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DIABETES TYPE 2 - Coggle Diagram
DIABETES TYPE 2
Suspect Hyperglycaemic Emergency
Complications are DKA require hospital admission
Polydipsia, Polyuria, abdominal pain, nausea/vomiting, SOB
Lethargy/drowsiness/confusion
Fruity smell acetone on breath, tachycardia, tachypnoea
Ketones, Severe dehydration
Systemically Unwell
Precipitating factors - Hyperosmolar Hyperglycaemic state
Admission to hospital
Sick day rules
Management Adults
Individualised care plan
Refer to DESMOND education programme
Annual review
Lifestyle measures
Offer Immunisation against infections
Always carry MedicAlert
Measure HbA1c 3-6monthly
Treatment
Metformin - gradual increase of dose over several weeks
Cardiovascular risk status
If Metformin contraindicated - SGLT- 2 inhibitor
Other people - offer Pioglitazone / Sulfonylurea
Sodium glucose cotransporter -2 inhibitor
If mono therapy ineffective - DPP-4 inhibitor
Diabetic eye screening and diabetic kidney disease
Info on diabetic foot problems
Management Children/Young Adults
Individualised care plan
Diabetes UK www.diabetes.org.uk
Advise on sexual health
Offer immunisation against flu/pneumococcal
BMI measurement
HbA1c target 48mmol
Lifestyle advice -diet, smoking, alcohol intake and physical activity
Treatment
Standard release Metformin
Insulin therapy in some cases
Features in Children/young Adults
Nocturia/Polydipsia/Polyuria
Blurred Vision, weight loss, recurrent infections and tiredness
Behavioural changes
Acanthosis Nigricans
Presence of risk factors - persistent hyperglycaemia
Do not use HbA1c measurement to diagnose children
Arrange immediate same day referral to multidisciplinary paediatric diabetes team
Clinical Features Adults
Acanthosis Nigricans
Polydipsia, Polyuria, Blurred vision, weight loss, recurrent infections
Persistent Hyperglycaemia
HbA1c result difficult to interpret
Suspect Hypoglycaemia
Blood glucose level < 3.5mmol
Main adverse effect of Insulin treatment - people taking sulfonylureas
Sick day rules