Dawaa Reference

chronic

Type 1 Diabetes Mellitus

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Egyptian National Drug Formulary - Endocrine, insulin monograph, Dosage Regimen, type 1 diabetes mellitus · Type 1 Diabetes - StatPearls, updated 5 October 2024 - https://www.ncbi.nlm.nih.gov/books/NBK507713/ · Type 1 Diabetes - StatPearls - NCBI Bookshelf - disease-level clinical article (type-1-diabetes-full.txt)

Verified against4 documents
  • Egyptian National Drug Formulary - Endocrine, insulin monograph, Dosage Regimen, type 1 diabetes mellitus
  • Type 1 Diabetes - StatPearls, updated 5 October 2024 - https://www.ncbi.nlm.nih.gov/books/NBK507713/
  • No dose - referral pathway, no medicine given in primary care
  • Type 1 Diabetes - StatPearls - NCBI Bookshelf - disease-level clinical article (type-1-diabetes-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Classic opening picture: passing lots of urine, heavy thirst, tiredness and weight coming off [fatigue]
  • Some arrive acutely in ketoacidosis rather than with a gradual build-up
  • Sudden visual disturbance or perineal thrush can be the presenting complaint
  • In adults the first label given is sometimes type 2 before the true type is recognised

Signs — what you find (4)

  • Foot check may reveal early neuropathy, deformity, pre-ulcer skin change, frank ulcers, callus or fungal nails [visible deformity]
  • A failed 10-g monofilament test marks a raised chance of foot ulceration
  • Fat change at injection or pump sites means the patient needs to rotate where insulin goes in
  • Vibration and protective sensation both need testing at the foot check

Tests (11)

  • Fasting plasma glucose reaching 126 mg/dL, seen on more than a single occasion
  • Random plasma glucose from 200 mg/dL upwards together with typical hyperglycaemic symptoms
  • Two hours after a 75-g glucose load, a value of 200 mg/dL or more
  • HbA1c of 6.5% or above meets the threshold
  • Where hyperglycaemia is not clear-cut, two abnormal results are needed to confirm
  • Pancreatic autoantibodies and stimulated C-peptide separate this from other forms; C-peptide reflects beta-cell function
  • Most have at least one positive antibody when first diagnosed
  • Repeat HbA1c three-monthly at follow-up to judge control
  • If not done in the last year: lipids, creatinine, urine albumin-to-creatinine ratio, liver tests, TSH, full blood count and potassium
  • Potassium matters especially when an ACE inhibitor, ARB or diuretic is being taken
  • Consider looking for coexisting autoimmune disease: thyroid, coeliac, adrenal failure, rheumatoid arthritis

If not this — what else fits (7)

  • Type 2 diabetes
  • Monogenic diabetes
  • Cystic fibrosis-related diabetes
  • Chronic pancreatitis
  • Diabetes after transplantation
  • Steroid-induced diabetes
  • Psychogenic polydipsia

SourceStatPearls "Type 1 Diabetes" - disease-level clinical article

Presentation findings are traced to the source above.

1

INSULIN (BASAL-BOLUS REGIMEN)

1st line

Forminjection

Adult dose and duration

Basal insulin is one-third to one-half of the total daily insulin dose; the remainder is given as rapid- or short-acting insulin before meals. The total daily dose is set and titrated by the diabetes service, not from this screen. - Lifelong

Paediatric dose

Children are managed by a paediatric diabetes service. Doses change with growth, puberty and activity, and are not reproduced here.

Dose source

Egyptian National Drug Formulary - Endocrine, insulin monograph, Dosage Regimen, type 1 diabetes mellitus

Why

Type 1 diabetes is autoimmune destruction of the insulin-producing cells, so insulin is replacement, not control - it can never be stopped and no oral agent substitutes for it. The split above is the Egyptian formulary's own, quoted verbatim; the total daily dose is deliberately not given here because it is individualised and specialist-set.

Cautions
  • NEVER STOP INSULIN, including when the patient is not eating. Stopping during an illness is the commonest route into diabetic ketoacidosis - see [Diabetic Ketoacidosis].
  • Metformin and the other type 2 agents do NOT treat type 1. The type 2 diabetes entry is a different disease.
  • New diagnosis needs same-week specialist referral, and same-day if there are ketones, vomiting or weight loss.
  • Hypoglycaemia is the price of tight control: confirm the patient and family can recognise and treat it before intensifying anything.
  • Distinguishing type 1 from type 2 in an adult can need autoantibodies (GAD65, IA-2, ZnT8) - StatPearls lists these and adult-onset type 1 is regularly misdiagnosed as type 2.
  • Egyptian pharmacies stock human insulins (soluble and isophane, and 70/30 mixes) far more cheaply than the analogues; the regimen has to match what the patient can actually keep buying.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

No dose - referral pathway, no medicine given in primary care

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Most patients in DKA require ICU-level admission and monitoring.
  • Repeated hypoglycaemic episodes, especially in someone who has had the disease a long time, blunt the warning symptoms until they appear only at dangerously low glucose levels.
  • A blood glucose below 54 mg/dL is a distinct, more severe level of hypoglycaemia and is usually accompanied by impaired thinking and reduced consciousness.
  • Treat a glucose below 70 mg/dL with 15 to 20 grams of oral glucose, recheck after 15 minutes, and follow with a snack once the level has normalised.
  • Screen for coexisting autoimmune disease - autoimmune thyroid disease, coeliac disease, primary adrenal insufficiency and rheumatoid arthritis are all commoner in this group.
  • Ask about disordered eating and insulin omission at review, particularly in young women, in whom eating disorders are common.
  • Examine the feet for early neuropathy, deformity, pre-ulcerative lesions, ulceration, calluses and fungal nail disease.
  • Inspect the injection and infusion sites at every review; if lipodystrophy has developed, rotation of sites has to be retaught.
  • First- and second-degree relatives of a patient with type 1 diabetes should be offered screening with autoantibody testing.
3

GLUCAGON

add-on - not a substitute

Strength1 mg

Forminjection

Adult dose and duration

IM, SC, IV: 1 mg; may repeat in 15 minutes as needed

Paediatric dose
Dose by age
Pediatric weighing <20 kg:IM, SC, IV: 0.5 mg; may repeat in 15 minutes as needed
Dose source

Egyptian National Drug Formulary - Endocrine

Why

Emergency rescue medication for severe hypoglycemia when the patient cannot take oral carbohydrate; prescribed for home use so carers can administer it before emergency services arrive.

Cautions
  • Hypersensitivity reactions including generalized rash and anaphylactic shock have been reported.
  • There is a lack of efficacy in patients with decreased hepatic glycogen such as starvation, adrenal insufficiency, or chronic hypoglycemia.
Egyptian brands
Egyptian brandManufacturerIndicative price
GLUCAGEN 1MG/ML VIALNOVO NORDISK > EGYPTIAN PHARMACEUTICAL TRADING COMPANY323.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.