SIGNS & SYMPTOMS, INVESTIGATIONS & DIAGNOSIS, TREATMENT PLAN

SIGNS & SYMPTOMS

INVESTIGATIONS & DIAGNOSIS

Random plasma glucose >11 mmol/L with symptoms outlined above – Same-day referral required for children/adults – C-peptide/diabetes autoantibodies only if:
T1DM + Atypical features (BMI >25 & Age onset >50)
Uncertain classification.

TREATMENT PLAN

Insulin Regimes:

Insulin Types:

Administration:

90-degree injection
Sites: abdomen, outer thigh, buttocks
Storage: 2-8 degrees
post administration: acute painful neuropathy (result of rapid glucose control) – reassurance is all that is needed.

Monitoring:

Hba1c every 3-6 months
Target <48 mmol/mol (6.5%)
Blood glucose monitoring: 4x daily (adults), 5x daily (children)
Increase frequency of monitoring if: Hba1c is not at the target level, increased number of hypoglycaemia episodes, illness, sport, to be done before driving and 2 hourly while driving – Target levels:
- Pre-meal: 4-7 mmol/L o Post-meal: 5-9 mmol/L o On waking: 5-7mmol/L o When driving: 5mmol/L Additional Management:
Individual care plans involving initial assessment (looking at medical hx, family hx, social & lifestyle hx, foot & vision examination, urine ACR/PCR, psych evaluation & family support if indicated)
Educational programmes like DAFNE (12-month programme)
Statin indication: age >40, diabetes >10 years, established nephropathy
ACE inhibitors for diabetic nephropathy
Annual screening: eyes, feet and autoimmune conditions
Diabetic foot screening: review periods depend on the risk stratification: o Low risk: annual o Moderate risk: 6-8 weeks o High risk: 2-4 weeks o Immediate concern: likely immediate assessment
BP targets o Normally <140/90 or <150/90 if >80yrs old o T1DM <135/85 o T2DM <140/80 o DM Complications

<130/80 o CKD (ACR <70) <140/90 o CKD (ACR >70) or CKD + DM <130/80

Dietary advice: low GI diet, carb counting, <14 U/wk of alcohol
Exercise: 150 mins moderate/75 mins vigorous activity weekly (adults) + weightlifting twice a week o For kids:
- 1-2 yrs: 180mins/per day
- 3-4 yrs: 180mins/per day, 60 mins should be moderate to

vigorous activity

5-18 yrs: 60mins/per day of moderate to vigorous activity – Annual Reviews: o Assess diet, exercise, smoking, alcohol and weight circumference o Reiterate Hba1c & blood glucose goals o Review blood pressure
Monitor for complications
E.g., Urine ACR to monitor for diabetic nephropathy o Lipid profile o If had MI/STROKE – Add B-blocker

Sick day rules:

CARDIOLOGY