Diabetes misdiagnosis: causes and consequences

Diabetes is a chronic condition that occurs when a person’s blood sugar is too high. There are different types of diabetes and each type requires different treatment and management. Misdiagnosis of diabetes can delay appropriate care and increases the risk of complications. These complications include diabetic ketoacidosis, which is where a lack of insulin causes ketones (acids) to build up in the blood. This can be life-threatening. Other complications include cardiovascular disease, kidney damage, eye, damage, nerve damage, as well as foot problems and even amputations.

Type 1 diabetes misdiagnosed as Type 2 diagnosis

Type 1 and type 2 diabetes have different causes. In type 1 diabetes, the body’s immune system attacks cells in the pancreas which make insulin. Type 2 diabetes occurs when the body becomes resistant to insulin and/or does not make enough insulin.

It is important to note that the symptoms of type 1 and type 2 diabetes are similar and some of the problem with misdiagnosis is because they overlap. Symptoms include increased thirst and urination, losing weight, ketones in urine, fatigue, irritability, blurry vision and slow healing sores/infections.

Type 1 diabetes is usually diagnosed in children, but it can develop at any age. This can lead to an incorrect assumption by a GP, should an adult attend with high blood sugar, that this must be due to type 2 diabetes when it is a result of type 1 diabetes.

Testing must occur to ascertain the type of diabetes a patient has, even if they are an adult who presents with other type 2 diabetes risk factors. The underlying cause of hyperglycaemia (high blood sugar) should be ascertained. A failure to do this can result in delayed insulin therapy.

Type 2 diabetics may be advised that lifestyle factors are the best first line treatment but this will not assist patients with type 1 diabetes. Failure to start insulin can lead to higher risk of diabetic ketoacidosis, poor long-term glucose control and increased risk of complications including retinopathy (a disease of the retina), blindness, kidney failure, stroke or even amputation.

Can Type 2 diabetes be misdiagnosed as Type 1 diabetes?

This is less common but the consequences can be just as serious. It can occur if doctors see a patient with very severe symptoms and immediately assume insulin is required. This is because the symptoms associated with type 2 diabetes generally develop more gradually over time. Doctors should not conclude a patient has type 1 diabetes just because they are a child because type 2 diabetes is unfortunately increasing all the time amongst young people.

If a type 2 diabetic is misdiagnosed as a type 1 diabetic, the patient can be treated with insulin when this is not actually required. Conversely, medication that may assist, such as metformin, may not be prescribed. It also can delay or prevent optimal treatment recommendations for type 2 diabetes which includes lifestyle changes such as diet and exercise.

Failure to diagnose gestational diabetes

Gestational diabetes develops typically during the second or third trimester of pregnancy and usually resolves after the child is born. It develops because hormones produced by the placenta can make the body more resistant to insulin.

Pregnant people are screened for gestational diabetes. It is unfortunate that misinterpretation of some screening has led to false negative results. It is important that symptoms are taken seriously by doctors and not mistaken for normal pregnancy changes, as the two can overlap, for example with fatigue and frequent urination.

If a diagnosis of gestational diabetes is made, it is essential that the pregnant person is given correct antenatal care and that they have a clear understanding of the treatment required. This often includes diet, exercise, blood sugar monitoring and sometimes insulin injections.

Poorly managed gestational diabetes can lead to risks for babies and mothers. Risks to the baby include an increased birth weight which can lead to a difficult delivery and birth injury such as nerve damage. The baby could be born prematurely because high blood sugar can trigger early labour. Heartbreakingly, stillbirth could occur especially with poorly controlled gestational diabetes in the third trimester. The mother could experience preeclampsia which is persistent high blood pressure, have an increased need for caesarean section and there is a higher risk long-term of developing type 2 diabetes especially in future pregnancies.

Why is it so important to have a prompt diagnosis of diabetes?

When you have diabetes you can be more at risk of developing diabetic foot ulcers and may be at risk of developing Charcot foot, a serious foot complication.  A delay in treatment of diabetic ulcers or Charcot foot can lead to a need for amputation.

Can I bring a claim for medical negligence as a result of a delay in diagnosis of diabetes?

You can bring a claim for delayed diagnosis of diabetes if you have experienced injury as a result of the delay. Common claims include those where patients have experienced kidney failure, strokes, heart attacks, blindness or amputation which otherwise would have been avoided.

Conclusion

It is essential that if a diagnosis of diabetes is suspected, comprehensive diabetes testing occurs, these tests are correctly interpreted and doctors are aware that patients can attend with atypical presentations. Diabetes management should be continually assessed so that a personalised management plan can be put in place and so that outcomes for those living with diabetes are improved.

The impact of a misdiagnosis of diabetes can be life-changing.