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[Screening for diabetes] [High risk group] [Diagnosis guidelines] [Criteria for diagnosis] [Investigations protocol] [Diabetes in pregnancy] [Targets for control] [Diet Advise] [Exercise] [Complications] [Management] [Drug action]
Protocol

History Examination Investigations Initial visit. Comprehensive history is essential including:
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Symptoms and any laboratory test results related to diagnosis. |
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Dietary habits, previous nutritional status and weight history. |
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Details of previous treatment regimens, if any. |
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Current treatment schedule , if not newly diagnosed; this includes diet prescriptions, exercise schedules, medications, previous and recent laboratory reports and results of self monitoring. |
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History of any acute complications like hypoglycemia, ketosis, including frequency, severity and cause, if known. |
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Prior or current infections, especially foot problem, Tuberculosis, recurrent urinary tract infections. |
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Symptoms associated with chronic diabetic complications, including previous treatment, if any. |
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Previous or current symptoms of macro vascular involvement. |
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Presence of associated conditions like hypertension, lipid disorders, smoking. |
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Other medical illnesses. |
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Medication which may affect glucose tolerance. |
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Psychological, social and economic factors which may have a bearing on management. |
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Family history of diabetes and other illnesses. |
Physical Examination. Complete physical examination must be carried out with emphasis on:
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Height and Weight, Waist-Hip ratio. |
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Blood pressure. |
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Foot inspection. |
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Detailed eye examination including retina (fundoscopy with dilated pupils) |
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Examination, to look for long term complications of diabetes. |
Biochemical and other tests.
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Hb, Complete blood count, ESR. (for existing infections, tuberculosis) |
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Blood glucose: Fasting and Postprandial. (to assess recent diabetic control) |
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Glycosylated hemoglobin levels. (to assess average diabetic control over last 3 months) |
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Fasting Lipid Profile: Total Cholesterol, LDL Cholesterol, VLDL Cholesterol, HDL Cholesterol, Triglycerides. (high association of lipid abnormalities and diabetes). |
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Serum Creatinine, blood urea. (to assess renal-kidney function and complications) |
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Serum electrolytes. (salts of body) |
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Serum Uric acid. |
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Complete urine examination-especially glucose, ketones, albumin, infection. |
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Test for Microalbuminuria. (if positive then first sign of kidney damage in diabetes) |
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Urine culture and sensitivity if, infection present. |
ECG, Chest X-ray. Education
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Set and discuss target levels. |
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Plan and explain management strategy. |
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Individualized dietary and exercise prescription. |
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Explain drug therapy if initiated. |
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Start education programme. |
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Teach self monitoring. |
--------------------------------------- Every three months.
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History |
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Assess result of self monitoring. |
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Discuss adjustments to therapy made by the patient, if any. |
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Examine frequency, causes and severity of hypoglycemic (low blood sugar) episodes or severe hyperglycemia (high blood sugar), if any. |
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Discuss problems with adherence to the management plan. |
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Examine diet and exercise compliance. |
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Symptoms suggesting development of any chronic complications or macro vessel involvement. |
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Current medication. |
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Physical examination similar to that during the initial visit. |
Biochemical investigations.
Blood glucose: Fasting and Postprandial. (to assess recent diabetic control) Glycosylated hemoglobin levels. (to assess average diabetic control over last 3 months). Routine urine examination as initially. Any other biochemical parameters, if initially abnormal. (assess whether target goals have been reached; if not, examine causes of failure to reach target levels).
------------------------------------------ Annual check up.
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Complete evaluation and biochemical tests as at initial visit. |
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Check self monitoring technique. |
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Reevaluate target levels. |
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Assess therapy. |
Note The investigations listed, frequency of follow-ups and type of investigations need to be individualized. Diabetic comprehensive checkup includes
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Blood counts (Hb, TLC, DLC, ESR) |
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Sugar Fasting and Post Prandial |
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Glycosylated hemoglobin (average 3 months control of diabetes) |
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Kidney function tests (KFT)-Urea, Creatinine, BUN, Uric acid |
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Liver function tests (LFT)-Bilirubin, SGOT, SGPT, Alk Phosphatase, Proteins-Total, Albumin, Globulin. |
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Salts (electrolytes)-Sodium, Potassium, Chloride, Bicarbonate, Calcium. |
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All Cholesterols (Lipid profile) - Total cholesterol, LDL, HDL, VLDL, Triglycerides, Cardiac risk factors. |
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Amylase (pancreas) |
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Thyroid Profile (T3 T4 TSH) |
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Urine Routine / Microscopy |
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Micro albumin (to detect early kidney damage) |
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ECG & Cardiac risk assessment. |
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Misc: Insulin levels, Echocardiography, Doppler studies, TMT, Angiography. |
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