Clinical Decision Making Guide Subjective Research Proposal

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A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes. OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water.

If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type 2 diabetes but do not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes. Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral glucose tolerance test on a different day.

C.

Medical therapeutics/Nursing therapeutics, prescriptions with rational for each treatment and appropriate references

D.

Patient education with references: On each physician visit, the patient should be evaluated for symptoms or signs of complications, together with a check of the feet and the pulses and sensation in the feet and legs, and a urine test for albumin.

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The BUN or serum creatinine levels should be assessed regularly (at least yearly), and an ECG and complete ophthalmologic evaluation should be performed at least yearly. Coexistent hypertension or hypercholesterolemia increases the risks for specific late complications and requires special attention and appropriate treatment.

Psychological problems are frequently seen in children and adolescents with IDDM and their families as a result of the associated stresses, and professional assistance is often helpful. Because there is an increased risk of acute renal failure in diabetics, x-ray studies that require IV injection of contrast dyes should be performed only when absolutely necessary and only when the patient is well hydrated.

Although ss-adrenergic blockers (eg, propranolol) can be used safely in most diabetics, they can mask the ss-adrenergic symptoms of insulin-induced hypoglycemia and delay an appropriate patient response. In some insulin-treated patients, they can contribute to severe hypoglycemia by impairing the normal counter regulatory response.

Diabetes and pre-diabetes are diagnosed by checking blood glucose levels. Many people with pre-diabetes develop type 2 diabetes within 10 years. If you have pre-diabetes, you can avoid type 2 diabetes with a low-fat, low-calorie diet, reserved weight loss, and normal physical activity.

If you are 45 or older, you should consider getting tested for diabetes. If you are 45 or older and overweight, it is strongly suggested that you get tested. If you are younger than 45, are overweight, and have one or more of the risk factors, you should consider testing.

E.

Counseling (when appropriate) NA

F.

Health promotion/health maintenance/Anticipatory Guidance: Follow a low-fat, low-calorie diet, lost a modest amount of weight, and engaged in regular physical activity like walking briskly for 30 minutes, five times a week and sharply reduced their chances of developing diabetes.

G.

Referral (when appropriate) NA.....

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