DM

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Author:
jaimee781
ID:
86111
Filename:
DM
Updated:
2011-05-16 12:46:38
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DM
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Description:
DM
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  1. Normal preprandial goal
    • <100
    • (70-99)
  2. Normal bedtime blood glucose
    <120
  3. Normal HgbA1C
    <6%
  4. Preprandial goal for DM
    80-120
  5. Bedtime blood glucose goal for DM
    100-140
  6. HgbA1C goal for DM
    <7%
  7. Action required for preprandial blood glucose
    < 80 or > 140
  8. Action required for bedtime blood glucose
    < 100 and > 160
  9. Action required for HbgA1C
    >7%
  10. When is drug therapy indicated?
    • 1) No progress with 3 months of diet and exercise
    • 2) Symptoms of hyperglycemia, surgery, ketoacidosis
  11. Alpha glucosidase action and preferred patient type
    Acts on GUT to reduce psotprandial carbohydrate absorption.

    Good for postprandial hyperglycemia
  12. Biguanide action and preferred patient type
    Acts on LIVER to decrease hepatic glucose output.

    Good for overweight and insulin resistant
  13. Sulfonylurea (Glyburide, Glypizide) action and preferred patient type
    Acts on PANCREAS to increase insulin secretion

    Good for insulinopenic and lean
  14. Glitazone (TZD) (Actos) action and preferred patient type
    Acts on SKELETAL MUSCLE to decrease insulin resistance.

    Good for insulin resistant, and CRI
  15. When should you withhold metformin?
    In conditions that predispose to renal insufficiency
    • 1) Iodinated contrast media
    • 2) Severe infection
    • 3) Major surgical procedure
    • 4) Acute MI or CHF
    • 5) Hospitalization
  16. Metformin Rx and SE

    Does not produce hypoglycemia
    Metformin 500mg BID

    SE: Mainly GI (bloating, N/D), usually self-limiting
  17. Glitazone (TZD) precautions
    Caution in conditions predisposing to fluid overload
    • 1) Recurrent CHF
    • 2) Increased BNP
    • 3) Chronic or worsened ankle edema
    • 4) Class III or IV HF
  18. Actos Rx
    Actos 15mg daily
  19. Action of incretin
    • 1) Increases satiety
    • 2) Decreases gastric emptying
    • 3) Inhibits glucagon release
  20. Byetta (incretin mimetic)
    Adjunct therapy with MET or SFU or in combo of the two.

    Costly. Good effect in 20% of population
  21. Byetta Rx
    Byetta 5mcg SQ BID within 60 minutes prior to meal
  22. Januvia (DPP-4 inhibitor) action
    • 1) Increase incretin levels
    • 2) Decrease glucagon
    • 3) Increase insulin release
    • 4) Decrease glucose after oral glucose load
  23. Indications for Januvia
    • 1) Monotherapy
    • 2) Adjunct with MET or TZD
  24. Acute complications of DM
    • 1) HHNK (hyperosmolar, hyperglycemic, nonketotic coma), DKA
    • 2) Hyperglycemia
    • 3) Hypoglycemia
    • 4) Decreasing GFR
  25. When is hypoglycemia severe?
    Seizures, altered LOC, and requiring the assistance someone else
  26. Chronic complications of DM
    • 1) Eye
    • 2) Kidney
    • 3) Peripheral nerve
    • 4) Autonomic never (ED, bladder, GI motility)
    • 5) Pulmonary
    • 6) Ortho (trigger finger, adhesive capsulitis)
    • 7) Skin (acanthosis nigricans, lipohypertrophy)

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