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T2 DIABETES - Management, Lifestyle, TARGET HBA1C, Metformin, Triple…

- - - - If routine self-monitoring is indicated, ensure that a structured assessment is carried out at least annually
        
        to check self monitoring skills, that they know how to interpret lows/highs and how to manage, impact of self monitoring on QOL and whether to continue
- - - - Assess and manage the intercurrent illness(es).
      - Assess how well blood glucose has been managed with diet and antidiabetic treatment (if relevant)
        
        For people on antidiabetic treatment, review their treatment as necessary.
    - - underlying condition is unclear.
      - Dehydrated, or at risk of dehydration
      - Vomiting persists beyond 2 hours.
      - The person and their family/carers are unable to keep the blood glucose level > 3.5 mmol/L.
      - The person and their family/carers are exhausted, for example due to repeated night-time waking.
- - - - If self-monitoring is indicated (i.e. on insulin therapy), it should be done carefully and frequently
        
        It should be checked at least every 3–4 hours **including through the night**, and sometimes every 1–2 hours. Remind the person to record the results.
        
        Consider ketone monitoring (blood or urine).
        
        check regularly, ie every 3–4 hours including through the night, and sometimes every 1–2 hours depending on results.
        
        If the urine ketone level is greater than 2+, or blood ketone levels are greater than 3 mmol/L, the person should contact the GP or diabetes specialist team immediately.
        
        Maintain their normal meal pattern (where possible) if appetite is reduced.
        
        normal meals could be replaced with carb-containing drinks (such as milk, milkshakes, fruit juices, and sugary drinks)
        
        Aim to drink at least 3 L of fluid a day Seek urgent medical advice if: sick, drowsy, cant keep it down, persistent D+V
        
        When feeling better, they should continue to monitor their blood glucose levels carefully (if indicated) until it returns to normal. This could take some time.