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Type 2 Diabetes Management Guidelines

Differentiating between the types of diabetes

  • Type 1 diabetes may occur at any age with an insidious onset and should be considered if:
  • Onset of diabetes < 35 years of age
  • Symptoms of insulin deficiency at diagnosis
  • Low C-peptide (e.g. fasting < 250 pmol/L or post-meal < 600 pmol/L) with a paired glucose > 8 mmol/L or positive capillary ketones/ketonuria at diagnosis
  • Normal or low BMI at diagnosis
  • Personal or family history of autoimmune disease
  • Family history of type 1 diabetes
  • NB: Positive Anti-GAD, anti-IA2 or anti-ZnT8 antibody titres are present in > 85% of patients with type 1 diabetes at diagnosis
  • Usually associated with clear precipitant and loss of exocrine pancreatic function but should consider if:
  • History of pancreatitis, cystic fibrosis or pancreatic surgery, cancer or trauma
  • Diarrhoea and/or features of malabsorption
  • Low faecal elastase
  • Often never diagnosed, but usually presents in young adults with a strong family history of diabetes and should consider if:
  • Family history of monogenic diabetes
  • Onset of diabetes < 35 years of age (particularly if < 6 months of age please refer all cases for genetic testing)
  • First degree relative(s) with onset of diabetes < 35 years of age (particularly multiple generations)
  • Exquisite sensitivity to sulfonylureas
  • Associated features such as sensorineural deafness with mitochondrial disease (subtypes only)
  • Diagnosis confirmed by gene testing – see NZSSD guidelines on testing for monogenic diabetes
  • A careful history and examination should be performed to exclude secondary causes of diabetes including:
  • Medications e.g. corticosteroids, anti-psychotics, thiazides, calcineurin inhibitors (post transplant) etc.
  • Cushing’s syndrome
  • Thyrotoxicosis
  • Acromegaly
  • Hyperandrogenism in women
  • Haemochromatosis