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Diabetes - Management of New Diabetes

Diabetes - Management of Newly Diagnosed Diabetes

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Aim

To ensure that all persons with newly diagnosed diabetes receive a full assessment

To implement initial diabetes management and education

To enter into a programme of structured care

Diagnostic criteria of diabetes  (See - Diabetes Prevention)

 

Most patients with newly diagnosed diabetes will have Type 2 diabetes and will be managed in primary care. However it is vital that patients who have new Type 1 diabetes are identified and insulin treatment started to prevent metabolic crises. There are also some cases of Type 2 diabetes who will require immediate specialist treatment.

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Patients requiring Urgent Referral to Specialist Care

Any patient who is acutely ill

Suspected Type 1 Diabetes

Ketonuria

Weight loss

Short history symptoms

Young age < 18 years

Coexisting conditions that requires specialist intervention e.g. infected foot ulcer, pregnancy or high dose steroids.

All children with diabetes

Classification & Care Pathway Flowchart

 

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History

Symptoms – thirst, polyuria, tiredness and recurrent infections

Weight loss

Family history of diabetes

Past medical history e.g gestational diabetes

Current medication (steroids in particular)

Lifestyle assessment – smoking, alcohol, exercise, diet

Employment – e.g. professional driver/shift worker

Social support

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Clinical Examination and Screening for Complications

Full clinical examination by practitioner is recommended to assess presence of co-morbidities e.g. heart failure, abdominal masses etc.

     

Weight (kg) / height (metres) / Body Mass Index (BMI)

     

Waist circumference (cms)

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Urinalysis for ketones and protein

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Blood pressure (lying and standing)

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Neuropathy – Lower limb sensation, reflexes, foot lesions.

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Peripheral vascular disease – Peripheral foot pulses

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Retinopathy – Visual Acuity and dilated fundoscopy (if skills available). Referral to local retinal screening programme.

  Learn More

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Laboratory

Renal function – urea, electrolytes and creatinine, eGFR

Lipid profile

Liver function

Thyroid function

ECG if > 40yrs

Urine Albumin: Creatinine ratio (early morning ideally)

HbA1c at diagnosis is a requirement for referral to a DESMOND programme. (see - Useful Resources and Links section for the relevant Referral Form)

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Initial Management of Type 1 Diabetes

The initial assessment and management of newly diagnosed Type 1 diabetes will be undertaken by the diabetes specialist team.

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Initial Management of Type 2 Diabetes

The aims of diabetes management are:

to alleviate symptoms of hyperglycaemia

to improve control of blood glucose levels

to reduce cardiovascular risk

to avoid excessive weight gain

to avoid hypoglycaemia

to prevent long-term complications of diabetes

to educate and empower patients to self-manage their diabetes

Immediate

Simple explanation of `what is diabetes’ and basic dietary advice

Consider future care and arrange review.

Consider any other clinically appropriate measures

Arrange initial investigations

At first review (soon after diagnosis)

Address patient issues and concerns

Full clinical assessment

Refer to retinal screening (see - Useful Resources and Links section for the relevant Referral Forms)

Start glucose self Monitoring

Access and advise on Lifestyle issues including Exercise

Structured education: one to one and refer to group flowcharts below.

Discuss / commence treatment

Diabetes UK has a range of helpful leaflets

Ongoing care

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Education - Pathway for People with Type 2 Diabetes in Primary Care
See - Structured Diabetes Education Guideline

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Useful External Links & Resources
 

PDF File

Diabetic Retinopathy Screening Referral Form

PDF File

Desmond Diabetes Referral Form (North & Central Beds)

PDF File

Desmond Diabetes Referral Form (South Beds)

PDF File

Luton Community Diabetes Referral Form

PDF File

Luton Education Programs & Referral 2015

Diabetes UK leaflets
 
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