Treatment of DM part 2

Question 1

Treatment of hypoglycemia

Answer 1

conscious pt: oral glucose tablets 15-20 gm, may repeat in 15 min if serum BG shows continued hypoglycemia
unconscious pt: glucagon 1mg SQ, IM, or IV produces a response in 5-20 min, may repeat x 1 or 2 times as needed: IV dextrose

Question 2

Tx of sick days

Answer 2

DM1:

• caloric intake declines, insulin sens decreases (may take larger doses of insulin to control BG)
• pts need to monitor BG more frequently, check urine ketones, and use short acting insulin as needed
• cont. usual insulin regimen and use supplemental rapid-acting insulin based on BG results
• solutions containing sugar and electrolyes can be used to maintain hydration

DM2:

• acute, self limited illness is usually not a problem for patients with DM2
• may need to switch to sugar free drinks if BG levels are cont. elevated

Question 3

Tx of hospitalizations

Answer 3

pts on oral therapy may need transient insulin therapy to control BG
scheduled insulin with additional short acting insulin as needed is recommended
potential to reduce mortality in ICU pts with IV insulin and tight glucose control in certain clinical situations
stop metformin on admission until CI have been ruled out

Question 4

Tx of hypertension

Answer 4

all pts with DM and HTN should be tx with a regimen that includes either an ACEI or ARB
diuretics, calcium channel blockers, and beta blockers should be used as additional therapy to further lower BP
multiple drug therapy is usally needed
administer one or more antihypertensive meds at bedtime

Question 5

Tx of dyslipidemia

Answer 5

75
-mod
-mod to high
-high
Preferred agents
statins to decrease LDL, TG and increase HDL

Question 6

Aspirin therapy

Answer 6

consider ASA for primary prevention in pts with DM at increased CV risk (10 yr risk >10%)
secondary
-use for pts with DM and a hx of CVD
-for pts with CVD and docmented ASA allergy, clopidogrel should be used

Question 7

Nephropathy tx

Answer 7

if urine albumin excretion is modestly elevated (30-299) or higher (>300) tx with ACEI or ARB and monitor Cr and K
cont. UACR monitoring to assess progression of disease
measure SCr at least annually to estimate GFR in all adults with DM and stage CKD
when eGFR is

Question 8

When to follow up:
A1C
Lipids
BP
Urine albumin
SCr

Answer 8

A1C (5 years and all DM2

SCr: check yearly

Question 9

When to follow up:
provider office visit
retinal eye exam
foot exam
CV autonomic neuropathy 
diabetes education update
dental visit

Answer 9

provider office visit: every 3-6 months
retinal eye exam: every year for DM1 within 5 years of onset and all DM2
foot exam: every office visit; yearly
CV autonomic neuropathy: consider periodic screening
diabetes education update: every year as needed
dental visit: every 6 months