DM.docx

[DM] - Diagnostic criteria: fasting glucose 126, random glucose 200 or \> with sym of DM, or A1c 6.5 and greater - A1c of 5.7-6.4 = pre-DM lifestyle modification - Therefore therapy is very individualized based on hypoglycemia symptoms, liver or renal distinction, price, A1c lowerin...

[DM] - Diagnostic criteria: fasting glucose 126, random glucose 200 or \> with sym of DM, or A1c 6.5 and greater - A1c of 5.7-6.4 = pre-DM lifestyle modification - Therefore therapy is very individualized based on hypoglycemia symptoms, liver or renal distinction, price, A1c lowering ability, and your own prescribing experience - Insulin dosing must be coordinated w/carbohydrate intake in DM1 - Increase in carbs increase in insulin - Missed meal or low carbs decrease in insulin - DM w/HTN - Ace or ARB (arb first) can reduce the risk of DM nephropathy - Thiazide or CCB +-----------------------------------+-----------------------------------+ | Insulin | | +===================================+===================================+ | **Short acting** | | +-----------------------------------+-----------------------------------+ | **Lispro (Humalog)** | Controls postprandial rise in | | | blood glucose. | +-----------------------------------+-----------------------------------+ | **Aspart (novolog)** | | +-----------------------------------+-----------------------------------+ | **Glulisine (apidra)** | | +-----------------------------------+-----------------------------------+ | **Regular** | Slowest of the short acting. Can | | | be given IV and inhaled afrezza | +-----------------------------------+-----------------------------------+ | **Intermediate or Long acting** | | +-----------------------------------+-----------------------------------+ | **NPH (Humulin N, Novolin N)** | Provides glycemic control between | | | meals and at bedtime | | | | | | (neutral protamine Hagedorn). | | | Protamine decreases solubility of | | | NPH delays absorption onset of | | | action is delayed. | | | | | | Only suitable for mixing | | | w/short-acting insulins | | | | | | Hypoglycemia during the night is | | | an issue | +-----------------------------------+-----------------------------------+ | **Detemir (Levemir)** | Long-acting | +-----------------------------------+-----------------------------------+ | **Glargine (Lantus)** | Long-acting | | | | | | 100 glargine | | | | | | 300 glargine | +-----------------------------------+-----------------------------------+ Hypoglycemia - When experiencing this in a conscious patient have the patient use orange juice, ½ can of REAL soda (coke, dr. pepper, ect), glucose tabs - Rule of 15 - 15 grams of sugar (any of the above examples) and then test in 15 minutes - Repeat until blood glucose is increasing - After increase eat fat/protein snack or meal (honey, syrup, juices) - Glucose-centric algorithm for Glycemic Control (REFER TO SHEET) - IF NOT AT GOAL: CONTINUE TO ALGORITHM FOR ADDING/INTENSIFYING INSULIN (REFER TO SHEET) \*\* Metformin should always be first. And incorporate lifestyle. Recheck A1c every three months -ALGORITHM FOR ADDING/INTENSIFYING INSULIN: basal insulin (long-acting) We do not start on prandial insulin unless not controlled on basal insulin with DM2 and regular dm meds \*\*\* A1c \8% TDD 0.2-0.3 U/kg Titrate every 2-5 days until under control! ORAL MEDS FOR DM2 +-----------+-----------+-----------+-----------+-----------+-----------+ | **Class** | **Drug | **MOA** | **INFO** | **A1c | **Weight | | | Name** | | | lowering | gain/ | | | | | | ability** | loss** | +===========+===========+===========+===========+===========+===========+ | **Sulfony | Glybu**r* | Stimulati | Hypoglyce | 1.5-2% | Weight | | lureas** | *ide- | on | mia | | gain | | | **r**enal | of | give | | | | | toxicity; | pancreati | w/meals | | | | | CrCl \