ABSTRACT
Introduction: COVID-19 has been linked to an increased risk of new-onset diabetes mellitus and increased incidence of diabetic ketoacidosis (DKA) either as a new presentation or with pre-existing diabetes. Various mechanisms such as impaired insulin secretion, impaired glucose disposal or increased counter regulatory responses are proposed.2 Case report: A 57-year-old man diagnosed with COVID-19 one month prior presented with epigastric pain, shortness of breath and weight loss. Investigations confirmed DKA (pH 7.22, bicarbonate 2.6 mmol/L, blood glucose 11.6 mmol/L, blood ketones 5.8 mmol/L) with HbA1c of 95 mmol/mol. Initial treatment was started as per national DKA guidelines. Upon discharge, the patient was prescribed a basal-bolus regime (total 30 units of insulin) and a FreeStyle Libre flash glucose monitoring (FGM) device. Rapid improvement in blood glucose levels was observed, with regular down titration of insulin and complete discontinuation after 24 days. HbA1c was 37 mmol/mol 96 days later. C-peptide normalised at 3 months for paired glucose at 837 pmol/L. Discussion: The use of diabetes technology (FGM device) with remote monitoring of blood glucose was instrumental in the safe and effective management of this patient. Given that the available literature suggests transient beta-cell dysfunction in the majority of COVID-19 patients resulting in DKA,3 we propose that patients who have been diagnosed with COVID-19 presenting with DKA should be discharged with insulin and FGM from secondary care. This enables remote insulin titration with ease, de-escalation of treatment with confidence and avoiding hypoglycaemia in the recovery phase of the illness in those with transient beta-cell dysfunction due to COVID-19.
ABSTRACT
We evidence English teacher and student perspectives on the learning of pre-university mathematics 'A Level' courses through the pandemic period to July 2021. Data are drawn from a 2017-21 classroom-close study of enactment of such courses in 13 fairly representative centres, using an institutional ethnographic approach. The pandemic picture was generally one of the significant and sustained negative impacts, though over the course of the study, respondents reported progress in addressing early limitations in the harnessing of digital platforms for learning. A small number of participating students reported home-based study beneficial for their mathematics learning, and a bigger group identified some wider benefits that partly offset the challenges. Most participating 16-18-year-old students, though, reported finding remote learning of mathematics both demanding and limiting. Pandemic constraints impacted most strongly on opportunities to engage with newer emphases within A Level courses: problem solving, reasoning, modelling, statistics and mechanics. Receiving academics reported that mathematical preparedness, and confidence, for mathematics-intense university courses has also been widely affected, with a bigger range of preparedness and confidence than usual. The study draws attention to the importance of studying subject-specific impact and drawing on student as well as teacher perceptions. It exposes a range of consequences of the cancellation of examinations and a need to develop and share effective pedagogies for working remotely with pre-university students. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of The Institute of Mathematics and its Applications.