Podcast
Questions and Answers
What is the recommended weight loss target for individuals screening positive for prediabetes?
What is the recommended weight loss target for individuals screening positive for prediabetes?
When should Metformin be started in the management of diabetes?
When should Metformin be started in the management of diabetes?
What is the maximum daily dose of Metformin that can be prescribed?
What is the maximum daily dose of Metformin that can be prescribed?
Which condition contraindicates the use of Metformin due to the risk of lactic acidosis?
Which condition contraindicates the use of Metformin due to the risk of lactic acidosis?
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What is the ideal HbA1c target for younger patients?
What is the ideal HbA1c target for younger patients?
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Which medication is associated with weight gain and increased risk of hypoglycemia?
Which medication is associated with weight gain and increased risk of hypoglycemia?
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What is the maximum starting dose of Sitagliptin?
What is the maximum starting dose of Sitagliptin?
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In which condition is Pioglitazone particularly preferred despite its side effects?
In which condition is Pioglitazone particularly preferred despite its side effects?
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What should be considered if the HbA1C levels remain persistently high after initial treatment with oral medications?
What should be considered if the HbA1C levels remain persistently high after initial treatment with oral medications?
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How many oral hypoglycemic agents (OHAs) can be prescribed before considering insulin therapy?
How many oral hypoglycemic agents (OHAs) can be prescribed before considering insulin therapy?
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Study Notes
Diabetes Management
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Prediabetes/Intermediate Hyperglycemia: Diagnosed using one of these criteria:
- Impaired fasting glucose (IFG): Fasting plasma glucose (FPG) 110-125 mg/dL
- Impaired glucose tolerance (IGT): 2-hour plasma glucose (2-h PG) 140-199 mg/dL during 75-g oral glucose tolerance test (OGTT)
- HbA1c 5.7%-6.4%
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Diabetes: Diagnosed using one of these criteria:
- FPG ≥126 mg/dL
- FPG ≥126 mg/dL and/or 2-h PG ≥200 mg/dL using 75-g OGTT
- Random plasma glucose ≥200 mg/dL with classic diabetes symptoms
- HbA1c ≥6.5%
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Limited Care: Diagnostic criteria same as for Diabetes. Asymptomatic individuals with a single abnormal test should repeat the test to confirm the diagnosis unless the result is clearly abnormal. Individuals with a diagnosis of diabetes should be classified using the WHO system.
Management of Prediabetes
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Lifestyle Modification:
- Weight loss (10% of current body weight)
- Adequate sleep (6-8 hours daily)
- Daily exercise (minimum 1 hour)
- Metformin: Initiate 500mg once daily if HbA1c still high after 6 months of lifestyle modification
Treatment of Florid Diabetes (HbA1c > 6.5)
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Initial Treatment:
- Start Metformin 500mg twice daily (maximum 2.5g/day), with meals.
- Gradually increase metformin dose weekly up to 2.5 grams in divided doses.
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HbA1c Target:
- Young patients: 6-7%
- Older patients: 7-8%
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Dual Therapy: If HbA1c is 1.5 points above target, initiate dual therapy, along with one of these medications:
- Glimepride
- Sitagliptin
- Voglibose
- Pioglitazone
- Dapagliflozin (Indian setting)
Insulin Initiation
- High Glycemic Parameters or Persistent High HbA1c Levels: Consider initiating insulin.
- Basal Insulin: Initiation at bedtime to suppress hepatic glucose production (starting dose of 0.1-0.2 IU/kg/day or 10 units as a whole).
- Short-Acting Insulin: Initiate short-acting insulin (regular insulin, lispro, or aspart) before the main meal (lunch) at a dose of 4 units or 0.1 IU/kg body weight.
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Description
Test your knowledge on diabetes management, including diagnostic criteria for prediabetes and diabetes. This quiz covers important lifestyle modifications and the WHO classification system. Perfect for healthcare professionals and students looking to enhance their understanding of diabetes care.
