Diabetes Insipidus

On the same day, as the salt and water talk - the remit extended to diabetes insipidus. This is Tom's talk - a run through the pathophysiology of water regulation with some cases to highlight the key points.

Diabetes Insipidus

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Salt and Water

I wasn't able to make this session, but I'm sure it was as good as ever.

Here is John Foote's talk on hyponatraemia. Looking through it now, it is a very good guide to diagnosing and managing hyponatraemia. It reinforces the need to assess the clinical volume status of a patient, before labelling them with the seemingly-ubiquitous diagnosis of SIADH.

Hyponatreamia

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Research, Abstracts, Posters, Presentations

Diabetes UK

British Endocrine Society

Who we are.

Gus Brooks - ST6 Royal Devon & Exeter
An avid United fan with (tenuous) links to Manchester. Currently on a big money loan to Newcastle for research.

Buki - ST7 Derriford Hospital taking part in the Early Bird research team.

Ali Chakera - aka Shakira, on account of his twinkle toes. SpR Royal Devon & Exeter. Currenly doing research with Prof Hattersley.

Chenchi Reddy - ST6 Royal Cornwall Hospital
Has moved to the region from Northern Ireland, where he was doing research.

Ioannis Dimitropoulos - ST5 Royal Devon and Exeter Hospital.The keen, mean, Greek machine. First to work and last to leave - stop putting us all to shame!

Tom Fox - ST7 Derriford Hospital. Our Type A/ Red colleague.

Angus Jones - ST7 Royal Devon & Exeter
Currently undertaking research into C-peptide in Exeter.

Carly Lawrence - ST4 Torbay Hospital Back from a year working in Australia.

Aftab Aziz - ST3 at Torbay

Obesity - a growing problem!

This was a really interesting session, leading to healthy debate on the solution to the obesity crisis. As ever, debate led to polarised views about the role of the endocrinologist, the role of government, the role of society and the role of surgery in the management of obesity.

Here is Tom's balanced look at things:

Obesity

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Addison's disease

Ali, having done some work with Bijay on Addison's disease presented this at a Thursday lunchtime to the DEVHC staff.

The first section is a general overview on Addison's disease, the second looking at the evidence for replacement steroid doses for patients with Addison's disease undergoing surgery and the last, looking at the short-synacthen tests performed in the hospital over the past three years.

Addison’s Disease

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Torbay Mid-Foot Amputation Audit

The Torbay Foot team, have audited their mid-foot amputations in the two years to 2007. These are their results.

Mid Foot Amputations Torbay 2009

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Estimated Average Glucose - eAG

It has been deemed by the powers that be that estimated average glucose isn't going to be used in the UK, yet.

However, in mainland europe and in the States - they are going for it and for every HbA1c request, you get back three numbers: a percent, a mmol/mol value and an estimated average glucose.

This American presentation explains what it is and why it might be useful. I wouldn't be surprised if we start using it here.

eAG - Estimated Average Glucose

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Insulins And Insulin Delivery

We had a really good session this Friday. This is a case based presentation highlighting how different insulin regimes may be useful in different people. It also highlights the results of the 4T study in initiating insulin for patients with T2DM.

Insulins And Insulin Delivery

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The Dreaded New HbA1c

This is an adapted presentation from one of lab equipment manufacturers and the only one that I've come across that gives sensible reasons for switching to the new HbA1c range.

It sets out the changes, the reasons behind those changes and has a conversion chart.

All someone needs to do is write a short programme that will convert one figure into another....

... on the horizon, which might change this is the idea of estimated average glucose (eAG) analogous to eGFR to be reported alongside the new HbA1c. Watch this space.

New Hb A1c Numbers Presentation

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Diabetic nephropathy

Angus' comprehensive look at the pathology, risk factors and treatable variables for diabetic nephropathy.

Diabetic Nephropathy

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Exeter Guidelines for Management of Painful Diabetic Peripheral Neuropathy

This flow-chart is that used at the RD&E for the management of painful diabetic peripheral neuropathy

Management of Painful diabetic neuropathy - Exeter guidelines

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Management of Painful Diabetic Neuropathy

Angus' presentation, which talks about all neuropathy associated with Diabetes Mellitus with a focus on the treatment options available for painful diabetic neuropathy.

Diabetic Neuropathy

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Consultant Interview Questions

Helen went for the consultant post in Poole, and has been kind enough to upload a list of the questions that she was asked.

Consultant Interview Questions for Poole

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RD&E Exenatide Audit.

Pam Bowman, the academic F2 has audited the initial use of exenatide at the RD&E.

Exenatide, the first commercially available GLP-1 analogue, has been mentioned in the latest NICE guidelines for those with a BMI >35, an HbA1c >7.5%, on maximum oral metformin and sulphonylurea, who would otherwise be starting a high-cost medication.

NICE also mention criteria for success: a weight loss >5% at one year and improvement in HbA1c >1%

The audit is limited in scope as not many patients have been on the medication 6 months, let alone one year.

The interesting issues are that we are using it off-licence (i.e in those already on insulin) and that doesn't seem to influence outcome.

Here is the audit. Other peoples thoughts, experiences and comments would be useful... just use the comments link at the bottom of this post.

Exenatide Presentation

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Aspirin for Primary Prevention of Cardiovascular Events in Diabetes: Still an Open Question

This JAMA editorial highlights the uncertainty in the use of aspirin in primary prevention for people with diabetes.

Hopefully the Ascend Trial will help to answer this question.

Below, the Exeter Drugs update (Co-authored by KMM) expands on this issue taking a look at the recently published evidence in the POPADAD and JPAD trials:

Exeter Drugs Update

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The DVLA diabetes and driving guidelines.

These are the DVLA guidelines for driving.

The guidelines are downloadable from here

Diabetes and Driving

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Hypoglycaemia and Funny Turns

A short presentation looking at the various definitions of hypoglycaemia
(clinical, biochemical and symptomatic).

It goes through what to give acutely and the options for treating disabling
hypos.

Hypoglycaemia and funny turns

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Thyroid Eye Disease

This was a presentation by Dr Bijay Vaidya on Thyroid Eye Disease. Using a case-based format, it systematically covers diagnosis, assessment, treatment and ongoing management. The evidence, where available, is provided.

Thyroid Eye Disease

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Erectile Dysfunction

Dr Tom Fox presented on Erectile Dysfunction. This presentation systematically goes through the Aetiology and Treatments available for Erectile Dysfunction

Erectile Dysfunction

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Classification of Diabetes

A general introduction to Diabetes Mellitus.

Classification And Diagnosis Of Diabetes

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