ummD - edit Diabetes

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Lab text:

<h2>Diagnosis</h2>
<table border="0">
<tbody>
<tr>
<td>Screening test</td>
<td style="text-align: center;">
= Diabetes
</td>
<td style="text-align: center;">
Increased risk
</td>
<td style="text-align: center;">
Normal
</td>
</tr>
<tr>
<td>HbA1c</td>
<td style="text-align: center;">&ge; 6.5%</td>
<td style="text-align: center;">5.7-6.4%</td>
<td style="text-align: center;">&lt; 5.7%</td>
</tr>
<tr>
<td>Fasting BG</td>
<td style="text-align: center;">&ge; 126 mg/dL</td>
<td style="text-align: center;">100-125 mg/dL</td>
<td style="text-align: center;">&lt; 100 mg/dL</td>
</tr>
<tr>
<td>Random BG</td>
<td style="text-align: center;">&ge;&nbsp;200 mg/dL</td>
<td style="text-align: center;">140-199 mg/dL</td>
<td style="text-align: center;">&lt; 140 mg/dL</td>
</tr>
<tr>
<td>Oral glucose tolerance (75 g, testing at 2 hrs)</td>
<td style="text-align: center;">&ge; 200 mg/dL</td>
<td style="text-align: center;">140-199 mg/dL</td>
<td style="text-align: center;">&lt; 140 mg/dL</td>
</tr>
</tbody>
</table>
<ul>
<li>Increased risk = "pre-diabetic"; increased risk for CAD as well</li>
<li>HbA1c does not require fasting</li>
<li>Fasting = no calories for &gt; 8 hrs</li>
<li>Oral glucose tolerance most sensitive test</li>
<li>Positive test in asymptomatic patient should be confirmed with same test on different day</li>
<ul>
<li>Can diagnose if asx with 2 different positive tests (e.g. A1c + fasting BG)</li>
<li>Can diagnose if + sx with 1 positive test</li>
<li>Symptomatic hyperglycemia - polyuria, polydipsia, weight loss, nocturia</li>
</ul>
</ul>

Management text:

<table>
<tbody>
<tr>
<td>Drug</td>
<td>&nbsp;Dose</td>
<td style="text-align: center;">Weight</td>
<td style="text-align: center;">Renal insuff.</td>
<td style="text-align: center;">Hypoglycemia</td>
<td style="text-align: center;">Side effects</td>
</tr>
<tr>
<td>Metformin</td>
<td>500 - 1000 mg BID</td>
<td style="text-align: center;">-</td>
<td style="text-align: center;">No (lactic acidosis)</td>
<td style="text-align: center;">-</td>
<td>Start at QD to minimize GI distress</td>
</tr>
<tr>
<td>
Sulfonylurea (glyburide, glipizide, gli-)
</td>
<td>&nbsp;</td>
<td style="text-align: center;">&uarr;</td>
<td style="text-align: center;">OK</td>
<td style="text-align: center;">+</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>GLP-1 analog exenatide (Bydureon)</td>
<td>
 
</td>
<td style="text-align: center;">
&darr;
</td>
<td style="text-align: center;">&nbsp;</td>
<td style="text-align: center;">-</td>
<td>Appetite suppressant Possibly a/w pancreatitis</td>
</tr>
<tr>
<td>DPP-4 inhibitor sitagliptin (Januvia)</td>
<td>&nbsp;</td>
<td style="text-align: center;">
-
</td>
<td style="text-align: center;">
OK
</td>
<td style="text-align: center;">
-
</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>TZD (pioglitazone) Increase insulin sensitivity</td>
<td>&nbsp;</td>
<td style="text-align: center;">&uarr;</td>
<td style="text-align: center;">OK</td>
<td style="text-align: center;">-</td>
<td>Edema, CHF</td>
</tr>
</tbody>
</table>
<a title="Insulin" href="/topics/29" target="_self">Insulin</a>
Diabetic ketoacidosis
<ul>
<li>IV fluids, insulin gtt</li>
<ul>
<li>NS vs 1/2 NS depending on corrected sodium (<a title="Electrolyte abnormalities - sodium" href="topics/72/#exam" target="_self">false hyponatremia</a>:&nbsp;corrected Na&nbsp;= measured Na + 2.4 x (serum glucose - 100)/100))</li>
</ul>
<li>Replete K &lt; 5.3 (total body potassium deficient; insulin will drive K intracellularly); hold insulin for K &lt; 3.3</li>
<li>Continue IV insulin until anion gap closes</li>
<ul>
<li>If BG &lt; 200 but still has anion gap, decrease insulin gtt by 50% and add D5 to prevent hypoglycemia</li>
<li>When gap closed, BG &lt; 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)</li>
</ul>
</ul>

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