THE BALANCE OF CONTROL: A CASE OF UNSTABLE INSULIN DEPENDENT DIABETES IN LEARNING DIFFICULTIES

We present a case of unstable insulin dependent diabetes. This patient’s care was complicated by learning difficulties and the illusion of comfort. In June 2013, his HbA1c was 51mmol/mol, coping well and asymptomatic. This allowed his family doctors the safety of passive surveillance and the hope of stability. For the next two years, his HbA1c rose to 101(August-2014) and 126(October-2015) mmol/mol. At presentation, this 74 year old gentleman was polydipsic, polyuric and suffering from chronic weight loss. There was not yet evidence of retinopathy or renal involvement. He was originally achieving good scores for Activities-of-Daily-Living; and thus started on, as per national guidance, self-administered basal insulin. This was not successful and was referred to our family practice. We agreed with the use of basal insulin, but immediately requested for district nurse support in administration. The risk of post-prandial peaks was partially offset by dietary advice. His glycaemic control was affecting his cognition, and on the background of learning difficulties, it would have been simpler to take a paternal method to management. However, the ability to create a solid architecture around which he could make is own decisions allowed his symptoms to improve; and three months later, his HbA1c was 52mmol/mol. Type 2 Diabetes Mellitus is a progressive condition, of which natural history is complicated by multiple factors. Specific attention should be given to those at risk of poor glycaemic control, even though they may be stable at present. We discuss current literature for glycaemic surveillance in at-risk population groups.