Building Competency in Diabetes Education THE ESSENTIALS

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most respects and may respond to changes in meal plan, activity and the use of oral agents. It is often confused with either type 1 or type 2 diabetes and often takes more than 10 years before a diagnosis is made (40). • Neonatal diabetes Neonatal diabetes is a rare condition usually diagnosed in the first six months of life. It may be reversible with resolution after several months of life or later relapse in adolescence. It is possible between nine to 12 months, however, type 1 diabetes is more common at that time (34). This type of monogenic diabetes may respond well to sulfonylurea (40). It is worth identifying people with diabetes onset under six months of age for potential genetic screening. Secondary diabetes Secondary diabetes, which comprises diabetes caused by other conditions, including pancreatic disease, cystic fibrosis, endocrine disease (acromegaly, hypoparathyroidism, Cushing’s syndrome), liver disease, cancer, renal insufficiency, drugs or chemical exposure (glucocorticoids, diuretics) (see Appendix 2 in the 2018 Guidelines for a more detailed list of drugs that can induce diabetes mellitus). The differentiation between various types of diabetes is important for both therapeutic decisions and educational approaches. Signs and symptoms In the absence of adequate insulin, the body’s insulin-sensitive cells are unable to properly use glucose for energy, so the glucose remains in the bloodstream, leading to hyperglycemia. The body attempts to compensate for this via several processes that eventually lead to the symptoms of diabetes (18,41): • When the renal threshold for glucose is reached (approximately 10 mmol/L in a non- pregnant adult), glucose will be excreted in the urine (glycosuria). • Glycosuria has an osmotic effect, drawing water from the intracellular compartment and causing water to be lost, leading to increased urination (polyuria). Dehydration will occur if fluid replacement is inadequate. • Polyuria and dehydration lead to increased thirst (polydipsia) and cause the lens of the eye to change shape (blurred vision).