Download Type 2 Diabetes at a Glance

HSE West Manual Type 2 Diabetes at a Glance Updated Feb 2016
Diagnosis
Classical symptoms of Diabetes plus random plasma venous glucose ≥ 11.1mmol/l
or
HbA1c ( glycated haemoglobin IFCC) ≥ 48mmol/mol (HbA1c of ≥ 6.5%) * † **
or
two fasting plasma glucose measurement ≥ 7.0mmol/l
or
Two-hour plasma glucose > 11.1mmol/l during a 75gm oral glucose tolerance test.
* The HbA1c should be performed using a standardised lab. assay
+ if there are no medical conditions present which preclude its accurate Measurement
** Note OGTT is the Gold Standard for Diagnosis if discrepancy between GTT result and HbA1c
The result should be confirmed by repeat test on a different day
Once Diagnosis Confirmed – Add to Register, Review, Recall
Healthy Eating:
Healthy eating, eat regularly, with high fibre carbohydrate as the basis for meals.
Eat low glycaemic index foods, minimise refined carbohydrates and total fats
(especially saturated fats).
Physical Activity: Aim for 30 mins moderate intensity physical activity 5 days per week.
For weight loss 60-90 mins 5 times per week.
Smoking:
Inform patients smoking increases all complications of Diabetes. Refer to local smoking
cessation service, visit www.quit.ie, or FREEFONE the QUITline on 1800 201 203.
Alcohol:
Maximum weekly intake of 17 units for men and 11 units for Women
Driving:
Advise if on Insulin or Sulphonurea patients must inform their Insurance Company and the NDLS
Vaccination:
Annual Flu Vac. Pneumonia Vac (1 dose, unless if <65 give second dose when >65)
Structured Patient Education: Refer patients to XPERT/CODE/DESMOND
Preconceptual Care: Folic Acid 5mg daily. Planned pregnancy aim for good control with HbA1c ideally
<53mmol/mol (7%)
Hypoglycaemia: If on Insulin or Sulphonurea advise re symptoms and treatment.
NB loss of Hypoawareness
Treat to Target to Prevent the Complications of Diabetes
BMI:
<25 kg/m2
Waist Circumference: <94cm for men and <80cm for women
HbA1c:
≤53mmol/l (7.0%) for most patients (Individualised Target)
BP:
<140/80
Lipids:
Cholesterol <4.5 mmol/l
LDL <1.8mmol/l (With existing Cardiovascular Disease) <2.5 mmol/l (No Cardiovascular Disease)
Triglycerides <1.7 mmol/l and HDL >1.0 mmol/l (Male) and >1.3mmol/l (Female).
Complications of Diabetes
Renal Disease: Annual Albumin Creatinine Ratio <3.5mg/mmol in Females and <2.5 mg/mol in Males
(NB 2 out of 3 samples over 3 months are required to confirm a positive result)
Annual estimated Glomerular Filtration Rate (e GFR)
Erectile dysfunction: Discuss treatment options. Review Glycaemic control.
Eye Care: Annual retinal screening by National Screening Programme. Check to see the patient is on the
Diabetic RetinaScreen register. Add all patients diagnosed since Jan 2012 by calling
Freephone 1800 45 45 55 (RetinaScreen). Or online www.diabeticretinascreen.ie
NB patients with mild retinopathy ( R1) require annual retinopathy screening, but additionally to
prevent progression of Diabetic Eye Disease address their Risk factors : Poor Glycaemic
Control, Hypertension, Hypercholesterolaemia, Smoking.
Foot Care: Annual screening for risk factors. Patient education. Categorise patients feet as
Low/Moderate/High Risk and refer Moderate and High Risk to Podiatry Service.
Risk factors: Neuropathy, ischaemia, deformity, callous, oedema, visual impairment,
previous ulceration
Active Foot Disease: Urgent Referral for review by podiatrist within 48 Hours.
Blood Glucose Monitoring
All patients on treatment associated with hypoglycaemia (Insulin/Sulphonureas) are required to test their
Blood Glucose Levels. The frequency of this varies see guideline on SMBG
Each patient should be assessed individually in relation to the usefulness of blood glucose monitoring in
the self management of their diabetes.
HSE West Manual Type 2 Diabetes at a Glance Updated Feb 2016