I. Acute complications of diabetes such as diabetic ketoacidosis, diabetic non-ketotic hyperosmolar syndrome, lactic acidosis, diabetic hypoglycemia, etc. If there is a confirmed or suspected appeal, emergency treatment should be done and referral should be made as soon as possible.
After referral, the patient’s condition should be stabilized by rehydration, electrolyte supplementation, acid correction, etc. After that, insulin should be used to control blood glucose, improve relevant auxiliary examinations, understand the complications, and develop individualized treatment plans for referral back to the community.
II. Chronic complications of diabetes
1. Eye.
a Sudden vision loss after referral to give assessment of the condition, insulin to control blood glucose, and ask ophthalmology to assist in consultation and treatment, blood glucose stabilization, ophthalmology treatment after referral back to the community.
b gradual blurring of vision or loss of vision, referred to the same a
cNo blurred vision or vision loss but fundus examination reveals abnormalities, community intensive control of blood glucose examination reveals abnormalities. (Referral for insulin therapy is possible if requested by the patient)
2. Kidney.
aPatients with bilateral lower extremity edema and stage IV-V diabetic nephropathy on laboratory examination, referred to insulin therapy to reduce urine protein, lower blood creatinine urea nitrogen, balance blood glucose and blood pressure, and then referred back to the community after the condition is stabilized.
b Patients without bilateral lower limb edema and stage III-IV diabetic nephropathy with laboratory tests were referred and given insulin or Repaglinide to control blood glucose or ARB drugs to reduce proteinuria and protect the kidney according to the patient’s specific condition. If the patient does not agree to be hospitalized, our experts will consult and develop an individualized treatment plan for treatment and regular checkups in the community.
3. Macrovascular.
a Sudden cardiovascular and cerebrovascular events and lower limb pain sensory abnormalities and intermittent claudication, extremity gangrene, immediate referral to give insulin to control blood glucose and request consultation with specialists in cardiology and neurology, after the condition is stabilized and individualized treatment plan is formulated, refer back to the community.
b ECG shows myocardial ischemia, ultrasound shows plaque formation, the patient has no obvious discomfort, individualized treatment can be formulated, community follow-up (referral is possible if the patient requests).
4.Neuropathy.
a clinical neuropathy, after referral, give nutritional nerve, insulin to control blood sugar, and refer back to community follow-up after the condition is stable.
b subclinical neuropathy, no obvious clinical symptoms, only abnormalities found in neurophysiological examination, community hospital inpatient or outpatient insulin treatment (patient request can be referred).
C. Diabetes mellitus requiring surgical treatment should be referred to our department for diabetes mellitus-related evaluation and insulin control after stable blood glucose, and then transferred to surgery, and after surgery should be transferred to our department for active blood glucose control and stable blood glucose treatment to the community.
Pregnant and lactating women should be referred to our department for individualized plan, diet, exercise and insulin to strengthen blood sugar control, strengthen diabetes management, improve the examination of all complications, refer back to the community for follow-up after blood sugar stabilization, refer to our department before and after delivery, pay attention to blood sugar and insulin related level.
V. Adverse reactions that cannot be explained or handled after taking oral hypoglycemic drugs.
Diabetes mellitus combined with hypertension: 1 Poor blood pressure control after using antihypertensive medication, exclude secondary hypertension after referral, adjust medication to actively control blood pressure. 2 Hypertensive crisis, first emergency treatment before referral, give active control after referral, and clarify the cause.
Seven, oral hypoglycemic drugs or insulin application poor blood sugar control: 1 unexplained recent increase in blood sugar, after referral to exclude infection stress and other factors that induce blood sugar increase, and actively control blood sugar. 2 a variety of oral hypoglycemic drugs are ineffective, after referral to insulin control blood sugar, blood sugar stabilization and then referred back to the community for follow-up.