TREATMENT PLAN

TREATMENT PLAN 

Initial approach:

• Individualised treatment plans
• Group education (DESMOND programme)
• Lifestyle modifications: diet, weight management, alcohol, smoking cessation, exercise, mouth care advice (increased risk of periodontitis in T2DM patients)
• Offer seasonal influenza and pneumococcal vaccines – NHS free prescriptions
• Screening for complications @ diagnosis & annually.

Monitoring: –

HbA1c 6-monthly – Target levels:

• Lifestyle/metformin only: <48 mmol/mol (6.5%)
• Multiple medications/medications linked to hypo’s: <53 mmol/mol (7%)
• Watch out for false positives (low Hba1c’s): sudden weight loss or deterioration of renal fx

Regular monitoring is only indicated for:

• Corticosteroid treatment
• Pregnancy planning/pregnant
• Using medications with hypo risk
• Insulin users
• History of hypos while driving

Medication approach:

Figure 3 – T2DM management flow chart Sick day rules:

• Stop medications for 24-48 hours (except insulin)
• Increase blood glucose monitoring
• Monitor ketones if on insulin.