Download this guideline as a pdf, or offline using the QuickChart EMR app for Android

Case Definition

Clinical assessment

  • Assess risk factors: >45 years, overweight,HTN/dyslipidemia, family historyD
  • Assess symptoms: polyuria, polydipsia, hunger, weight loss, fatigueA, C,D
  • Diagnose diabetes if:
    • Fasting (8hrs) BS >120-126mg/dlB,C,Don two occasionsA,B,D,
    • Random BS >200mg/dl A,B,D and/or symptomsC on two occasionsB

Red Flags

  • Urgent follow-up for random BS >400mg/dlD
  • Hospital for random BS >200mg/dl WITH hypertension, dehydration, altered mental statusD,
  • Urine for glucose, ketones or proteinsF
    • If 2+ proteinuria on 2 different days, order serum creatinine and potassium. If GFR is <30, refer to nephrology.D

Management

General recommendations

  • Record BP, pulse, BMID, check and record BS liberallyB, C,F, J
  • Monitor for complications (vision changes, diabetic neuropathy, diabetic ulcers)D, F,
  • Lifestyle changes including diet, exercise, weight lossA,D
  • Educate on signs of hypoglycemia and hyperglycemiaF

Pharmacologic treatment

  • 1st line: Metformin 500mg BIDA,B,D, F, H,I,L(may increase after a few weeksI
  • 2nd line: Sulfonylurea (glybenclamide, glyburide, glipizide, glimeprimide)B,D, F, H, I, K, L
    • Start if FBS >200 despite lifestyle changes and metforminD