that if diabetes is confirmed, he will be started on intravenous fluids and insulin in hospital to bring his blood sugar levels under control and prevent complications.
- Explain that if his symptoms worsen on the way to hospital (e.g. vomiting, severe tiredness, confusion, or breathing difficulty), he or the person accompanying him should call 999 immediately.
- Advise the patient that once he is discharged from hospital, he should book a follow-up appointment, to discuss what happened during his hospital stay and to receive further support, including lifestyle changes, diet, and long-term management of his blood sugar.
Learning point from this station:
This case highlights the importance of recognising the early signs of type 1 diabetes in adults, particularly given the potential risk of rapid deterioration and diabetic ketoacidosis (DKA). Unlike type 2 diabetes, type 1 diabetes can present suddenly, and prompt diagnosis is essential to prevent life-threatening complications.
According to NICE guidance, type 1 diabetes should be diagnosed on clinical grounds in adults presenting with hyperglycaemia (random plasma glucose >11 mmol/L), especially when one or more of the following features are present:
- Ketosis
- Rapid weight loss
- Age of onset younger than 50 years
- Body mass index (BMI) below 25 kg/m²
- Personal and/or family history of autoimmune disease
In such cases, the patient should be referred immediately (on the same day) to a diabetes specialist team to confirm the diagnosis and begin urgent treatment, usually with insulin.
Delays in recognition or referral can result in progression to DKA, a medical emergency. Early identification and timely referral are critical to improving outcomes.