Diagnosis and treatment protocols for Diabetes Mellitus in Uganda

Type 1 DM

Insulin SC: 0.6-1.5 IU/kg/day. Children <5 years: start with 0.5 IU/Kg/day and refer to paediatrician.

Lifestyle Modifications

Diabetic diet, weight loss if overweight, regular exercise, moderate/no alcohol, smoking cessation.

Management of Risk Factors

Hypertension: target BP 120/80 (first line: ACE inhibitors e.g. enalapril). Dyslipidaemia: Statin (Atorvastatin 20-40 mg) if age >40 or CVD present.

Management of Complications

Aspirin 75-100 mg/day for IHD/stroke. Amitriptyline 10-25 mg at night for peripheral neuropathy.

Type 2 DM (Non-pharmacological failed)

Start Metformin 500 mg daily or twice daily (max 1g 12 hourly) if BMI >25. If BMI <25, consider Glibenclamide 2.5-5 mg daily (max 15 mg).

Type 2 DM (Triple therapy failure)

If Metformin + Sulphonylurea fail, add NPH Insulin 10 IU in the evening. Increase by 4-5 IU/weekly until targets reached.