Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
Diabetes mellitus, disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar (glucose) in the blood.
To know more about diabetes mellitus click on the below link
https://docmode.org/about/
https://docmode.org/lectures/
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
Diabetes mellitus, disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar (glucose) in the blood.
To know more about diabetes mellitus click on the below link
https://docmode.org/about/
https://docmode.org/lectures/
Advances and Management of Diabetes MellitusPratiksha Doke
Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. High blood glucose levels are symptomatic of diabetes mellitus as a consequence of inadequate pancreatic insulin secretion or poor insulin-directed mobilization of glucose by target cells. Diabetes mellitus is aggravated by and associated with metabolic complications that can subsequently lead to premature death. This presentation explores diabetes mellitus in terms of its types, causes and management interventions for improved lifestyle for patient.
This was a presentation delivered at Gandhinagar on 18th August 2017. This is a talk on a Case of Adolescent Type 2 Diabetes successfully managed with Basal Insulin with Metformin
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
SIGNIFICANCE
OVERVIEW
WHAT IS DIABETES?
DEFINITION
MECHANISM
PREVELANCE
EPIDEMIOLOGY
CLASSIFICATION
GESTATIONAL DIABETES
RISK FACTORS
DIAGNOSIS
COMPLICATIONS
MEDICAL TEST
MEDICAL NUTRITIONAL THERAPY
HERBS FOR DIABETES
MYTHS AND FACTS
REFERENCES
Advances and Management of Diabetes MellitusPratiksha Doke
Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. High blood glucose levels are symptomatic of diabetes mellitus as a consequence of inadequate pancreatic insulin secretion or poor insulin-directed mobilization of glucose by target cells. Diabetes mellitus is aggravated by and associated with metabolic complications that can subsequently lead to premature death. This presentation explores diabetes mellitus in terms of its types, causes and management interventions for improved lifestyle for patient.
This was a presentation delivered at Gandhinagar on 18th August 2017. This is a talk on a Case of Adolescent Type 2 Diabetes successfully managed with Basal Insulin with Metformin
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia is due to one of two mechanisms:
Inadequate production of insulin , or
Inadequate sensitivity of cells to the action of insulin.
It affects more than 220 million people worldwide, and it is estimated that it will affect 440 million by the year 2030
"Diabetes" comes from the Greek word for "siphon", and implies that a lot of urine is made.
The second term,"mellitus" comes from the Latin word, "mel" which means "honey", and was used because the urine was sweet.
• The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.
SIGNIFICANCE
OVERVIEW
WHAT IS DIABETES?
DEFINITION
MECHANISM
PREVELANCE
EPIDEMIOLOGY
CLASSIFICATION
GESTATIONAL DIABETES
RISK FACTORS
DIAGNOSIS
COMPLICATIONS
MEDICAL TEST
MEDICAL NUTRITIONAL THERAPY
HERBS FOR DIABETES
MYTHS AND FACTS
REFERENCES
definition, classification of diabetes, what causes of diabetes,symptoms of diabetes, mechanism of diabetes,which drugs are used to diabetes, how to prevention of diabetes
Diabetes Mellitus is a group of disorders characterized by high levels of blood glucose in the body which is a result from the defects caused by insulin production, insulin action and sometimes both.
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. Diabetes Mellitus
About 422 million people worldwide,
particularly in low-and middle-income
countries, are either deficient of Insulin, a
pancreatic hormone, or their bodies can't use it
effective. And, more importantly, it is one of the
leading causes of death in the world.
3. INTRODUCTION
Diabetes is a life long(chronic)disease and is a
group of metabolic disorder characterized by
high levels of sugar in blood(hyperglycemia)
with disturbances of carbohydrates , fat and
protein metabolism resulting from defects in
insulin secretion , insulin action or both.
5. What causes Diabetes?
Diabetes causes vary depending on genetic
makeup, family history, health and environmental
factors.
There is no defined diabetes cause because the
causes of diabetes vary depending on the
individual and the type.
6. PANCREAS
The endocrine component of the pancreas consists
of islet cells (islets of Langerhans) that create and
release important hormones directly into the
bloodstream. Two of the main pancreatic hormones
are insulin, which acts to lower blood sugar,
and glucagon, which acts to raise blood sugar.
Insulin is released by the 'beta cells' in the islets of
Langerhans in response to food.
9. TYPES
There are three main types of diabetes mellitus:
Type 1 DM
Type 2 DM
Gestational Diabetes
10. INCIDENCE OF DM
TYPE 1 (7%)
TYPE 2 (90%)
GESTATIONAL (5% OF ALL
PREGNANCIES)
11. TYPE 1 DM
• Results from the pancreas failure to produce
enough insulin.
• This form is previously referred to as “insulin-
dependent DM”.
• Type 1 diabetes occurs when some or all of the
insulin-producing cells in the pancreas are
destroyed. This leaves the patient with little or no
insulin. Without insulin, sugar accumulates in the
bloodstream rather than entering the cells. As a
result, the body cannot use this glucose for energy.
13. TYPE 2 DM
Begins with insulin resistance , a condition in which
cells fail to respond to insulin properly.
This form was previously referred to as “non insulin-
dependent DM”.
Type 2 diabetes is much more common than type 1
diabetes.
In people with insulin resistance, the pancreas "sees"
the blood glucose level rising. The pancreas responds
by making extra insulin to maintain a normal blood
sugar. Over time, the body's insulin resistance gets
worse. In response the pancreas makes more and more
insulin. Finally, the pancreas gets "exhausted". It cannot
keep up with the demand for more and more insulin. It
poops out. As a result, blood glucose levels start to rise.
15. GESTATIONAL DIABETES
It is the third main form and occurs in pregnant
women without previous history of diabetes.
Gestational diabetes mellitus (GDM) is a condition
in which a hormone made by the placenta prevents
the body from using insulin effectively. Glucose
builds up in the blood instead of being absorbed by
the cells.
Unlike type 1 diabetes, gestational diabetes is not
caused by a lack of insulin, but by other hormones
produced during pregnancy that can make insulin
less effective, a condition referred to as insulin
resistance.
18. SIGNS AND SYMPTOMS
The classic symptoms of untreated diabetes are :
Weight loss
Polyuria (increased urination)
Polydipsia (increased thirst)
polyphagia (increased hunger)
Symptoms may develop rapidly (weeks or months)
in type 1 DM , while usually develop much more
slowly and may be absent in type 2 DM.
19. SIGNS AND SYMPTOMS
In addition they also include:
Blurry vision
Headache
Fatigue
Slow healing of cuts
Itchy skin
A number of skin rashes that can occur in diabetes
are collectively known as diabetic dermadromes.
23. Complications
Diabetes increases your risk for many serious health problems. The
good news? With the correct treatment and recommended lifestyle
changes, many people with diabetes are able to prevent or delay the
onset of complications.
DKA (ketoacidosis) & ketones
Neuropathy
Skin complications
Eye complications
Foot complications
Kidney disease (nephropathy)
Cardiovascular disease (CVD)
High blood pressure
Stroke
24. EPIDEMIOLOGY
The number of people with diabetes rose from
108 million in 1980 to 422 million in 2014.
The global prevalence of diabetes among
adults over 18 years of age rose from 4.7% in
1980 to 8.5% in 2014 (1).
Between 2000 and 2016, there was a 5%
increase in premature mortality from diabetes.
Diabetes prevalence has been rising more
rapidly in low- and middle-income countries
than in high-income countries.
25. In 2016, an estimated 1.6 million deaths were
directly caused by diabetes. Another 2.2 million
deaths were attributable to high blood glucose in
2012.
Almost half of all deaths attributable to high blood
glucose occur before the age of 70 years. WHO
estimates that diabetes was the seventh leading
cause of death in 2016.
26. DIAGNOSIS
Can be diagnosed by demonstrating one of the
following:
• Fasting plasma glucose level ≥ 126mg/dl
• Plasma glucose ≥ 200mg/dl two hours after a 75g
oral load as in a glucose tolerance test.
• Symptoms of high blood sugar and casual plasma
glucose ≥ 200mg/dl.
• Glycated hemoglobin(A1C) , below 5.7% is
considered normal.
30. Pharmacologic Treatment: Noninsulin
Therapies
When considering appropriate pharmacologic
therapy, it is important to determine whether the
patient is insulin-deficient, insulin-resistant, or both.
Treatment options are divided into noninsulin
therapies—insulin sensitizers, secretagogues,
alpha- glucosidase inhibitors, incretins, pramlintide,
bromocriptine, and sodium-glucose cotransporter 2
(SGLT-2) inhibitors—and insulin therapies (insulin
and insulin analogues).
31. Noninsulin Therapies
Subgroup
Generic name
(Brand)
Route Comments
Insulin sensitizers
Biguanides Metformin Oral Weight loss
No
hypoglycemia
GI upset
Thiazolidinedi
ones
Rosiglitazone
Pioglitazone
Oral Weight gain
Peripheral
edema
33. Noninsulin Therapies
Alpha-glucosidase inhibitors
Acarbose
Miglitol
Oral GI upset
No hypoglycemia
Incretins
GLP-1 receptor agonists
Short-acting (4-
6 hrs)
Exenatide
(Byetta)
SC Weight loss
GI upset
Intermediate-
acting (24 hrs)
Liraglutide
(Victoza)
SC Weight loss
Nausea
Long-acting (7
days)
Exenatide ER
(Bydureon)
Albiglutide
(Tanzeum)
Dulaglutide
(Trulicity)
SC Weight loss
Nausea
34. Noninsulin Therapies
Others
Pramlinitide Pramlinitide
(Symlin)
SC Weight loss
GI upset
Adjunctive
treatment with
insulin
Rapid-release
bromocriptine
Bromocriptine Oral Take within 2 hrs
of awakening
Nausea, stuffy
nose
SGLT-2 inhibitors Canagliflozin
(Invokana)
Dapagliflozin
(Farxiga)
Empagliflozin
(Jardiance)
Oral Polyuria UTIs
35. Regimens for Insulin Therapy.
Insulin
Regimen
HbA1c (%) Medication Pattern Diet Lifestyle Monitoring
Basal-only >7.5-10 Oral
medications
adequately
control
postprandial
glucose
excursions
High fasting
glucose with
minimal
glucose rise
during the
day
Small,
regular
meals; large
meals will
result in
postprandial
hyperglycemi
a
Reluctance
to do MDI;
requires oral
agents
Fasting
Basal-bolus
(MDI)
>7.5 Regimen can
be matched
to any
pattern to
achieve
glycemic
control
Regimen can
be matched
to any diet to
achieve
glycemic
control
Erratic
schedule,
motivated to
achieve tight
glycemic
control
Frequent
blood
glucose
monitoring
(minimum
before meals
and bedtime)
36. Regimens for Insulin Therapy.
Once- or Twice-Daily Premixed
Rapid-acting
analogue
and
intermediate
acting
>7.5 Oral agent
failure
(maximum
tolerated
dosages,
contraindicat
ions, cost
issues)
Any fasting
glucose;
glucose
rises during
the day
Large
suppers,
small
lunches
Consistent
daily routine,
reluctance to
do MDI
Fasting and
pre-supper
(if insulin is
administered
twice daily)
Regular and
NPH
>7.5 Oral agent
failure
(maximum
tolerated
dosages,
contraindicat
ions, cost
issues)
Any fasting
glucose;
glucose
rises during
the day
Isocaloric
meals or
larger
lunches
Consistent
daily routine,
reluctance to
do MDI
Fasting and
pre-supper
(if insulin is
administered
twice daily)