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DIABETES MELLITUS-TYPE 2, MANAGEMENT

Endocrinology

DIABETES MELLITUS-TYPE 2, MANAGEMENT

1. Insulin should be added after oral drugs are used except in the following special situations: consistently high random plasma glucoses (> 300-350 mg/dL), HbA1c > 10%, HbA1c > 9% with symptoms, DKA/HHNK.

2. Start with 2-3 medications in patients with HbA1c > 9%

3. Basal-bolus dosing, where patients are given a long-acting insulin that keeps glucoses controlled during the fasting state, and short-acting insulin is given pre-prandially (just before meals).

4. Patient who are fasting should not have their basal insulin discontinued simply because they are not eating. Stop the rapid-acting prandial (mealtime) insulins instead.

5. Tip: with most patients, commence Metformin & second-line agent (SGLT2 inhibitor or DPP4 inhibitor) after explaining SE to patients. Also check C-peptide to check insulin-reserve.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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