Diabetes Protocol for Madina and Mobile Clinics To detect diabetes mellitus in its earliest stages in order to provide effective treatment and to reduce the risk of diabetic complications Suspect diabetes if any of the following symptoms or signs Type 1: fairly obvious, acute, drastic weight loss, thirst, polyuria, smell of ketones Type 2 : more insidious, thirst, polyuria, nocturia, tiredness, symptoms or signs of
complications eg Erectile Dysfunction (ED)
1.VASCULAR, Heart attack, stroke, gangrene due to peripheral vascular disease 2 .EYES. Cataract, retinal eye disease leading to blindness 3. NEUROLOGICAL. Numbness feet (neuropathy) Confirm diagnosis with blood glucose meter RANDOM BLOOD GLUCOSE > 11.1 MMOL/L
DIABETES OUTCOME DEPENDS UPON LOCAL MEDICAL FACILITIES, PATIENT EDUCATION AND AVAILABILITY OF MEDICATION These patients need IV infusion and insulin to save their lives Enter details in record book and complete cardex register for diabetes HEALTH EDUCATION should be given immediately on diagnosis and reinforced at every visit. • Diabetes is for life. • Diabetes will never go away and if you do not look after yourself and attend medical check-ups you will become more unwell and develop complications of diabetes (see above) • Good diabetic care results in fewer diabetic complications • Diet: avoid sugar in any form eg sugary drinks;reduce fat content of food; • Exercise • Smoking STOP • Blood pressure control must be meticulous. SMOKING + DIABETES + HYPERTENSION = VERY HIGH RISK OF STROKE Are the symptoms of hyperglycaemia improved ie polydipsia, polyuria and nocturia If yes, continue with health education and review every 2 weeks. • For patients who are overweight, start metformin 500mg bd, with meals (no • If not overweight, start glibenclamide 2.5mg od 30 minutes BEFORE breakfast (THIS MAY CAUSE HYPOGLYCAEMIA AND SO INSTRUCT PATIENT TO EAT REGULAR MEALS THROUGHOUT THE DAY). Check Blood Pressure and treat if > 140/90 as per hypertension protocol Nurse sees patient every 2 weeks for medical review, BP recording, and medication
Check symptoms and compliance at each visit. If symptoms of hyperglycaemia persist • Metformin can be increased to 1g bd • Glibenclamide can be increased to 5mg od then 10mg od. Maximum 15mg od • Metformin and glibenclamide are to be prescribed together is still poor diabetic control (for further guidance refer to BNF or MIMS) • Examples • Patient is on metformin 1gm bd. Patient still has symptoms hyperglycaemia, so, add glibenclamide 2.5 mg od and increase glibenclamide to maximum of 15mg od if necessary. • Patient is on glibenclamide 15mg od. Patient still has symptoms of hyperglycaemia,so,add metformin 500mg bd and increase metformin to maximum of 1gm bd if necessary • If despite all of this, patient remains hyperglycaemic, refer to local hospital for consideration of insulin treatment to control blood sugars. Reinforce lifestyle advice at each visit It is important to examine feet for ulcers or gangrene, enquire about visual symptoms All records on clinic cardex system (computer database in the future) The diabetes clinic is to run on Fridays and as with the hypertension clinic, attendances for the clinic are to be recorded on a clip board sheet.



The Netherlands Research done by: - Annemieke Wolthuis - Mirjam Blaak With assistance of: - Kordula Braat - Sabine Brand - Stan Meuwese - Theo Noten - Sandra de Vries - Caroline Waudo DEFENCE FOR CHILDREN INTERNATIONAL SECTION THE NEDERLANDS P.O.Box 75297 1070 AG Amsterdam The Netherlands Tel: +31 20 420 3771 Fax: +31 20 420 3832 E-mail: [email protected] 1. INTRODUC

Fault / attribute chart

Attribute / Fault Chart New York State Home Winemaker’s Competition Note : Sugar classification is not critical – indicate as error in comments – judge the wine as it stands Appearance Aftertaste / Finish 1 Excellent Color 5 Excellent Nose 11 Excellent Flavor 17 Long Finish 2 Brilliant Clarity 6 Typical Nose 12 Typical Flavor 18 Very Well B

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