4. What else can help
Elevated Antibodies
Anti GAD antibodies (glutamic acid
decarboxylase)
Anti islet cell antibodies
Anti Insulin antibodies
IA 2 antibodies
C-peptide levels
10. Metformin
First line
Mortality benefits
Weight neutral
CI: Severe Renal, hepatic, and heart failure
Renal failure:
eGFR 30-60: Half dose
eGFR < 30: CI
GI adverse effects- dose related
Start low and uptitrate to maximum tolerated dose
* NB: Vitamin B12 defeciency
11. Sulphonylureas
Long track record
Cheap and effective
Hypoglycemia and weight gain
Can be used as initial therapy if metformin not
tolerated/contraindicated
Issues in Renal failure
24. CSII
Indications:
Type 1 DM
? Type 2 DM
Inadequate control despite good compliance
Frequent severe hypoglycemia
Motivated, well educated and cognitively intact
patient
Specialist centre management
25. CSII terminologies
• Basal rate
Can be different at different times of the day
• Meal Bolus
Immediate
Prolonged (Square wave), combination
Insulin to Carbohydrate ratio
Carb counting
• Correction Factor
Blood glucose range
Correction / Insulin sensitivity factor
27. Inpatient Management
Acutely unwell but not critical:
Causes of Hyperglycemia:
Known DM or previously unrecognised
Stress response (counter regulatory hormones)
Use of systemic steroids
Inadequate treatment strategy
30. Inpatient Management
Targets:
6-10mmol/L (fasting and pre meal)
Avoid hypoglycemia
Need for Insulin
Sliding scale only – NO
Basal Bolus Insulin
Basal (long acting)
Mealtime bolus (short acting)
Correction (short acting)
ADS guidelines
31. HbA1c on Hospital admission
Should be done if not available from last 2-3
months
Admission bloods HbA1c can avoid result
variation because of blood transfusion
Provides indication of pre hospital glycemic
control
Can guide management plan at time of
discharge
Hospitalisation- moment of patient education
opportunity- please assess and intervene!
32. Recommended Readings
A new blood glucose management algorithm for type 2 Diabetes- A
position statement of Australian Diabetes Society. MJA December
2014
Position statement Australian Diabetes Society: Individualisation of
glycated haemoglobin targets for adults with Diabetes mellitus- MJA
September 2009
Inpatient Management of Hyperglycemia and Diabetes- Clinical
Diabetes, 2011
The past 200 years in Diabetes- NEJM October 2012
An overview of Insulin pump therapy- Medicine Today December
2010
The role of HbA1c in diagnosis of Diabetes Mellitus in Australia-
MJAAugust 2012