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Outpatient Diabetes (Diabetes (Tx: 1. Lifestyle mods & metformin, …

- - - - :green_cross: not at goal
        3. Add Insulin
        
        :pencil2:PO Rx: expect decr 3% A1c
        while
        Insulin: decr 7% A1c
      - :pencil2:Anything: no evidence about what is better than another
        
        :check:Sulfonurea (Glipizide, Glyburide)
        
        for practice, use these, theyre cheap
        
        can cause hypoglycemia (esp in CKD patients)
        
        Toy (FM): says these are the go-to 2nd line Rx
        
        :check:Glitazone (TZD)
        
        weight gain
        
        can cause CHF
        
        prob won't use, but safe
        
        :check:DDP4 (Gliptin)
        
        weight neutral
        
        :check:GLP-1 (utides)
        
        weight loss
        
        injectables
        
        :green_cross:Acarbose
        
        blocks intestinal absorption
        
        diarrhea/flatulance :poop:
        
        Toy (FM): contraindicated in ketoacidosis & liver dysfunction
        
        :green_cross:SGLT2 inhibitors (flozin)
        
        euglycemic DKA
        
        dont use: dehydration to DKA
        
        :pencil2: Brian's Note: New research suggests SGLT2
        
        lowers renal failure rates
        
        lowers risk of heart failure. :<3:
        ...so Dustyn's advice may be old in a few years or sooner.
        see: CREDENCE clinical trial June 2019
    - - :check:Biguanides (metformin)
        
        diarrhea ( :poop:goes away), keep increasing, keep working thru diarrhea
        
        always use, unless contraindicated
  - - - annual screen:
        
        :eye:Retinal exam (may need laser ablation if bad)
        
        UA (micro albumin to creatinine ratio) (may need ACEi :spades:)
        
        :footprints:Monofilament screen (treat w/ Gabapentin, and ulcer checks)
- - - - Pt: Polydipsia
        Polyuria
        hi BG
        can be adult presentation (rapidly presenting in previously Asx)
        
        screen: Ab testing GAD, IA-2
        
        :check:positive Ab, T1DM :checkered_flag:
        
        Tx: Insulin
        
        :warning:PO Rx won't work
  - - - Better test: Fasting BG x 2
        
        ≥ 125 = :checkered_flag:DM
        
        100-125 = prediabetes
        
        < 100 = normal
        
        Prediabetes?
        
        2 hr Oral glucose tolerance test: simulates postprandial diabetic
        
        ≥200 = :checkered_flag:DM
        
        140-200 = prediabetes
        
        <140 = normal
        
        :pencil2:good because its confirmatory, but time intensive
        
        :pencil2:good confirmatory but pt needs to be fasting
      - worst: only useful if pt has Sx
    - - :pencil2:
        
        measures avg blood sugar over past 3 month.
        
        Capturing whats happening all the time.
        
        Affected by hemoglobinopathies and
        
        can't detect early glucose changes (GDM :pregnant_woman::skin-tone-3:)