Initial management of the patient with newly diagnosed diabetes.

A family physician is often the one who makes an initial diagnosis of diabetes. The physician must consider the impact of this diagnosis on both the patient and the patient's family members. Outpatient management is less costly and less traumatic for the patient than inpatient care. Initial management goals are control of hyperglycemia, correction of fluid and electrolyte imbalances, and avoidance of hypoglycemia. For patients with type I (insulin-dependent) diabetes, the initial insulin dosage ranges from 0.25 to 1.0 U per kg per day. For patients with type II (non-insulin-dependent) diabetes, standard therapy begins with dietary modifications, exercise and an oral hypoglycemic agent, if needed. Insulin is indicated in patients with type II diabetes during times of acute stress, infection, surgery and pregnancy, and if the patient is allergic to sulfonylureas. Initially, patients only need to have a basic understanding of glucose monitoring, medications, diet and symptoms of hypoglycemia. Simple instructions can help the patient achieve glycemic control without being overwhelmed with information. As the patient learns more about diabetes and the treatment regimen, therapy can become more intensive.