PHYSICAL HEALTH and PSYCHIATRY

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PHYSICAL HEALTH and PSYCHIATRY

• Interpreting Diabetes, When to Refer
• Paul Seviour
• Tracey Brownlow
• Locality Health Centre, Weston-super-mare

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What Is Diabetes?

• It is not just a high blood sugar.
• It is a metabolic syndrome
• With secondary consequences both acute and
  chronic.
• Type 1 and Type 2

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Diagnostic Criteria for Diabetes

• Random plasma glucose gt 11.1mmol/l
• Fasting plasma glucose gt 7.0 mmol/l
• 2hour plasma glucose gt 11.1 mmol/l
• (During OGTT)

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Impaired Glucose Tolerance

• 2 hour plasma glucose gt7.8mmol/l but
• 
  lt11.1 mmol/l

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Screening for Diabetes / IGT

• Overweight and obesity
• Family history
• Hypertension
• Pregnancy
• Drugs used in psychiatry

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When to Refer ( or Not )

• On diagnosis?
• Type 1 diabetes
• Type 2 diabetes

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When to Refer ( or Not )

• Established diabetes and its consequences
• Acute metabolic problems
• - Hyperglycaemia/ketoacidosis
• - Hypoglycaemia

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When to Refer ( or Not )

• Acute secondary problems
• Infection feet
• Vascular problems myocardial infarction
• - Stroke
• - Peripheral
  ischaemia
• Acute visual disturbance

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When to Refer ( or Not )

• Chronic complications
• Retinopathy ( screening )
• Renal failure
• Vascular disease
• Neuropathy
• Pregnancy

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When to refer ( or not )

• Diabetes out of control
• HbA1 targets
• diet and drugs
• insulin conversion
• Home monitoring

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Case Scenario 1

• An 80 year old lady is admitted to the ward for
  assessment of dementia. A routine blood sugar is
  15mmol/l. All other tests are normal.
• Refer or not?
• If not, what would you do?

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Case Scenario 2

• A 30 year old man treated with olanzapine for a
  psychotic illness gains 8kg in weight so that his
  BMI is 32. He complains of thirst and a blood
  sugar is 26.
• Refer or not?
• If not, what would you do?