Diabetes

Diagnosis

Screening test

= Diabetes

Increased risk

Normal
HbA1c ≥ 6.5% 5.7-6.4% < 5.7%
Fasting BG ≥ 126 mg/dL 100-125 mg/dL < 100 mg/dL
Random BG ≥ 200 mg/dL 140-199 mg/dL < 140 mg/dL
Oral glucose tolerance
(75 g, testing at 2 hrs)		 ≥ 200 mg/dL 140-199 mg/dL < 140 mg/dL
  • Increased risk = "pre-diabetic"; increased risk for CAD as well
  • HbA1c does not require fasting
  • Fasting = no calories for > 8 hrs
  • Oral glucose tolerance most sensitive test
  • Positive test in asymptomatic patient should be confirmed with same test on different day
    • Can diagnose if asx with 2 different positive tests (e.g. A1c + fasting BG)
    • Can diagnose if + sx with 1 positive test
    • Symptomatic hyperglycemia - polyuria, polydipsia, weight loss, nocturia
Drug  Dose Weight Renal insuff. Hypoglycemia Side effects
Metformin 500 - 1000 mg BID - No (lactic acidosis) - Start at QD to minimize GI distress

Sulfonylurea
(glyburide, glipizide, gli-)

   ↑ OK +  
GLP-1 analog
exenatide (Bydureon)



↓

   - Appetite suppressant
Possibly a/w pancreatitis
DPP-4 inhibitor
sitagliptin (Januvia)		  

-

OK

-

  
TZD
(pioglitazone)
Increase insulin sensitivity		   ↑ OK - Edema, CHF

Insulin

Diabetic ketoacidosis

  • IV fluids, insulin gtt
    • NS vs 1/2 NS depending on corrected sodium (false hyponatremia: corrected Na = measured Na + 2.4 x (serum glucose - 100)/100))
  • Replete K < 5.3 (total body potassium deficient; insulin will drive K intracellularly); hold insulin for K < 3.3
  • Continue IV insulin until anion gap closes
    • If BG < 200 but still has anion gap, decrease insulin gtt by 50% and add D5 to prevent hypoglycemia
    • When gap closed, BG < 200, and able to eat, switch to subq insulin (give first dose 1-2 hrs before gtt stops to prevent rebound ketoacidosis since SQ insulin takes longer to absorb)
author: last edited: Oct. 21, 2018, 11:17 a.m. | pk: 16 | unpublished