Type 1 diabetes: diagnosis and initial management — branching viva

Branch 1 — Opening: confirm and triage

Examiner: "A six-year-old has two weeks of thirst, polyuria and weight loss and a finger-prick glucose of 22 mmol/L. How do you confirm the diagnosis, and what is the single most important thing you must decide next?" ^[2]

Expected: The diagnosis of diabetes is confirmed on glucose — a random level of 11.1 mmol/L or higher with symptoms (met here), a fasting level of 7.0 or higher, or an HbA1c of 48 mmol/mol (6.5 percent) or higher. The most important next decision is whether the child has ketoacidosis, because that changes the whole pathway. ^{[2] [1]}

Branch probes (examiner selects based on the answer): ^[1]

• If the candidate confirms and triages well, state how you exclude ketoacidosis: measure capillary or blood ketones with venous pH and bicarbonate, and assess hydration, conscious level and breathing. ^[1]
• If the candidate wants to wait for antibody results before treating, correct them: the diagnosis is made on glucose alone and treatment must not wait for the type-defining tests. ^[4]