Diabetes Type 2

Clinical Description

• Type 2 diabetes (usually late onset but can be early onset (MODY-mature onset diabetes of the young)
• Family history of diabetes (genetic predisposition)
• Obesity also a risk factor
• Screen for secondary causes (e.g., endocrine disorders, steroids etc. as described in section 6.1)

Signs and Symptoms

• As in section 6.1

Investigations

• As in section 6.1

Non-pharmacological

• Adjustment of diet and/or weight reduction (if obese) and increased exercise may control blood glucose without the need for drug therapy.
• Wherever possible (when sugar is mild high) give a 4–6-week trial of diet before introducing oral hypoglycaemic agents. If the above is unsuccessful, then:

Pharmacological

• Give Metformin 500mg twice daily, increased to a maximum of 2500mg in divided doses.

Metformin is the drug of choice in type 2 diabetes, particularly in obese patients. It is contra- indicated in significant renal insufficiency, and severe respiratory and cardiac disease due to risk of lactic acidosis.

• If glycaemic control still poor, add Glibenclamide 5mg daily, increasing to a maximum of 10 mg q12h.

20% of type 2 diabetics eventually require Insulin treatment - use principles as in type 1 diabetes to initiate treatment. Use Lente/NPH insulin 0.3U/kg bodyweight to start with at breakfast and dinner and titrate over time according to blood glucose levels.

• General follow up plan for diabetic patients:
• Attend monthly clinics at hospital- blood glucose and/or urine should be checked.
• Check injection sites
• Ask about nocturia.
• HbA1c can be measured
• Diabetic patients should have the following annually: fundoscopy, urine microalbuminuria and thyroid function tests if available.