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Diabetes Protocol

This document outlines a diabetes protocol for clinics in Madina and Mobile. It aims to detect diabetes early to provide effective treatment and reduce complications. Type 1 diabetes causes acute symptoms and requires immediate hospitalization and insulin. Type 2 diabetes has more insidious symptoms and patients are referred to diabetes clinics for education, monitoring, and oral medication to control blood sugar levels. Complications of uncontrolled diabetes include vascular, eye, neurological, kidney, and infection issues. The protocol details confirming diagnoses, treating and monitoring patients, adjusting medications based on symptoms, reinforcing lifestyle changes, and record keeping.

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Eugen Cerevan
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94 views4 pages

Diabetes Protocol

This document outlines a diabetes protocol for clinics in Madina and Mobile. It aims to detect diabetes early to provide effective treatment and reduce complications. Type 1 diabetes causes acute symptoms and requires immediate hospitalization and insulin. Type 2 diabetes has more insidious symptoms and patients are referred to diabetes clinics for education, monitoring, and oral medication to control blood sugar levels. Complications of uncontrolled diabetes include vascular, eye, neurological, kidney, and infection issues. The protocol details confirming diagnoses, treating and monitoring patients, adjusting medications based on symptoms, reinforcing lifestyle changes, and record keeping.

Uploaded by

Eugen Cerevan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Diabetes Protocol for Madina and Mobile Clinics

Aim
To detect diabetes mellitus in its earliest stages in order to provide effective
treatment and to reduce the risk of diabetic complications

Suspect diabetes if any of the following symptoms or signs


Type 1: fairly obvious, acute, drastic weight loss, thirst, polyuria, smell of ketones
Type 2 : more insidious, thirst, polyuria, nocturia, tiredness, symptoms or signs of
complications eg Erectile Dysfunction (ED)

Complications of diabetes
1.VASCULAR, Heart attack, stroke, gangrene due to peripheral vascular disease
2 .EYES. Cataract, retinal eye disease leading to blindness
3. NEUROLOGICAL. Numbness feet (neuropathy)
4. KIDNEY. Major cause of renal failure
5. INFECTION. Abscesses etc
6. ULCERS, Legs
7. ERECTILE DYSFUNCTION

Confirm diagnosis with blood glucose meter

RANDOM BLOOD GLUCOSE > 11.1 MMOL/L


or
FASTING BLOOD GLUCOSE > 7.1 MMOL/L

Treatment

DIABETES OUTCOME DEPENDS UPON LOCAL MEDICAL


FACILITIES, PATIENT EDUCATION AND AVAILABILITY OF
MEDICATION

Type 1 diabetes:
Admit hospital immediately.
These patients need IV infusion and insulin to save their lives

Type 2 diabetes:
Refer diabetes clinic Friday, Madina
Enter details in record book and complete cardex register for diabetes
HEALTH EDUCATION should be given immediately on diagnosis and reinforced at
every visit.

Diabetes is for life.


Diabetes will never go away and if you do not look after yourself and attend
medical check-ups you will become more unwell and develop complications of
diabetes (see above)
Good diabetic care results in fewer diabetic complications
Diet: avoid sugar in any form eg sugary drinks;reduce fat content of food;
reduce weight if obese
Exercise
Smoking STOP
Blood pressure control must be meticulous.

SMOKING + DIABETES + HYPERTENSION = VERY HIGH RISK OF STROKE

Simple foot care advice

1st Review 2 weeks:

Check symptoms
Are the symptoms of hyperglycaemia improved ie polydipsia, polyuria and nocturia
If yes, continue with health education and review every 2 weeks.
If no, prescribe oral medication.

For patients who are overweight, start metformin 500mg bd, with meals (no
risk of hypoglycaemia).
If not overweight, start glibenclamide 2.5mg od 30 minutes BEFORE
breakfast (THIS MAY CAUSE HYPOGLYCAEMIA AND SO INSTRUCT
PATIENT TO EAT REGULAR MEALS THROUGHOUT THE DAY).

Check Blood Pressure and treat if > 140/90 as per hypertension protocol

Follow up:
Nurse sees patient every 2 weeks for medical review, BP recording, and medication
Check symptoms and compliance at each visit. If symptoms of hyperglycaemia
persist

Metformin can be increased to 1g bd


Glibenclamide can be increased to 5mg od then 10mg od. Maximum 15mg od
Metformin and glibenclamide are to be prescribed together is still poor
diabetic control (for further guidance refer to BNF or MIMS)
Examples
Patient is on metformin 1gm bd. Patient still has symptoms hyperglycaemia,
so, add glibenclamide 2.5 mg od and increase glibenclamide to maximum of
15mg od if necessary.
Patient is on glibenclamide 15mg od. Patient still has symptoms of
hyperglycaemia,so,add metformin 500mg bd and increase metformin to
maximum of 1gm bd if necessary
If despite all of this, patient remains hyperglycaemic, refer to local hospital for
consideration of insulin treatment to control blood sugars.

Reinforce lifestyle advice at each visit


It is important to examine feet for ulcers or gangrene, enquire about visual symptoms
Record Keeping

All records on clinic cardex system (computer database in the future)


The diabetes clinic is to run on Fridays and as with the hypertension clinic,
attendances for the clinic are to be recorded on a clip board sheet.
Dr Veronica Sawicki
March 2012

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