I. Examination
1.Screening: fasting glucose (biochemical), 2h postprandial glucose (intravenous) or OGTT, urine 8 items.
2.Suspected: OGTT or repeat fasting and 2h postprandial glucose, glycated hemoglobin.
3.New patients.
① glycated hemoglobin, biochemistry 12.
② OGTT or bun meal (INS-CLA×5 and/or C-peptide-CLA×5, blood glucose×5, urine glucose×5), fasting and 2h postprandial glucose, INC-CLA / CP-CLA if unconditionally checked Note: INS and C-peptide must be added with suffix -CLA. fasting and 2h postprandial glucose, INC-CLA / CP-CLA if unconditionally checked
③ ICA, GAD, 24h urine albumin.
4. Follow-up: more than 1 time per month, check 3 points of rapid glucose, urine 8
Quarterly: glycated hemoglobin, biochemistry 12, 24h urine albumin. Blood pressure, weight
Every 6 months~1 year: fundus, SEP
Every year: fasting and 2h postprandial INC-CLA / CP-CLA. Carotid artery, lower limb artery ultrasound.
5. Selected investigations: EKG, UCG, Holter, HRV (heart rate variability) Brain CT.
II. Treatment requirements
1.Advise ideal weight: standard weight: standard weight = height (cm) – 105
>20% of standard weight is obese
Make the weight gradually reach ±5% of the standard weight
2.Advise the principles of diet therapy
3.Advise the principle of exercise therapy: exercise at least one hour after meals every day (half an hour-1 hour each time).
4.Advise the method of taking medication and precautions, and prevent the occurrence of hypoglycemia for those who use secretagogues and insulin.
5.Inform the standard of diabetes control
6. Inform the time of follow-up examination, review items and prescribe laboratory tests.
III. Medication principles
(A) Oral hypoglycemic drugs (non-producers)
Indications: For new onset / non-ketotic phase / obese or overweight (preferred) / mild to moderate elevation of blood sugar
(1) Metformin
Metformin 0.25×48 tablets/bottle, 0.25~0.5 tid
Gevalt (imported) 0.5×20 tablets/bottle 0.5 tid~qid
(2) a-glucosidase inhibitor (suitable for patients with good fasting blood sugar control but postprandial hyperglycemia)
Bystolic 50mg×30 tablets/box, 50~100 mg tid, chewed at the first meal.
(3) Insulin sensitizer
Vindia 4mg×7 tablets/box/, 4mg qd
(II) Oral hypoglycemic agents (pro-secretory agents)
Indications: Type 2 diabetes / moderately – severely elevated blood glucose / non-obese / non-promoter ineffective / watch out for hypoglycemia
(1) Sulfonylureas
① Glucophage (Gliquidone) 30mg×30 tablets/box, 30~60mg tid
② Damacell (Gliclazide) 80mg×60 tablets/box, 40mg~120mg bid~tid
③ Glipizide 5mg×30 tablets/box/$23.4, 2.5~10mg tid
④ Eri (Glimepiride) 2mg×8tablets/box, 1~4mg qd
⑤ Eugenol (glibenclamide) 5mg×100 tablets/box/, 2.5~10mg tid
(2) Lenexa
Novaluron 0.5~1mg×30tablets/box/, 0.5~1mg tid
(C) Failure or partial failure of oral hypoglycemic drugs
With 2 or more oral hypoglycemic drugs, of which sulfonylurea up to sub-full dose for more than 3 months, blood glucose continues to fail to meet the standard.
(FBG>8mmol/L,2hBG>12mmol/L,HBA1C>7.5)
1.Correct the influencing factors
2.Add insulin regimen: use medium-acting or mixed insulin 1~2 times/day, keep one of the original oral hypoglycemic drugs and reduce sulfonylurea by half.
3.Change to insulin therapy, daily insulin > 40u, stop sulfonylurea oral drugs.
4. For those who are not hospitalized, participate in outpatient insulin intensive therapy and prepare HBA1C, biochemistry, fasting and 2h postprandial blood glucose test results before participation.
(iv) Insulin
Domestic animal insulin: Regular insulin abbreviated as RI 400u/10ml/bottle
Long-acting insulin, abbreviated PZI 400u/10ml/bottle
Human insulin
Novolin (imported from Denmark) refill 300u/3ml/bottle: Novolin(R), Novolin(N), Novolin(30R)
Novolin(50R)
Eugenol (imported from USA) 400u/10ml/bottle: Eugenol(R), Eugenol(N), Eugenol(70/30)
Refill 300u/3ml/bottle: Eugenol (R), Eugenol (N), Eugenol (70/30)
Indications: Type 1 diabetes mellitus
Type 2 diabetic ketoacidosis, hyperosmolar coma, lactic acidosis
Stressful conditions: surgery, trauma, myocardial infarction, stroke, severe infection, etc.
Type 2 diabetes combined with chronic comorbidities in the progressive phase
Type 2 diabetes mellitus not well treated with oral medication
Gestational diabetes
IV. Other medications
(A) Antihypertensive drugs.
1. ACEI class (preferred dual channel): Lodinexin 10mg×14 tablets/box, 10mg qd
Monnot 10mg×14 tablets/box, 10mg qd
2, ARB class: Coxua 50mg×7 tablets/box, 50~100mg qd
Dynavin 80mg×7 tablets/box/$51.6
3.Calcium antagonists: Nifedipine 10mg×100 tablets, 10mg tid, Nifedipine extended release tablets, 10mg bid, Loxodipine 5mg×7 tablets, 5mg qd, Byxin with 30mg×7 tablets, 30mg qd.
4.Diuretics: Shoubishan 2.5mg×30 tablets/box, 2.5mg qd
Efficacy assessment: blood pressure ≤ 130/80mmhg
Note: qd is once a day, bid is twice a day, tid is three times a day.