Management of Diabetes | STUDY GUIDE
Giving education / information to enable
patient to self manage Focussing on dietary
How is good health maintained and lifestyle change to enable weight loss
Offering psychological and social support
Controlling cardiovascular risk factors to reduce
risk of complications Screening regularly for
complications
Review of
What does a dibaetes annual
symptoms
review include
Review clinical
issues Screen for
complications
Weight /
BMI Glucose
What clinical issues are reviewed levels Blood
pressure
Cholesterol
Creatinine (eGFR) + urine albumin creatinine ratio (ACR)
What areas are screened for Eyes / Feet / Kidneys
complications
What is the managemnt of BP of Ace inhibitors or ARBs
140/90 or 130/90 with renal,
occular or CV disease with
diabetes
Caclium channel cbloker
What is then given if BP thiazide diuretic is CCB not tolerated
doesnt reduced after ACEi or
ARB if that doesnt work Beta blocker, mineralcorticoid recpetor antag
What is also given in terms of atorvostatin 20mg a day
lipids to ppl with T2D and no
CVD
What is given in terms of lipids Atorvostatin 80mg daily
to ppl with T2D and known
CVD
, eye to prevent
What screening is does retinopathy foot
to prevent ulcers
urine to prevent renal failure
What does a high glucose lead Higher glucose leads to more glycation of haemoglobin
to in glycation
Red cells survive around 3 months, so HbA1c tells you
WHat does HBA1c tell you
approx. level of glucose control over preceding 3
months
What is a good HBA 1 c generally less than 53 mmol/mol (old units = 7.0%) (but individualized)
What may invalidate the HBA1c haemoglobinopathy or anaemia
What is fructosamine Another glycated protein, lasts around 2 weeks
Used if HbA1c invalid (eg. due to
When is fructosamine used
haemoglobinopathy) May be useful in to
measure glucose control in pregnancy
Self monitoring of blood glucose
What is SMBG
§Patient can self test glucose levels using a meter. Used in patients on
insulin therapy
What is the pre prandial and Pre-prandial aim for around 4-7 mmol/L
post prandial aim for SMBG Post-prandial 2 hour glucose aim for around 5-9 mmol/L
all people with T1D
What people cna have continous
Consider in people with T2D if they are on twice daily or
glucose monitoring
more insulin therapy AND have recurrent hypos or
severe hypos or hypo unawareness
OR Learning disability
Age / Life expectancy / Co-
what is considered when
morbidity Duration of DM
choosing a glycaemic target
Motivation, capacity for self care, social support
Younger
In what circumstances would Shorter duration of
you have tighter glucose diabetes Few co-
control morbidities
Higher motivation / knowledge
Glucose
Cholesterol
Weight
WHat is imporved with
Reduced requirement for
strucutred education
diabetes meds Increased
on diabetes
consumption of fruit and veg
Increased knowledge of
diabetes
Self empowerment
low in fat, sugar, salt, higher in fibre,
what diet should diabetics follow
Giving education / information to enable
patient to self manage Focussing on dietary
How is good health maintained and lifestyle change to enable weight loss
Offering psychological and social support
Controlling cardiovascular risk factors to reduce
risk of complications Screening regularly for
complications
Review of
What does a dibaetes annual
symptoms
review include
Review clinical
issues Screen for
complications
Weight /
BMI Glucose
What clinical issues are reviewed levels Blood
pressure
Cholesterol
Creatinine (eGFR) + urine albumin creatinine ratio (ACR)
What areas are screened for Eyes / Feet / Kidneys
complications
What is the managemnt of BP of Ace inhibitors or ARBs
140/90 or 130/90 with renal,
occular or CV disease with
diabetes
Caclium channel cbloker
What is then given if BP thiazide diuretic is CCB not tolerated
doesnt reduced after ACEi or
ARB if that doesnt work Beta blocker, mineralcorticoid recpetor antag
What is also given in terms of atorvostatin 20mg a day
lipids to ppl with T2D and no
CVD
What is given in terms of lipids Atorvostatin 80mg daily
to ppl with T2D and known
CVD
, eye to prevent
What screening is does retinopathy foot
to prevent ulcers
urine to prevent renal failure
What does a high glucose lead Higher glucose leads to more glycation of haemoglobin
to in glycation
Red cells survive around 3 months, so HbA1c tells you
WHat does HBA1c tell you
approx. level of glucose control over preceding 3
months
What is a good HBA 1 c generally less than 53 mmol/mol (old units = 7.0%) (but individualized)
What may invalidate the HBA1c haemoglobinopathy or anaemia
What is fructosamine Another glycated protein, lasts around 2 weeks
Used if HbA1c invalid (eg. due to
When is fructosamine used
haemoglobinopathy) May be useful in to
measure glucose control in pregnancy
Self monitoring of blood glucose
What is SMBG
§Patient can self test glucose levels using a meter. Used in patients on
insulin therapy
What is the pre prandial and Pre-prandial aim for around 4-7 mmol/L
post prandial aim for SMBG Post-prandial 2 hour glucose aim for around 5-9 mmol/L
all people with T1D
What people cna have continous
Consider in people with T2D if they are on twice daily or
glucose monitoring
more insulin therapy AND have recurrent hypos or
severe hypos or hypo unawareness
OR Learning disability
Age / Life expectancy / Co-
what is considered when
morbidity Duration of DM
choosing a glycaemic target
Motivation, capacity for self care, social support
Younger
In what circumstances would Shorter duration of
you have tighter glucose diabetes Few co-
control morbidities
Higher motivation / knowledge
Glucose
Cholesterol
Weight
WHat is imporved with
Reduced requirement for
strucutred education
diabetes meds Increased
on diabetes
consumption of fruit and veg
Increased knowledge of
diabetes
Self empowerment
low in fat, sugar, salt, higher in fibre,
what diet should diabetics follow
