PLAN Diabetes-Mellitus-Type-2
PLAN BODY
|
|
PLAN Diagnostics
PLAN BODY
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PLAN Anamnesis
PLAN BODY
do sequentially
, wait-for all
|
|
if
(or
(typical-signs = true)
(risk-factors = true)
)
|
then
glucose-determination-needed = true
|
|
else
glucose-determination-needed = false
|
|
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PLAN Anamnesis-typical-signs
PLAN BODY
do sequentially
, wait-for all
|
do any-order
, wait-for all
|
ask thirst
|
ask polyuria
|
ask weight-loss
|
|
if
(and
(age > 60)
(sex = female)
)
|
then
|
|
|
if
(or
(thirst = true)
(polyuria = true)
(weight-loss = true)
(and
(age > 60)
(sex = female)
(pruritis-vulvae = true)
)
)
|
then
|
else
|
|
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PLAN Anamnesis-olderthan-45
PLAN BODY
do sequentially
, wait-for all
|
do any-order
, wait-for all
|
ask DMT2-in-1sr-grade-relatives
|
ask hypertension
|
ask CV-diseases
|
ask fat-metabolism-problems
|
ask quetelet-index
|
ask ethnic-group
|
|
if
(sex = female)
|
then
ask DM-in-past
|
ask newborns-biggerthan-4kg
|
|
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|
if
(or
(DMT2-in-1st-grade-relatives = true)
(hypertension = true)
(CV-diseases = true)
(fat-metabolism-problems = true)
(quetelet-index >= 27)
(ethnic-group = hindustanian)
(and
(sex = female)
(or
(DM-in-past = true)
(newborns-biggerthan-4kg = true)
)
)
)
|
then
|
else
|
|
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|
PLAN Glucose-determination
PLAN BODY
do sequentially
, wait-for all
|
|
if
(glucose-evaluation = DMT2)
|
then
|
|
|
|
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PLAN Fasting-glucose-test-manual
Fasting glucose test
CONDITIONS activate-mode = manual
PLAN BODY
do any-order
, wait-for all
|
ask glucose-measurement-type
|
ask fasting-glucose
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PLAN Non-fasting-glucose-test-manual
Non-fasting glucose test
CONDITIONS activate-mode = manual
PLAN BODY
do any-order
, wait-for all
|
ask glucose-measurement-type
|
ask non-fasting-glucose
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|
|
PLAN Fasting-glucose-test
Fasting glucose test
PLAN BODY
do any-order
, wait-for all
|
ask glucose-measurement-type
|
ask fasting-glucose
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PLAN Risk-inventory
PLAN BODY
do any-order
, wait-for all
|
ask CH-diseases
|
ask CH-disease-in-youngerthan-60-1st-grade-relatives
|
ask feeding-habits
|
ask smoking
|
ask alcohol-consuming
|
ask physical-exercise
|
ask quetelet-index
|
ask higher-blood-pressure
|
ask lower-blood-pressure
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|
ask GHb
|
ask creatinin
|
Cholesterol-tests
|
Feet-examination
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Retinopathy-investigation
[-, -]
[,
6mon]
[-, -]
|
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PLAN Albumin-test
PLAN BODY
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|
PLAN Albumin-test-manual
CONDITIONS activate-mode = manual
PLAN BODY
ask albumin-in-urine
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|
PLAN Albumin-creatinin-ratio-test-manual
CONDITIONS activate-mode = manual
PLAN BODY
ask albumin-creatinin-ratio-in-urine
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|
PLAN Cholesterol-tests
PLAN BODY
do sequentially
, wait-for all
|
ask total-cholesterol
|
ask HDL-cholesterol
|
ask triglycerids
|
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PLAN Feet-examination
Perform a feet examination
PLAN BODY
user-performed
|
PLAN Retinopathy-investigation
Perform a retinopathy investigation
PLAN BODY
user-performed
|
PLAN Policy
PLAN BODY
|
|
PLAN Education-DMT2
Give information about the most important aspects of DM
PLAN BODY
user-performed
|
PLAN Treatments-and-Controls
PLAN BODY
|
|
PLAN Non-insulin-DMT2-treatments
PLAN BODY
|
|
PLAN Diet-specialist-referral
Diet specialist referral
PLAN BODY
user-performed
|
PLAN SU-derivative-treatment
PLAN BODY
do sequentially
, wait-for all
|
DMT2-treatment = antidiabetics
|
if
(quetelet-index <= 27)
|
then
ask drug-name
|
put-last drug-name in antidiabetics
|
|
else
put-last metformin in antidiabetics
|
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|
antidiabetic-doses
=
Initialise-drug-doses
(antidiabetics,
iterator-antidiabetics,
antidiabetic-doses,
iterator-antidiabetic-doses)
|
antidiabetic-doses
=
Find-antidiabetic-doses
(antidiabetics,
iterator-antidiabetics,
antidiabetic-doses,
iterator-antidiabetic-doses)
|
|
|
PLAN Initialise-drug-doses
ARGUMENTS
drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses
PLAN BODY
do sequentially
, wait-for all
|
reset-iterator iterator-drugs
|
reset-iterator iterator-drug-doses
|
go-to-next iterator-drug-doses
|
| iterative-plan |
do-repeatedly
|
ask drug-dose
|
drug-dose
go-to-next iterator-drugs
|
go-to-next iterator-drug-doses
|
termination-condition
|
is-at-end (iterator-drugs)
|
|
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RETURNS
drug-doses
|
|
PLAN Find-antidiabetic-doses
ARGUMENTS
drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses,
antidiabetic-maximal-doses
PLAN BODY
cyclical-plan
drug-doses
,...
=
Increase-drug-doses
(drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses)
|
repeat-specification
retry-delay min = 2w,
max = 4w
|
|
|
RETURNS
drug-doses
|
|
PLAN Increase-drug-doses
ARGUMENTS
drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses
PLAN BODY
do sequentially
, wait-for all
|
ask maximal-drug-doses
|
reset-iterator iterator-drugs
|
reset-iterator iterator-drug-doses
|
| iterative-plan |
do-repeatedly
|
ask drug-dose-increase
|
put-last
(
+
drug-dose-increase
get(iterator-drug-doses)
)
in aux-doses
|
go-to-next iterator-drugs
|
go-to-next iterator-drug-doses
|
termination-condition
|
is-at-end (iterator-drugs)
|
|
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RETURNS
aux-doses
,
maximal-drug-doses
|
|
PLAN SU-derivative-plus-metformin-treatment
PLAN BODY
do sequentially
, wait-for all
|
ask drug-name
|
put-last drug-name in antidiabetics
|
put-last metformin in antidiabetics
|
antidiabetic-doses
=
Initialise-drug-doses
(antidiabetics,
iterator-antidiabetics,
antidiabetic-doses,
iterator-antidiabetic-doses)
|
|
|
|
PLAN Check-for-antidiabetic-problems
ARGUMENTS
drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses
PLAN BODY
do sequentially
, wait-for all
|
ask problematic-antidiabetic
|
reset-iterator iterator-drugs
|
reset-iterator iterator-drug-doses
|
| iterative-plan |
do-repeatedly
|
go-to-next iterator-drugs
|
go-to-next iterator-drug-doses
|
termination-condition
|
(or
( = problematic-antidiabetic)
is-at-end (iterator-drugs)
|
)
|
put-last acarbose in drugs
|
ask drug-dose
|
put-last drug-dose in drug-doses
|
|
RETURNS
drugs
,
drug-doses
|
|
PLAN Insulin-DMT2-treatments
PLAN BODY
|
|
PLAN Education-insulin
Give information about insulin self-control
PLAN BODY
user-performed
|
PLAN Insulin-plus-antidiabetics-treatment
CONDITIONS activate-mode = manual
PLAN BODY
|
|
PLAN Four-points-day-curve
PLAN BODY
do sequentially
, wait-for all
|
ask fasting-glucose
|
ask after-breakfast-glucose
|
ask after-lunch-glucose
|
ask after-dinner-glucose
|
|
|
PLAN Find-evening-insulin-dose
ARGUMENTS
evening-dose
PLAN BODY
cyclical-plan
evening-dose
=
Test-glucose-and-adapt-evening-insulin
(evening-dose)
|
repeat-specification
retry-delay min = 7d,
max = 10d
|
|
|
RETURNS
evening-dose
|
|
PLAN Test-glucose-and-adapt-evening-insulin
ARGUMENTS
evening-dose
PLAN BODY
|
RETURNS
(
+
evening-doseevening-adaptation)
|
|
PLAN Change-insulin-to-2dd
ARGUMENTS
evening-dose
PLAN BODY
|
RETURNS
dd
,
evening-intake
,
morning-dose
,
morning-intake
|
|
PLAN Find-morning-insulin-dose
ARGUMENTS
morning-dose
PLAN BODY
cyclical-plan
morning-dose
=
Test-glucose-and-adapt-morning-insulin
(morning-dose)
|
repeat-specification
retry-delay min = 7d,
max = 10d
|
|
|
RETURNS
morning-dose
|
|
PLAN Test-glucose-and-adapt-morning-insulin
ARGUMENTS
morning-dose
PLAN BODY
|
RETURNS
(
+
morning-dosemorning-adaptation)
|
|
PLAN Diabetes-specialist-referral
Diabetes specialist referral for change of insulin regime
PLAN BODY
user-performed
|
PLAN Only-insulin-treatment
CONDITIONS activate-mode = manual
PLAN BODY
do sequentially
, wait-for all
|
DMT2-treatment = insulin
|
ask par-insulin-type
|
insulin-type = par-insulin-type
|
insulin-dd = 2
|
morning-insulin-dose = 12
|
morning-insulin-intake = before-meal
|
evening-insulin-dose = 6
|
evening-insulin-intake = before-meal
|
evening-insulin-dose
,...
=
Find-insulin-doses
(evening-insulin-dose,
morning-insulin-dose)
|
|
|
PLAN Find-insulin-doses
ARGUMENTS
morning-dose,
evening-dose
PLAN BODY
cyclical-plan
evening-dose
,...
=
Test-glucose-and-adapt-insulin
(evening-dose,
morning-dose)
|
repeat-specification
retry-delay min = 2d,
max = 3d
|
|
|
RETURNS
evening-dose
,
morning-dose
|
|
PLAN Test-glucose-and-adapt-insulin
ARGUMENTS
evening-dose,
morning-dose
PLAN BODY
|
RETURNS
(
+
evening-doseevening-adaptation)
,
(
+
morning-dosemorning-adaptation)
|
|
PLAN Treatment-of-CV-disease-risk-factors
PLAN BODY
|
|
PLAN Smoking-advice
Recommend strongly that the patient stops smoking
PLAN BODY
user-performed
|
PLAN Hypertension-treatment
Refer to NHG Hypertension protocol
PLAN BODY
user-performed
|
PLAN Cholesterol-treatment
Refer to NHG Cholesterol protocol
PLAN BODY
user-performed
|
PLAN Microalbuminuria-treatment
PLAN BODY
do sequentially
, wait-for all
|
ask drug-name
|
put-last drug-name in ACE-inhibitors
|
ACE-inhibitor-doses
=
Initialise-drug-doses
(ACE-inhibitors,
iterator-ACE-inhibitors,
ACE-inhibitor-doses,
iterator-ACE-inhibitor-doses)
|
ACE-inhibitor-doses
=
Find-ACE-inhibitor-doses
(ACE-inhibitors,
iterator-ACE-inhibitors,
ACE-inhibitor-doses,
iterator-ACE-inhibitor-doses)
|
|
|
PLAN Find-ACE-inhibitor-doses
ARGUMENTS
drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses,
ACE-inhibitor-maximal-doses
PLAN BODY
cyclical-plan
drug-doses
,...
=
Increase-drug-doses
(drugs,
iterator-drugs,
drug-doses,
iterator-drug-doses)
|
repeat-specification
retry-delay min = 1mon,
max = 3mon
|
|
|
RETURNS
drug-doses
|
|
PLAN Quarterly-control
PLAN BODY
do any-order
, wait-for all
|
ask wellbeing
|
ask hypoglycemia
|
ask feeding-problems
|
ask treatment-problems
|
ask weight
|
if
(or
(DMT2-treatment = insulin)
(DMT2-treatment = insulin-plus-antidiabetics)
)
|
then
|
else
|
|
do sequentially
, wait-for all
|
ask feet-problems
|
if
(feet-problems = true)
|
then
|
|
|
|
|
|
PLAN Annual-control
PLAN BODY
do any-order
, wait-for all
|
Quarterly-control
|
ask visus-problems
|
ask CV-problems
|
ask neuropathy
|
ask sexual-problems
|
ask higher-blood-pressure
|
ask lower-blood-pressure
|
Feet-examination
|
if
(or
(DMT2-treatment = insulin)
(DMT2-treatment = insulin-plus-antidiabetics)
)
|
then
|
|
|
ask GHb
|
ask creatinin
|
if
(cholesterol-treatment = false)
|
then
|
|
|
|
Funduscopy
|
|
|
PLAN Injection-points-investigation
Perform an investigation of injection points
PLAN BODY
user-performed
|
PLAN Funduscopy
Perform a funduscopy
PLAN BODY
user-performed
|
PLAN Policy-for-concurrent-diseases
PLAN BODY
|
|
PLAN Glucose-lowering-therapy-advice
Temporary increase based on blood glucose levels. Never discontinue insulin, even if less food is consumed
PLAN BODY
user-performed
|
PLAN Extra-fluid-intake-prescription
Prescribe extra fluid intake
PLAN BODY
user-performed
|
PLAN Policy-for-hypoglycemic-coma
PLAN BODY
|
|
PLAN Glucose-solution-prescription-manual
Prescribe glucose solution
CONDITIONS activate-mode = manual
PLAN BODY
user-performed
|
PLAN Glucagon-prescription-manual
Prescribe glucagon
CONDITIONS activate-mode = manual
PLAN BODY
user-performed
|
PLAN Carbohydrate-rich-feeding-prescription
Prescribe carbohydrate rich feeding
PLAN BODY
user-performed
|
PLAN Hypoglycemia-cause-investigation
Perform a investigation of hypoglycemia cause
PLAN BODY
user-performed
|
PLAN Policy-for-consultation
PLAN BODY
do sequentially
, wait-for all
|
Consultation
|
ask consultation-over
|
|
|
PLAN Consultation
Consultation
PLAN BODY
user-performed
|
PLAN Policy-for-chiropodist-referral
PLAN BODY
|
|
PLAN Chiropodist-referral
Chiropodist referral
PLAN BODY
user-performed
|
PLAN Policy-for-nurse-referral
PLAN BODY
|
|
PLAN Nurse-referral
Nurse referral
PLAN BODY
user-performed
|