Diabetes Management Strategies

Preventing Acute Complications

• Monitor for hyperglycemia and hypoglycemia
• Minimize adverse drug reactions
• Screen for and control comorbidities (hyperlipidemia, hypertension, nephropathy, hypothyroidism, celiac disease)
• Foster self-management with age- and ability-appropriate goals that meet patient expectations

Lifestyle Modification

• Diabetes self-management education (DSME) and support (DSMS) programs
• Weight management to delay progression from prediabetes to type 2 diabetes
• Limit alcohol consumption to avoid hypoglycemia, weight gain, and hyperglycemia

Nutrition Therapy

• Carbohydrate counting:
  • Educate patients on carbohydrate counting
  • Help plan meals and count carbohydrates in each meal and snack
  • Adjust insulin dose according to carbohydrate intake
• Protein: does not increase plasma glucose concentrations
• Dietary fat: recommend foods rich in long-chain omega-3 fatty acids to prevent CVD
• Sodium: limit intake to 2,300 mg/day
• Nonnutritive sweeteners: reduce calorie and carbohydrate intake

Physical Activity and Smoking Cessation

• Improve blood glucose control, reduce cardiovascular risk factors, and contribute to weight loss
• Quit smoking to reduce diabetic complications

Medication

• Insulin: for type 1 and type 2 diabetes
• Antidiabetic drugs: for type 2 diabetes

Insulin Classes

• Short-acting insulin: regular human insulin (bolus)
• Rapid-acting insulin: insulin lispro, insulin aspart (bolus)
• Intermediate-acting insulin: neutral protamine Hagedorn (bolus/basal)
• Long-acting insulin: insulin glargine, insulin detemir, insulin degludec (basal)

Oral Hypoglycemic Agents

• Insulin secretagogues: sulfonylureas (1st generation: tolbutamide, 2nd generation: glimepiride, glyburide, glipizide)

Chronic Complications

• Microangiopathy:
  • Diabetic nephropathy: kidney damage leading to chronic renal failure
  • Diabetic neuropathy: abnormal and decreased sensation
  • Diabetic retinopathy: damage to small blood vessels and neurons of the retina
• Macrovascular disease:
  • Coronary artery disease
  • Peripheral vascular disease
  • Diabetic foot
  • Female infertility
• Immune dysfunction:
  • Infections and autoimmune diseases
  • Leukocytoclastic vasculitis

Treatment Goals

• Maintain daily blood glucose concentrations to prevent inhibition of daily activities
• Prevent long-term macrovascular and microvascular complications
• Meet A1C goals (<7.5)