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Acute endocrine presentations in general practice

A man with hyperosmolar type 2 diabetes

Vivienne Miller

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Abstract

Joe, a 56-year-old overweight (body mass index of 29 kg/m2) man, comes to your general practice today because he has balanitis (he is uncircumcised). He was given cephalexin 500 mg four times daily three days ago by another doctor from your practice; however, although Joe says the swelling is improving, his foreskin is still very sore and irritated. He has no urine frequency or urgency, or lower abdominal pain. You look at his medical records as this is your first consultation with him. He says this is the usual general practice that he visits, but he does not come very often.

Key Points

    Practice points
  • Always consider a patient’s social history and occupation in the setting of their diabetes.
  • Consider and investigate for general medical conditions that may contribute to a patient’s presenting problem.
  • Generally assess each patient who has hyperglycaemia to determine their degree of dehydration and cognitive impairment and thus the need for acute in-hospital care. If in doubt, refer the patient to the emergency department.
  • Promptly manage hyperglycaemia with combined diet and medication approaches where indicated.
  • Do not assume patients with diabetes understand their condition or have been educated about it. Always ask them about this and use the allied health team and specialist services where needed.
  • Timely tertiary healthcare team support, such as the endocrinology registrar on call and the local diabetes centre, including through phone contact, can help determine clinical review and care priorities in challenging clinical care situations.

    Picture credit: © NJR_2011/Dollar Photo Club. Model used for illustrative purposes only.

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