• Diabetes not controlled: add + increase metformin slowly- normal advice re GI SE/action- call if any problems.
  • Diabetes not controlled: increase metformin slowly- normal advice re GI SE/action- call if any problems.
  • Diabetes not controlled: add SU- normal advice re hypo risk/action: TREND hypo leaflet given, doesn’t drive- call if any problems. hypo-leaflet.pdf
  • Diabetes not controlled: increase SU- normal advice re hypo risk/action: TREND hypo leaflet given, doesn’t drive- call if any problems. hypo-leaflet.pdf
  • Diabetes not controlled: add SU- normal advice re hypo risk/action/driving : TREND hypo + driving leaflets given- call if any problems. Driving_leaflet-v3[1].pdf
  • Diabetes not controlled: increase SU- normal advice re hypo risk/action/driving : TREND hypo + driving leaflets given- call if any problems. Driving_leaflet-v3[1].pdf
  • Diabetes not controlled: add gliptin – normal advice re new medication/SE/panc risk- advised read leaflet- call if any problems.
  • take one daily. Contact the surgery and speak to the doctor if you get back / abdominal pain
  • Diabetes not controlled: add gliflozin – normal advice re new medication and risks and SE (GU symptoms, ^urine output, dehydration, UTI , Thrush, amputation risk, Fourniers gangrene, Euglycaemic DKA signs and symptoms as per BNF etc) – advised read leaflet- seek advice early if any problems. SGLT2i patient information leaflet with sick day guidance.pdf
    • Informed of the signs and symptoms of DKA: including rapid weight loss, nausea or vomiting, abdominal pain, fast and deep breathing, sleepiness, a sweet smell to the breath, a sweet or metallic taste in the mouth, or a different odour to urine or sweat > contact us/111 ASAP.
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  • Refusing Rx increase/changes advised re risks MI/CVA/renal failure/retinal disease- accepts and understand risk and competent to refuse
  • Repeat bloods in 3/12 and ring for results.

  • For standard-release metformin tablets:
    • One tablet with evening meal for at least 1 week, then One tablet with breakfast and One tablet with evening meal for at least 1 week, then One tablet with breakfast and Two tablets with evening meal for at least 1 week, then thereafter Two tablets with breakfast and Two with the evening meal.
  • For modified-release metformin tablets:
    • Initially One tablet once daily, then increased slowly up to Four tablets once daily, dose increased gradually, every 10–15 days, dose to be taken with the evening meal.
    • Alternatively, dose increased to 1 g twice daily, dose to be taken with meals, alternative dose only to be used if control not achieved with once-daily dose regimen. If control is still not achieved, then change to standard-release tablets.
  • – Add gliflozin – normal advice re new medication and risks and SE (GU symptoms, ^urine output, dehydration, UTI , Thrush, amputation risk, Fourniers gangrene, Euglycaemic DKA signs and symptoms as per BNF etc) – advised read leaflet- seek advice early if any problems. SGLT2i patient information leaflet with sick day guidance.pdf
  • – Informed of the signs and symptoms of DKA: including rapid weight loss, nausea or vomiting, abdominal pain, fast and deep breathing, sleepiness, a sweet smell to the breath, a sweet or metallic taste in the mouth, or a different odour to urine or sweat > contact GP/111 ASAP.
  • BP not to target: rpt in 4/52 and treat if still above target.
  • BP not controlled: add ACEI- normal advice re SE/risks- check U+E in 2/52 and ring for results and review BP in 4/52.
  • BP not controlled: increase ACEI- check U+E in 2/52 and ring for results and review BP in 4/52.
  • BP not controlled: add CCB- normal advice re SE/risks- review BP in 4/52.
  • BP not controlled: increase CCB- review BP in 4/52.
  • BP not controlled: add/increase diuretic/doxazosin- normal advice re SE/risks- rpt in 4/52.

Ramipril → Amlodipine → Indapamide

  • Step 1: Today – start Ramipril 2.5mg – rpt U+E in 2/52 and review in 4 weeks – if bloods normal and HBPM/standing BP above target move to next step
  • Step 2: 4 weeks – if no contra-indications – increase Ramipril to 5mg – rpt U+E in 2 weeks and review BP in 4 weeks – if bloods normal and HBPM/standing BP above target move to next step
  • Step 3: 8 weeks – if no contra-indications – increase Ramipril to 10mg – rpt U+E in 2 weeks and review BP in 4 weeks – if bloods normal and HBPM/standing BP above target move to next step
  • Step 4: 12 weeks – if no contra-indications – add Amlodipine 5mg and review BP in 4 weeks – if HBPM/standing BP above target move to next step
  • Step 5: 16 weeks – if no contra-indications – increase Amlodipine to 10mg and review BP in 4 weeks – if HBPM/standing BP above target move to next step
  • Step 6: 20 weeks – if no contra-indications – add Indapamide 2.5mg and review BP in 4 weeks – if HBPM/standing BP above target REFER TO GP for review

Losartan → Amlodipine → Indapamide

  • Step 1: Today – start Losartan 50mg – rpt U+E in 2 weeks and review BP in 4 weeks – if bloods normal and HBPM/standing BP above target move to next step
  • Step 2: 4 weeks – if no contra-indications – increase Losartan to 100mg – rpt U+E in 2 weeks and review BP in 4 weeks – if bloods normal and HBPM/standing BP above target move to next step
  • Step 3: 8 weeks – if no contra-indications – add Amlodipine 5mg and review BP in 4 weeks – if HBPM/standing BP above target move to next step
  • Step 4: 12 weeks – if no contra-indications – increase Amlodipine to 10mg and review BP in 4 weeks – if HBPM/standing BP above target move to next step
  • Step 5: 16 weeks – if no contra-indications – add Indapamide 2.5mg and review BP in 4 weeks – if HBPM/standing BP above target REFER TO GP for review