Retinal Screening

1
Retinal Screening

• Achieved Target for last year
• Required external grading to address backlog
• Undergoing External Quality Assurance
• Central Call/recall (please keep us up to date)
• Much development going on

2
Unusual Cases of Diabetes

• 17 year old Female presents with polyuria,
  polydipsia and weight loss
• Heavy Glycosuria
• BMI 24 initial HbA1c 9.7
• Diagnosis Type 1 Diabetes
• RX Insulin

3
Unusual Cases of Diabetes

• Non compliant with treatment
• Poor diet
• Hba1c 9.4
• Family History Grandmother, Mother
• Diagnosis HNF1 alpha deficiency
• High risk of microvascular complications
• Treatment Sulphonylureas

4
Unusual Cases of Diabetes 2

• 39 year old female diagnosed type 1 diabetes age
  27
• Insulatard 46 units, good control
• Only needed extra insulin in pregnancy
• Family History
• Glucokinase deficiency easily controlled with SUs
  low risk of complications

5
Unusual Cases of Diabetes 3

• 56 year old female difficult to treat diabetes,
  normal BMI but requiring large doses of insulin
• Diagnosis 4 years ago
• Complains of sweating
• Diagnosis Acromegaly
• Treatment now impaired glucose tolerance

6
Unusual Cases of Diabetes 4

• 55 year old male presents with psychosis and
  hyperphagia
• DM diagnosed 6 years ago, but more difficult to
  control
• Strong FH
• 3 stone weight gain in last 2 months
• BMI 42
• Hypertensive

7
Unusual Cases of Diabetes 4

• Urinary free Cortisol one up one normal
• Low dose dexamethasone fails to suppress
• ACTH increased and Cortisol up
• Further investigations
• Diagnosis Cushings Disease
• Pituitary Surgery

8
Unusual Cases of Diabetes

• Is there a strong family history of disease
  (autosomal dominant)
• Rapid change in weight with worsening metabolic
  control
• Different from the rest of the family?
• Change in appearance?
• High! Pick up in Psychiatric units and Obesity
  clinics (Cushings1 in 1million/year)

9
Unusual Cases of Diabetes

• Screening MODY take good family history
• If on insulin can check c-peptide (low or absent
  in true type 1)
• Genetics screening at Exeter
• Cushings 24 hour urinary free cortisol x1
• Acromegaly IgF-1 (the HbA1c of growth hormone)

10
Unusual Cases of Diabetes

• MODY Unnecessary insulin and hypoglycaemia, worse
  control
• Untreated Cushings 50 5 year survival
• Untreated Acromegaly, significant cardiovascular
  risk, joint problems, bowel cancer