Sunday, February 1, 2009

Follow up plan for type 1diabetes mellitus

After diagnosis of the diabetes, the Clinician and the patient should discuss to set a follow up plan. The aim of the follow up plan is to ensure that the patient is compliance with treatments and at the same time the patient should have a normal life as well.

Points are as follows;

1. Stick to treatment regimes
2. care during surgical procedures
3. regular assessment
4. foot care
5. patient education

Stick to treatment regime

Patients with type 1diabetes require lifetime insulin in order to have a normal life. This is a huge burden for the patients but the importance of continuation should be emphasized. This is important to have a good blood sugar control.

Regular insulin doses may cause hypoglycemia if the patient becomes anorectic or has another cause for reduced food intake, has gastroparesis, or is vomiting. Therefore insulin dose should be changed to tally the requirement.

The insulin coverage, with a sliding scale for insulin administration, should not be the only intervention because it is reactive, rather than proactive, in correcting hyperglycemia. Also, insulin may be used inappropriately when hyperglycemia reflects hepatic gluconeogenesis in response to previously uncorrected hypoglycemia.


Care during surgical procedures


Surgical procedures, inclusive of pre-surgery emotional stress, the effects of general anesthesia, and the trauma of the procedure, can markedly increase plasma glucose levels and induce DKA in patients with type 1 DM. In patients who normally take 1-2 daily injections of insulin, a third to a half of the usual morning dose can be administered in the morning before the operation and an IV infusion of 5% glucose in either 0.9% sodium chloride solution or water administered at a rate of 1 L (50 g glucose) over 6-8 hours.

Some physicians prefer to withhold subcutaneous insulin on the day of the operation and to add 6-10 units of regular insulin to 1 L of 5% glucose in 0.9% sodium chloride solution or water infused initially at 150 mL/h on the morning of the operation, depending on the plasma glucose level. The infusion is continued through recovery, with insulin adjustments depending on the plasma glucose levels obtained in the recovery room and at 2- to 4-hour intervals thereafter. The use of an intravenous insulin infusion in the postoperative period after major surgical procedures now is considered the standard of care in most hospitals.


Regular assessment

This is very important to ensure the good blood sugar control. Clinical examination should be carried out to detect complications. Several investigations should be done regularly;

1. Fasting blood sugar
2. Lipid profile


Foot care

This is a special topic. Read more


Patient education

Education is the most important aspect of diabetes management. The physician or the health care provider should educate the patient and, in the case of children, the parents about the disease process, management, goals, and long-term complications. They should be made aware of the signs and symptoms of hypoglycemia and ways to manage it.

A dietitian should provide specific diet control education to the patient and family.

A nurse should educate the patient about self–insulin injection and performing finger sticks for blood glucose level monitoring.

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