Name: abdiaziz mahamud dahir

Module 1 :case 1

Discussion question (1)

1: How frequently do you currently screen for diabetes in your

patients ?
ANS: if the patient is symptomatic or has strong family history we
screen them for diabetes immediately otherwise ones a year
2: what techniques do you use to screen for diabetes in your
patients ?
ANS: FPB, PPG, Hb1AC,
3: what are the some challenges associated with identifying and
treating diabetes patients in your clinic?

ANS: there are challenges from the patients : like financial burden
which prevents patients to come the hospital for screening, to
purchase the appropriate medications and proper follow up, lack of
education and awareness of patients.
There is also health care facilities factors: like lack of resources and
tools for screening diabetes .
Health care workers challenges: lack of training for diabetes
management , limited number of health care providers.

Discussion question (2)

1 . how frequently do see patients like this ?
ANS: very often almost every diabetic clinic

2.in relation IDF glycemic targets is mrs .L considered to be

maintaining good gylcemic control ?
ANS: No, infact her glycemic control is poor based her Hb1Ac
3. if the patient remains untreated ,what complications might arise
from her diabetes
ANS: acute complication: DKA,HHS,sepsis,
Chronic complications: CAD,PAD,s CVS, diabetic nephropathy ,
diabetic retinopathy, diabetic neuropathy,

 Patient management plan:

 Patient education on diabetes ,management and its

complications,
 Lifestyle modification should be educated about importance of
aerobic exercises, weight reduction if the patient is overweight or
obese, avoidance of foods with glycaemic index ,cessation of
smoking and alcohol ,
 Bp management with oral anti-hypertensives namely with ACE-
I,add second drug bp remains high either CCB/TZD,
 OAD start of metformin 500mg bd and uptitrate it to 1g bd if
needed , introduce 2nd OAD if good glycemic control not achieved
with above measures e.g SUI,SGLT2 inhibitors
 ASCVD primary prophylaxis with statins
 Hb1aAc monitoring 3-6 monthly
 Ophthalmologist review for diabetic retinopathy screening

 Prescription
 Metformin 500mg bd
 Enalapril 5mg od
 Atorvastatin 20mg nocte
 Empagliflozin 10mg od

 Patient follow-up
 TC A two weekly follow-up with FPG /PPG , HBP
diaries ,and other desired investigation like uec’s till patient
achieves targeted glycemia after which we do 2-3 monthly
follow-up.

 Maintain above plan if FPG/PPG, HBP, Hb1A are normal

 Patient instructions :
  Lifestyle and diet modification
 weight reduction
 regular aerobic exercises
 drug adherence
 strict follow up of doctors and nutritionist
instructions
 cessation of alcohol and smoking cigarettes
 hypoglycemia awareness and how to manage it

Discussion question (3)

1. how frequently so you see your diabetes patients ?

ANS: twiceevery month for patient with unstable hyperglycaemic

control and every 2-3months for patients with controlled

2. is patient follow-up an issue ? if so why?

Ans: yes, money patient cannot afford the hospital fee therefore lose
follow-up, due lack of awareness and education money patients
either discontinue or poorly adhere on medications .