Endocrine: DM Tx Goals & Guidelines

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Author:
jcbarbery
ID:
212286
Filename:
Endocrine: DM Tx Goals & Guidelines
Updated:
2013-04-21 14:01:48
Tags:
DM diabetes endocrine pharmacotherapy
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Description:
General DM guiselines in current practice
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  1. Criteria for annual high risk DM screening
    • FH in 1st degree relative     
    • Overweight/obesity     
    • Sedentary lifestyle
    • Race/ethnicity (AA, H, NA, AA, PI)
    • Previous pre-diabetes
    • GDM or baby > 9 lbs     
    • HTN      
    • High HDL, ­ low TG
    • Conditions assoc w/ insulin resistance
    •      (e.g. PCOS, acanthosis nigricans)
    • Hx of vascular disease
  2. Regular Screening Schedule
    Initiate @ 45 y/o and repeat q3 yrs
  3. A1c Dx
    >/=  6.5    %
  4. Random Glu Dx
    >/= 200 PLUS S/Sx of diabetes
  5. FBG Dx
    >/= 126 on 2 occasions
  6. 75g OGTT Dx
    >/= 200 @ 2h
  7. FBG Pre-Dx
    100-125
  8. 75g OGTT Pre-Dx
    140-200 @ 2h
  9. A1c Pre-Dx
    5.7-6.4%
  10. Glycemic Goals
    • 70-130 preprandial
    • < 180 peak postprandial
    • A1c < 7%
  11. Consider A1c goal of <6.5% if...
    • Short duration of DM    
    • No significant hypoglycemia
    • Long life expectancy
    • No significant CV
  12. Consider A1c goal of <8% if...
    • h/o severe hypoglycemia   
    • Limited life expectancy
    • Adv micro/macrovascular disease
    • Extensive co-morbid conditions
    • Longstanding DM w/ diff achieving <7% goal
  13. Type 2 Insulin dosing
    10 U (or 0.2 U/kg) qhs w/ QD BG testing

    then add 2 U Q3d ( 4 U Q3d if FBG > 180)

    check A1C in 3 months

    Once in range add BG checks before lunch and dinner

    Add injections as needed based on BG
  14. Insulin mixing
    "clear before cloudy"

    NEVER mix glargine or detemir w/ANYTHING
  15. Calculating TDD, basal & bolus doses
    kg/2 -> TDD

    TDD/2 -> basal (or bolus)
  16. Meal Bolus and CHO
    500/TDD = CHO

    Meal Carbs/CHO -> units of bolus
  17. Insulin Sensitivity Correction
    1800/TDD -> BG effect of 1 U
  18. 2 Injection NPH + R
    2/3 TDD QAM ; 1/3 TDD w/dinner

    2/3 ea NPH ; 1/3 ea R
  19. 10 Day Room Temp Stability
    Pen or Cartridge: 75/25, 50/50, Humulin & Novolin 70/30
  20. 14 Day Room Temp Stability
    Pen or cartridge NPH & Novolog 70/30
  21. 28 Day Room Temp Stability
    Pen or Vial: Homalog, Novolog, Apidra, Levemir
  22. 42 Day Room Temp Stability
    Lantus, Novolin N, Novolin R & Novolin 70/30

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