Diabetes Melitus - Discussion
Diabetes Melitus - Discussion
Diabetes Melitus - Discussion
Melitus
Diabetes Melitus
CLINICAL PRESENTATION
Type 2 DM
Type 1 DM
Diagnostic criteria
Dietary modification
Exercise
Weight reduction (Mostly with Type II)
Pharmacological management
Type II
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Contraindications to metformin include:
The therapeutic options for patients who fail initial therapy with
lifestyle intervention and metformin are to add a second oral or
injectable agent, including insulin
For patients without clinical CVD who cannot take metformin, options
for initial therapy include:
basal insulin.
peptidase 4 (DPP-4) inhibitors.
glucagon-like peptide 1 (GLP-1) receptor agonist-based therapies.
sodium-glucose cotransporter 2 (SGLT2) inhibitors.
sulfonylureas.
thiazolidinediones.
For patients relatively far from their hemoglobin A1C goal, insulin or a
GLP-1 receptor agonist-based therapy is preferred.
Indications for insulin therapy in DM II
Insulin regimen
Initial total daily dose (TDD) – Most adults who are newly
diagnosed started on a TDD of 0.2 to 0.5 units of insulin / kg / day,
although many will ultimately require 0.6 to 0.7 units/ kg /day
Regimens that use NPH in the morning may not require a pre-
lunch dose of short-acting (regular) or rapid-acting insulin because
the peak of NPH action is occurring at that time, potentially
reducing the frequency of injections.
Injection sites
The abdomen is the preferred site for pre-meal injections of
regular insulin because absorption is quicker from this site m.
the thigh or buttock is a good site for the evening intermediate-
acting insulin (NPH) dose; the slower rate of absorption from
these sites enhances the likelihood that the insulin will last through
the night.
The site of injection is less important for rapid-acting or long-acting
insulin analogs, and therefore, they may be administered in the
abdomen, thighs, buttock, or upper arms. However, insulin
absorption may be faster in an exercising limb.