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Type 2 DIABETES MELLITUS
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Type 2 DIABETES MELLITUS

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Diabetes mellitus management...

Diabetes mellitus management...

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  • 1. Type 2 DiabetesMellitus http://crisbertcualteros.page.tl
  • 2. Etiology• Insulin resistance: – decrease peripheral utilization of glucose elevated PPG - Increase liver glucose output -> elevatedFBS• Beta cell dysfunction• Alpha cell dysfunction – lack suppression of glucagon secrection
  • 3. Pathophysiology of Diabetes FBS 2Hr PP Insulin Insulin Treatment Resistance SecretionPhase 1 Normal Normal increased increased none OGTTPhase 2 Normal or increased Markedly increased Diet, a- increased increased glucosidase, metforminPhase 3 increased increased increased increased OHA, insulin
  • 4. diagnosis• Any of: (ADA, 2008)Symptoms of DM + RBS >200FBS > 126 (normal: <100) IFG: 100 – 12575 gm OGTT a) 2hr Plasma glucose: > 200  DM normal: <140 b) 2hr Plasma Glucose: 140 – 199  IGT
  • 5. Goals of treatmentHBA1C: <7Preprandial plasma glucose: 90 – 130Peak post-prandial plasma glucose: < 180Hospitalized patient: – Critically ill: kept as close to 110; gen. <140; insulin needed – Non-critical: FBS <126; RBS<180
  • 6. Goals of treatmentBP: <130/80LDL: <100Triglycerides: <150HDL: >140
  • 7. DM Management• All DM with HPN ACEI or ARB• Annual influenza vaccine• Atleast 1 lieftime pneumococcal vaccine• >40yo: give statin to achieve LDL reduction of 30-40%• <40yo: medical tx if diet modification is failed• Aspirin tx
  • 8. DM ManagementMonotx: for FBS<140; 2PPBS<1801st line:1. metformin: dec liver glucose output2. Sulfonylurea: inc insulin secretion3. TZD: inc insulin sensitivity
  • 9. Alternative tx:1. Non-SU insulin secretagogue: inc insulin secretion2. Glucosidase inhibitor: delays GI absortion of carbohydrates
  • 10. Combination TX: if FBS>140; 2PPBS>1801. If on SU: add metfomin or TZD2. If on metformin: add SU or TZD3. If on TZD: add SU or metforminInsulin TX: if blood sugar is not controlled
  • 11. http://crisbertcualteros.page.tl

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