| What is the nature of the guidelines provided in the STWs? | advisory, and are based on expert opinions and available scientific evidence. | These STWs have been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit our web portal (stw.icmr.org.in) for more information. | 174 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. | 3 | page=3,block=1 | 0.700 | valid |
| What determines the insulin doses for managing uncontrolled hyperglycemia? | depending on age and pubertal status | Uncontrolled hyperglycemia For education of patient & family For insulin injection techniques/ SBGM/ identifying hypoglycemia s/s Recurrent hypoglycemia Severe diabetic ketoacidosis (altered sensorium, rapid breathing) Chronic diabetes specific complications Insulin administration (0.25 to 1.0U/kg depending on age and pubertal status) ∙ Basal: glargine or detemir or NPH 40-50% of daily requirement ∙Bolus: regular or rapid acting 50% of daily requirement/3 injections before each meal Insulin doses can be adjusted depending upon 1. | 299 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | Uncontrolled hyperglycemia For education of patient & family For insulin injection techniques/ SBGM/ identifying hypoglycemia s/s Recurrent hypoglycemia Severe diabetic ketoacidosis (altered sensorium, rapid breathing) Chronic diabetes specific complications Insulin administration (0.25 to 1.0U/kg depending on age and pubertal status) ∙ Basal: glargine or detemir or NPH 40-50% of daily requirement ∙Bolus: regular or rapid acting 50% of daily requirement/3 injections before each meal Insulin doses can be adjusted depending upon 1. |
| What determines variations in the management of individual patients according to the STWs? | his/her specific condition, as decided by the treating physician. | These STWs have been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit our web portal (stw.icmr.org.in) for more information. | 328 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. | 3 | page=3,block=1 | 0.700 | valid |
| What type of fractures might indicate an underlying condition if caused by minimal trauma? | fractures resulting from trivial trauma or fall from a standing height or less | Ultrasound abdomen, gall stones, renal stones and nephrocalcinosis, Ultrasound neck, enlarged parathyroid Sestamibi scan for parathyroid enlargement • To be suspected in fractures resulting from trivial trauma or fall from a standing height or less • For example fracture neck of femur, forearm fracture (Colle’s), vertebral fracture | 170 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | Ultrasound abdomen, gall stones, renal stones and nephrocalcinosis, Ultrasound neck, enlarged parathyroid Sestamibi scan for parathyroid enlargement • To be suspected in fractures resulting from trivial trauma or fall from a standing height or less • For example fracture neck of femur, forearm fracture (Colle’s), vertebral fracture | 11 | page=11,block=6 | 0.700 | valid |
| How should meal and snack planning be tailored for people with diabetes? | Meals/snacks to be individualized and reflect insulin schedule (usually 3 meals, 2 snacks) | Pre-meal and post-meal glucose level 2.Carbohydrates in the meal 3.Excercise pattern NUTRITION ∙ Calories should be appropriate to the expected body weight, pubertal status, activity ∙ Balanced diet including all food groups ∙ Simple sugars and excessive fats to be avoided ∙ Meals/snacks to be individualized and reflect insulin schedule (usually 3 meals, 2 snacks) REGULAR EXERCISE ∙ Beneficial and should be encouraged EDUCATION ∙ Emphasize diabetes related education to patient and caregivers COMPLICATIONS & COMORBIDITIES (5 YEARS AFTER DIAGNOSIS, THEN ANNUALLY) • Fundus examination (Retinopathy) • Foot examination (Neuropathy) • Urine albumin/creatinine ratio • Other investigations (S-creatinine, TSH), lipid profile EVERY THREE MONTHS • Glycated hemoglobin (HbA1c) • Target: <7% (should be individualized) | 276 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | Pre-meal and post-meal glucose level 2.Carbohydrates in the meal 3.Excercise pattern NUTRITION ∙ Calories should be appropriate to the expected body weight, pubertal status, activity ∙ Balanced diet including all food groups ∙ Simple sugars and excessive fats to be avoided ∙ Meals/snacks to be individualized and reflect insulin schedule (usually 3 meals, 2 snacks) REGULAR EXERCISE ∙ Beneficial and should be encouraged EDUCATION ∙ Emphasize diabetes related education to patient and caregivers COMPLICATIONS & COMORBIDITIES (5 YEARS AFTER DIAGNOSIS, THEN ANNUALLY) • Fundus examination |
| What is the importance of regular exercise in managing diabetes? | Beneficial and should be encouraged | Pre-meal and post-meal glucose level 2.Carbohydrates in the meal 3.Excercise pattern NUTRITION ∙ Calories should be appropriate to the expected body weight, pubertal status, activity ∙ Balanced diet including all food groups ∙ Simple sugars and excessive fats to be avoided ∙ Meals/snacks to be individualized and reflect insulin schedule (usually 3 meals, 2 snacks) REGULAR EXERCISE ∙ Beneficial and should be encouraged EDUCATION ∙ Emphasize diabetes related education to patient and caregivers COMPLICATIONS & COMORBIDITIES (5 YEARS AFTER DIAGNOSIS, THEN ANNUALLY) • Fundus examination (Retinopathy) • Foot examination (Neuropathy) • Urine albumin/creatinine ratio • Other investigations (S-creatinine, TSH), lipid profile EVERY THREE MONTHS • Glycated hemoglobin (HbA1c) • Target: <7% (should be individualized) | 386 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | Pre-meal and post-meal glucose level 2.Carbohydrates in the meal 3.Excercise pattern NUTRITION ∙ Calories should be appropriate to the expected body weight, pubertal status, activity ∙ Balanced diet including all food groups ∙ Simple sugars and excessive fats to be avoided ∙ Meals/snacks to be individualized and reflect insulin schedule (usually 3 meals, 2 snacks) REGULAR EXERCISE ∙ Beneficial and should be encouraged EDUCATION ∙ Emphasize diabetes related education to patient and caregivers COMPLICATIONS & COMORBIDITIES (5 YEARS AFTER DIAGNOSIS, THEN ANNUALLY) • Fundus examination |
| What is the purpose of formulating treatment algorithms for medical and surgical conditions? | for both outdoor & indoor patient management at primary, secondary and tertiary levels of India’s healthcare system | To formulate treatment algorithms for common and serious medical & surgical conditions for both outdoor & indoor patient management at primary, secondary and tertiary levels of India’s healthcare system that are scientific, robust and locally contextual. • Participation also from Public Health Specialists Search Strategists Graphic Designers • Review by Editorial Board • Approval by Advisory Committee • Prevalence studies • Global burden of diseases studies • HBP of AB-PMJAY Output ADVISORY COMMITTEE ICMR STW Team Speciality wise Expert Committees Editorial Board Book Web Portal Mobile Apps | 87 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | To formulate treatment algorithms for common and serious medical & surgical conditions for both outdoor & indoor patient management at primary, secondary and tertiary levels of India’s healthcare system that are scientific, robust and locally contextual. | 6 | page=6,block=11 | 0.700 |
| What is the recommended fluid replacement strategy after diabetic ketoacidosis is resolved? | 1 l of 0.9% saline over first hour followed by 250-500 ml/hour | • After resolution of DKA: Blood glucose monitoring every 4 hours • Replace fluids – 1 l of 0.9% saline over first hour followed by 250-500 ml/hour (10-20ml/kg/hour initially for children) • Administer regular insulin – 0. IU/kg IV then 0. | 85 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | • After resolution of DKA: Blood glucose monitoring every 4 hours • Replace fluids – 1 l of 0.9% saline over first hour followed by 250-500 ml/hour (10-20ml/kg/hour initially for children) • Administer regular insulin – 0. | 10 | page=10,block=26 | 0.700 | valid |
| What is the suggested treatment for acute severe hyponatremia that has lasted less than 48 hours? | Emergency correction with hypertonic 3% saline 1-2 ml/kg/hr until safe Na target to a total 4-6m/M | Severe hyponatremia treatment Acute < 48 hours Emergency correction with hypertonic 3% saline 1-2 ml/kg/hr until safe Na target to a total 4-6m/M, this modest increase is sufficient to alleviate severe symptoms. After that corrective guidelines chronic hyponatremia are appropriate Chronic/Unknown ( > 48 hours ) Correction with 3% saline@ 0.5-1ml/kg/hour till resolution of symptoms or until safe Na target Correction* not > 8-10 mM within first 24 hours Oral Tolvaptan 15 mg on day one and then 30-60 mg per day if serum Na remains below 135 or rise is less than 5 mmol per 24 hours. 6 -8 hourly monitoring of serum Na to be done Duration? | 47 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | Severe hyponatremia treatment Acute < 48 hours Emergency correction with hypertonic 3% saline 1-2 ml/kg/hr until safe Na target to a total 4-6m/M, this modest increase is sufficient to alleviate severe symptoms. | 12 | page=12,block=20 | 0.700 |
| What is the ultimate objective of empowering healthcare physicians and surgeons as stated by the Ministry of Health and Family Welfare? | achieving the overall goal of Universal Health Coverage | Ministry of Health and Family Welfare, Government of India To empower the primary, secondary and tertiary health care physicians/surgeons towards achieving the overall goal of Universal Health Coverage with disease management protocols and pre-defined referral mechanisms by decoding complex guidelines. | 146 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1733214641_endocrinology.pdf | Ministry of Health and Family Welfare, Government of India To empower the primary, secondary and tertiary health care physicians/surgeons towards achieving the overall goal of Universal Health Coverage with disease management protocols and pre-defined referral mechanisms by decoding complex guidelines. | 6 | page=6,block=11 | 0.700 | valid |