Diabetes Management and Therapy

Diagnostic Criteria and Pre-DM

• Fasting glucose ≥ 126, random glucose ≥ 200, or symptoms of DM with A1c ≥ 6.5
• Pre-DM: A1c 5.7-6.4, requires lifestyle modification

Insulin Therapy

• Individualized therapy based on hypoglycemia symptoms, liver/renal distinction, price, A1c lowering ability, and prescribing experience
• Insulin dosing must be coordinated with carbohydrate intake in DM1
• Increase in carbs requires increase in insulin, while missed meal/low carbs requires decrease in insulin

DM with HTN

• ACE or ARB (first choice) can reduce the risk of DM nephropathy
• Thiazide or CCB can also be used

Insulin Types

• Short-acting:
  • Lispro (Humalog): controls postprandial rise in blood glucose
  • Aspart (Novolog)
  • Glulisine (Apidra)
  • Regular: slowest of short-acting, can be given IV and inhaled Afrezza
• Intermediate/Long-acting:
  • NPH (Humulin N, Novolin N): provides glycemic control between meals and at bedtime, suitable for mixing with short-acting insulins
  • Detemir (Levemir): long-acting
  • Glargine (Lantus): long-acting, 100 and 300 units available

Hypoglycemia Management

• Conscious patient: use orange juice, ½ can of REAL soda, or glucose tabs
• Rule of 15: 15g of sugar and test in 15 minutes, repeat until blood glucose increases
• After increase, eat fat/protein snack or meal
• Glucose-centric algorithm for glycemic control: refer to sheet

Metformin and Insulin Algorithm

• Metformin should always be first, incorporate lifestyle, and recheck A1c every three months
• Algorithm for adding/intensifying insulin: basal insulin (long-acting), then prandial insulin if not controlled
• A1c ≥ 8%: TDD 0.2-0.3 U/kg, titrate every 2-5 days until under control

Oral Meds for DM2

• Sulfonylureas: stimulate pancreas, hypoglycemia risk, weight gain, and renal toxicity
• Other classes of oral meds for DM2: refer to table

This quiz covers the diagnostic criteria for diabetes, its therapy and management, including individualized treatment plans and insulin dosing coordination with carbohydrate intake.