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                Investigations protocol

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[Screening for diabetes] [High risk group] [Diagnosis guidelines] [Criteria for diagnosis] [Investigations protocol] [Diabetes in pregnancy] [Targets for control] [Diet Advise] [Exercise] [Complications] [Management] [Drug action]

 

Protocol

 

 

                                    History          Examination      Investigations

 

 

Initial visit.

Comprehensive history is essential including:

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Symptoms and any laboratory test results related to diagnosis.

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Dietary habits, previous nutritional status and weight history.

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Details of previous treatment regimens, if any.

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Current treatment schedule , if not newly diagnosed; this includes diet prescriptions, exercise schedules, medications, previous and recent laboratory reports and results of self monitoring.

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History of any acute complications like hypoglycemia, ketosis, including frequency, severity and cause, if known.

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Prior or current infections, especially foot problem, Tuberculosis, recurrent urinary tract infections.

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Symptoms associated with chronic diabetic complications, including previous treatment, if any.

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Previous or current symptoms of macro vascular involvement.

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Presence of associated conditions like hypertension, lipid disorders, smoking.

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Other medical illnesses.

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Medication which may affect glucose tolerance.

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Psychological, social and economic factors which may have a bearing on management.

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Family history of diabetes and other illnesses.

 

Physical Examination.

Complete physical examination must be carried out with emphasis on:

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Height and Weight, Waist-Hip ratio.

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Blood pressure.

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Foot inspection.

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Detailed eye examination including retina (fundoscopy with dilated pupils)

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Examination, to look for long term complications of diabetes.

 

Biochemical and other tests.

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Hb, Complete blood count, ESR. (for existing infections, tuberculosis)

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Blood glucose: Fasting and Postprandial. (to assess recent diabetic control)

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Glycosylated hemoglobin levels. (to assess average diabetic control over last 3 months)

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Fasting Lipid Profile: Total Cholesterol, LDL Cholesterol, VLDL Cholesterol, HDL Cholesterol, Triglycerides. (high association of lipid abnormalities and diabetes).

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Serum Creatinine, blood urea. (to assess renal-kidney function and complications)

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Serum electrolytes. (salts of body)

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Serum Uric acid.

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Complete urine examination-especially glucose, ketones, albumin, infection.

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Test for Microalbuminuria. (if positive then first sign of kidney damage in diabetes) 

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Urine culture and sensitivity if, infection present.

 

ECG, Chest X-ray.

 

Education
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Set and discuss target levels.

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Plan and explain management strategy.

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Individualized dietary and exercise prescription.

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Explain drug therapy if initiated.

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Start education programme.

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Teach self monitoring.

 

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Every three months.

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History

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Assess result of self monitoring.

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Discuss adjustments to therapy made by the patient, if any.

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Examine frequency, causes and severity of hypoglycemic (low blood sugar) episodes or severe hyperglycemia (high blood sugar), if any.

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Discuss problems with adherence to the management plan.

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Examine diet and exercise compliance.

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Symptoms suggesting development of any chronic complications or macro vessel involvement.

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Current medication.

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Physical examination similar to that during the initial visit.

 

Biochemical investigations.

Blood glucose: Fasting and Postprandial. (to assess recent diabetic control)

Glycosylated hemoglobin levels. (to assess average diabetic control over last 3 months).

Routine urine examination as initially.

Any other biochemical parameters, if initially abnormal.

(assess whether target goals have been reached; if not, examine causes of failure to reach target levels).

 

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Annual check up.

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Complete evaluation and biochemical tests as at initial visit.

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Check self monitoring technique.

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Reevaluate target levels.

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Assess therapy.

 

Note

The investigations listed, frequency of follow-ups and type of investigations need to be individualized.

 

Diabetic comprehensive checkup includes

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Blood counts (Hb, TLC, DLC, ESR)

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Sugar Fasting and Post Prandial

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Glycosylated hemoglobin (average 3 months control of diabetes)

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Kidney function tests (KFT)-Urea, Creatinine, BUN, Uric acid

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Liver function tests (LFT)-Bilirubin, SGOT, SGPT, Alk Phosphatase, Proteins-Total, Albumin, Globulin.

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Salts (electrolytes)-Sodium, Potassium, Chloride, Bicarbonate, Calcium.

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All Cholesterols (Lipid profile) - Total cholesterol, LDL, HDL, VLDL, Triglycerides, Cardiac risk factors.

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Amylase (pancreas)

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Thyroid Profile (T3 T4 TSH)

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Urine Routine / Microscopy

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Micro albumin (to detect early kidney damage)

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ECG & Cardiac risk assessment.

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Misc: Insulin levels, Echocardiography, Doppler studies, TMT, Angiography.
 

 

 

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