Who to test
- Symptoms: thirst, lots of urine, blurred vision, tiredness, weight loss.
- Aged 40 and over with BMI 25 or more.
- No symptoms: confirm on another day.
Diagnosis
| Test | Diabetes if |
|---|
| Fasting plasma glucose | 7.0 mmol/L or more |
| Random, with symptoms | 11.1 mmol/L or more |
| HbA1c | 6.5% or more |
Hypoglycaemia (3.9 mmol/L or less)
- Awake: 15 to 20 g glucose, sugary drink or milk; recheck in 15 minutes; then a meal.
- Unconscious or 2.8 or less: 20 to 50 mL of 50% glucose IV.
- Find the cause; reduce or stop gliclazide.
DKA or HHS: refer
Ill with vomiting, deep breathing, drowsiness, ketones 2+: 0.9% saline 1 litre over 2 hours, then 1 litre every 4 hours until hospital.
WHO PEN steps (review every 3 months)
- Lifestyle advice (1 month).
- Metformin 500 mg daily, then 1000 mg, then 1000 mg twice daily.
- Add gliclazide 80 mg, then 80 mg twice daily.
- Refer, or NPH insulin 10 units at bedtime, up 1 to 2 units every 3 days.
Protect
- BP: treat 130/80 or more; aim below 130/80.
- Statin from age 40.
- Urine protein and creatinine yearly; eyes every 2 years.
- Goal HbA1c about 7.0% (fasting glucose 7.0 or less).
Foot check (skills station)
- Look: ulcers, callus, deformity, nails, between toes.
- Feel pulses: dorsalis pedis, posterior tibial.
- Sensation: 10 g monofilament, or light touch on toes 1, 3, 5.
- Low risk yearly; moderate 3 to 6 months; high 1 to 3 months; active problem refer urgently.
Say it simply
Take your tablets every day, look at your feet every day, and carry something sweet. If you feel shaky, sweaty or confused, eat sugar at once.
150 minutes of activity a week. No tobacco. Never walk barefoot.
Sources
World Health Organization. Diagnosis and management of type 2 diabetes (HEARTS-D). 2020. World Health Organization. WHO package of essential noncommunicable (PEN) disease interventions for primary health care. 2020. World Health Organization. Guidelines on second- and third-line medicines and type of insulin for the control of blood glucose levels in non-pregnant adults with diabetes mellitus. 2018.