Diabetes treatment guideline

After a patient has been diagnosed with diabetes mellitus, he need to see diabetic nurse specialist and dietician for full medical assessment. The first important principle is to decide if the patient suffer from type 1 diabetes or type 2 diabetes. If the patient suffer from type 1 diabetes he will requires to have an insulin treatment immediately while the patient who suffer from type 2 diabetes will require dietary modification which need to be tailored with the cultural and the patient circumstance.

The assessment of the newly diagnosed diabetic patient may include history, examination and investigation. The history part include taking a full medical detail from the patient such as the present of any symptoms such as polyuria, weight loss and thirst and duration of the symptoms. Patient also need to be evaluate about secondary cause of diabetes such as acromegaly. Patient also need to provide information about family history as well as any complication of diabetes develop. The patient also need to be checked for any risk factors for the complication such as hyperlipidemia, smoking and hypertension.

The examination requires include measuring the body mass index ( weight/ (height ) 2) . Looks for any signs of secondary causes such as acromegaly . Look also for sign of cardiovascular system such as blood pressure measurement and measuring the peripheral pulse. Examination of the nervous system include autonomic and peripheral neuropathy and look for the eyes for any evidence of retinopathy.

The investigation includes initial investigation which should be modified according to the patient 's history and examination. However the minimum investigation includes blood test such as urea and electrolytes, lipid profile and thyroid and liver function tests.An ECG may requires to investigates the heart condition in any patient with type 2 diabetic complication .Urine test is also important to look for any evidence of ketone or macro and microalbuminuria.

The treatment for diabetic type 1 include modification of the dietary intake,insulin therapy and educating the patient with diabetes. The newly diagnosed patient should be educated to provide incentive for good compliance. The education program/package should includes:

An explanation of what is diabetes and what is the importance aspect/means of the diabetes to the patient.

The education also include the aim of the treatment and the purpose of the treatment to reduce the complication and to achieve the aim ( /normal optimum/exact level of the blood sugar ).

The patient also is provided with information such as the type of diet, drugs and lifestyle modification such as reducing alcohol intake, stop smoking and increase any physical activity.

The patient is educated with how to self monitor the blood sugar level, the reason to monitor the blood sugar level and what to do with any abnormality in the results.

If the patient suffer from type 2 diabetes, the patient need an overview of the complication and what to expect and look out for. In this case , the input and review from podiatrist is important.

Advised regarding driving license and insurance is important.

This education information is important for patient with type 2 diabetes. After the educational period, the patient is ask to to try dieting, weight loss ( if obese) and increase in physical activity before starting the drug therapy if the patient diabetic level is uncontrollable.

After 3 months, if this fails to improve, the patient is introduced with oral/drug therapy such as metformin if the patient is overweight and sulfonylureas if the patient is lean. The drugs are prescribed if there is no contraindication.

After the initial assessment is complete, the patient is required to attend the the formal review by their general practitioner or hospital diabetic clinic. The purpose of the treatment is to provide further information, maintaining the control system and examining for any sign of complication.

Dietary advice

If the patient is overweight with BMI more than 25 , it is important for the patient to reduce the total calories intake to aid in reducing the weight.A standard diabetic diet should aims to have:

less than 30 % of the total body fat .

less than 10% of energy from the saturated fat ( less than 8 % in case the patient suffer form hyperlipidemia.)

limitation of sugar intake to less than 25g/day.

50% to 60% of carbohydrates which is in complex high fiber

if hypertensive sodium content should be less than 3g per day and in normal people should be less than 6g per day.

In overweight or hypertriglyceridaemic patient reduction in alcohol intake is required as alcohol is the source of calories.

Weight reducing low fat low glycaemic index diet with reduction in sodium content is the standard diet for diabetic patient most commonly type 2 diabetes and overweight individual .

diabetic diet
diabetic diet

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