Diabetes management guidelines:

Blood pressure – target 130/80 mmHg

Lipid management – target cholesterol <5
1. ACE-inhibitor or diuretic Enalapril 5 mg od or
Simvastatin 10 mg od (HS) up to 40mg od
Ditide 1 T od
2. ACE-inhibitor and diuretic
3. Add Ca2+-channel blocker Amlodipine 5 mg od
4. Add β-blocker HbA1c – target <7% Atenolol 25 mg od

For Type 2 DM:

1. Oral hypoglycaemic agent Metformin 500mg bd
2. Increase dose Metformin 500mg tds
3. Increase dose Metformin 850mg tds
4. Add Sulphonylurea Gliclazide 40 – 160 mg od
5. Add Pioglitazone or consider insulin regime instead.

Guardian drugs

 Aspirin 75 mg od
Indicated for those >30 years with any of the following: MI, angina, hypertension, diabetic
retinopathy, peripheral vascular disease or microalbuminuria.

 ACE-inhibitor e.g. Enalapril 5 mg od

Prevent complications to a greater extent than the effects of lowering blood pressure.
Indicated in normotensive patients >55 years with any of the following: cholesterol > 5.2,
HDL < 0.9, smoker or microalbuminuria.

Foot examination

1. Neuropathy: vibration sense, ankle jerks, 10g monofilament testing

2. Vascularity: pedal pulses, claudication, other signs of peripheral vascular disease
3. Anatomy: check for deformities (e.g. pes cavus, claw toes, lost transverse arch, rocker
bottom soles) and Charcot’s joints
4. Infections: treat aggressively (admit for IV antibiotics)