Diabetes – diagnosis

Data gathering

  • Red flags – chest pain, SOB, DKA (abdo pain, vomiting, confusion)
  • Others – thirst, polyuria, wt loss, vision, feet
  • Examine – BP, BMI, fundoscopy, feet inc pulses

 

Clinical management

  • Investigations
    • Urine – dipstick, ACR
    • Bloods – FBC, U+E, LFTs, lipids, HbA1c
  • Explanation
    • Level of sugar in blood is controlled by a hormone called insulin. In diabetes, either there is not enough insulin or the body is not reacting to the insulin enough – high sugar levels can cause problems to the eyes, feet, kidneys, heart and stroke
  • Treatment
    • Lifestyle – healthy diet, smoking cessation, weight control, exercise
    • BP control (140/80 or 130/80 if organ damage)
    • Cholesterol control
    • Services – patient education programme, dietician, eye screening
    • Vaccinations
  • Follow-up / Safety-net
    • Annual checks – bloods, eyes, feet

 

Notes

  • HONK/DKA – drowsy, vomiting, confused, SOB, thirst, polyuria, raised BMs, urinary ketones
  • Diagnosis – HbA1c > 48 + symptoms (or two results of >48)
  • Free prescriptions if taking diabetes medications
  • ACR – 3.5 – 30 – consider ACE-I if diabetic + repeat ACR in 3 months
  • Metformin – warn re diarrhoea/bloating when initiating