Please enable JavaScript.
Coggle requires JavaScript to display documents.
36-year-old F diagnosed with DM when her fasting blood glucose comes back…
36-year-old F diagnosed with DM when her fasting blood glucose comes back 12mmol/L.
initially be treated with lifestyle
modification (diet and exercise)102 unless they are symptomatic or
severely hyperglycaemic (i.e. random blood glucose >15 mmol/l or
fasting blood glucose >10 mmol/l)
A1C at (<7.6 percent) or close to (>0.5 to 1.5 percent above
Metformin
Alternative therapy:
Sulfonylurea Dipeptidyl
peptidase 4 inhibitors /
Thiazolidinedione Dual
therapy
A1C relatively far from goal (eg, 8.5 to 9.5 percent)
insulin + metformin
Contraindication for metformin
●Impaired renal function (estimated glomerular filtration rate [eGFR] <30 mL/min)
●Concurrent active or progressive liver disease
●Active alcohol abuse
●Unstable or acute heart failure at risk of hypoperfusion and hypoxemia
●Past history of lactic acidosis during metformin therapy
●Decreased tissue perfusion or hemodynamic instability due to infection or other causes
A1C near target (ie, <7.5 percent)
3-6 months trial of lifestyle modification
Cardiovascular risk factor management
smoking cessation, aspirin, blood pressure control, reduction in serum lipids, diet, and exercise
Weight reduction
patients who are overweight (BMI ≥25 to 29.9 kg/m2) and obese (BMI ≥30 kg/m2), major emphasis should be placed on lowering caloric intake, increasing physical activity, and behavior modification
Adult onset type 1 (25% pt)
unexplained recent weight loss (irrespective of the initial weight), a short history with severe symptoms, and the presence of moderate-to-heavy ketonuria. Diabetic ketoacidosis at first presentation
Two (ie, islet cell and GAD65) or three (insulin, GAD65, and IA-2 or GAD65, IA-2, and ZnT8) antibodies can be measured.
Gestational diabetes
Medical nutritional therapy is the initial approach. Calories are generally divided over three meals and two to four snacks and are composed of about 40 percent carbohydrate, 20 percent protein, and 40 percent fat. Exercise
administering insulin when fasting blood glucose concentration is ≥95 mg/dL (5.3 mmol/L) or one-hour postprandial blood glucose concentration is ≥130 to 140 mg/dL (7.2 to 7.8 mmol/L), or two-hour glucose is >120 mg/dL (6.7 mmol/L)
Endocrinopathies
Cushing's syndrome (cortisol action), Acromegaly, Catecholamine excess in pheochromocytoma, Glucagon-secreting tumors (glucagonomas), Somatostatin-secreting tumors (somatostatinomas)
chronic pancreatits
diabetes (and steatorrhoea) appear after a clinical evolution characterized by recurrent attacks of upper abdominal pain, generally lasting some days with transiently increased concentrations of pancreatic enzymes in serum. When diabetes appears, pain frequently disappears.