Newly diagnosed diabetes? - bounced between gp and hospital

[tendofether]

Hoping someone might be able to offer some insight

Husband has been thirsty, weeing a lot and losing weight, had a urine test and the outcome of which was told to go straight to hospital. Hospital put him on a drip, ran some tests and discharged, advising he absolutely must see the GP first thing in the morning.

Saw GP & Nurse this morning (after getting through the 8am phoneline scramble) and they've sent him straight back to hospital with a letter, saying they can't understand why he's been discharged.

So back to hospital, they've run blood gases and they are trying to discharge again.

Can anyone offer any insight as to what the normal process would be for a new diagnosis of diabetes (i'm assming type 2)? He has had no treatment apart from a saline drip thus far from either doctors or hospital.

Bump

Did they really not say what type diabetes he has?

He hasn't had any formal diagnosis yet, I don't know how they differentiate, I'd thought part of going to hospital was to determine which one?

I’m guessing the urine dip at the surgery was positive for ketones. Has the hospital checked/treated ketosis?
This can be caused by poorly managed diabetes

Ketosis would need treated in hospital

Have they said it is diabetes or are they still looking at the cause. Have you rung the ward and spoken to a doctor or the nurse, what does he say they think it is,

Well usually in most cases the GP will arrange for you to have blood tests to confirm diagnosis, and refer you to the diabetes clinic where you'll see a diabetes nurse for education (how to use your equipment and record your blood sugars, what to do if they are high) and you see a dietician there too.

Did your husband have any blood tests done in the hospital? He needs to speak to a doctor to find out exactly what was wrong with his urine. Was he given a discharge letter to give to his GP and what did it say?

So he's tested positive for ketones twice with the gp, once yesterday when they first sent him to hospital and once today when they said the levels were worse than yesterday and sent him back to hospital. Both ketoacidosis tests have come back negative, although the gp looked at the hospital results and said she didn't know why he had been sent home. I think ( and bearing in mind most of my information has come over WhatsApp) the gp is expecting treatment to immediately reduce his blood sugar irrespective of lack of ketoacidosis.

Are his blood sugar readings high as well. The hospital would do glucose and ketone blood tests, I would ring the ward and ask and say you are concerned if he is discharged home.

His blood sugar readings were 15 something (can't recall units but where normal is 6/7) and HBAC1? over 90.

What we expected to happen after discharge yesterday would be he visits the gp, she says "congrats you have type 2 diabetes" (maybe not in those exact words!), and be given medication and or treatment plan or similar. Instead they dipped his urine again, phoned the hospital and explained they were sending him back and sent him off with a letter. He's had blood gases done and then they tried to discharge him again until he pointed out that gp had spoken to hospital doctor and something had been agreed. But he's just been sat in a room for 4 hours now

That sounds pretty frustrating, has he seen a doctor or the hospital diabetic nurse, can you try and call the hospital, which department is he sitting in.

I would be concerned that he has type 1 diabetes. Please confirm with the doctors what type of diabetes they suspect he has because the treatment would be quite different. If he has type 1 it can be quite dangerous to not be on any treatment from the get go. If he has type 2 then treatment can start a little more gently.
It’s less common to get type 1 at his age but not unheard of. I wouldn’t leave the hospital without a diagnosis of which type of diabetes he has.

FFS. He needs to be given a diagnosis urgently. They cannot rule out Type 1 even in an adult so this is ridiculous. Don't let them discharge him until he's been diagnosed. My daughter has Type 1 and you absolutely cannot fanny about with it like this.

Yes, I guess I was interested in knowing how quickly you get put onto treatment with type 2. I'm struggling with the idea that he can be sent to hospital twice but sent home without any sort of treatment plan.

He is in the ambulatory care unit but thus far the only care has been a cup of tea.

Yeah, I would agree that this sounds like it could easily be T1. It’s exactly what happened to me when I was diagnosed at 25 but when I was in hospital the diabetes nurse came to see me and spent hours setting me up with a new insulin regimen and I want discharged until I had proven I could inject myself. They also booked me in for follow up and gave me a prescription for my gp at the next appt.

*wasn’t

Those blood sugars are high so I'm not surprised the GP sent him back to the hospital. The hospital needs to come up with a diagnosis and a plan to get the blood sugars under control. He must be feeling quite unwell as it is?

Have they forgotten he is there, he needs to speak to the staff, has he been having blood glucose readings, it seems strange that he has just been left with high bm and ketones in his urine.

He must be feeling quite unwell as it is?

The strange thing is he says he feels fine, he doesn't look unwell either. He only got the doctors appointment as I said I thought he was drinking an excessive amount and I thought he should get checked out.

His ketones would need to be a certain level for them to be concerned say 0.6 and above the hospital probably tested and below that level and therefore treatment can be managed in the community. If he has high BG and ketones he needs to to be assessed by the diabetic team in the community and if necessary district nursing team. As likely he will be on some insulin to manage his levels till there controlled. Longer term he may be in long term insulin / medication depending on his levels but it's difficult to fully assess without his discharge summary

Ketone levels last night on blood test were 0.8, I don't know if they've retested today.

The thing is they've discharged to 'community' once who've referred him back to the hospital. This has been helpful as I at least know a bit more about what to ask if they try and discharge again.

My son was diagnosed in his twenties with type one diabetes. It was picked up at the eye clinic at the hospital on a Tuesday. They told him to see his GP. They couldn't fit him in til the Friday.
When he went there the doctor was concerned with his ketones and sent him to hospital.
He did have to hang around for ages before he saw anybody. He finally got to see the Diabetic nurse and she made sure he could do the injections properly.
They would have discharged him that evening but he was sick so they kept in overnight.
I thought they would have sorted him out with medication sooner but they didn't seem in any hurry.

Untreated Type 2 diabetes won't cause ketones, so if he has raised sugars and HBA1C, and ketones, he needs insulin; if he doesn't have ketones, he needs dietary advice and something like Metformin.
Adults can sometimes get a 'type 1/2' but this usually only becomes apparent when what looks like type 2, doesn't respond to treatment.

What he doesn't need is to be shuttled back and forth between GP and hospital! 🙄 Hope someone thinks about him properly soon & sorts it out.

Just adding my voice that ketones sound like type 1 and I would be concerned about getting sent home.