Diagnosis
NIH conducted study in GRHC on pts diagnosed with this .................
About 10% have retinopathy and neuropathy in this group
Prediabetes
Decreases hepatic glucose production
increases insulin sensitivity by increasing peripheral glucose uptake
Use associated with inhibition of cancer cell growth and reduction in cancer incidence
Metformin
A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia
Level 3 hypoglycemias
Anti VeGF injections are used in treatment of
Diabetes retinopathy
WHEN YOU WANT PATIENTS TO SEE A PROVIDER FOR DIABETES
LC PROVIDER
This group of patients have A1c goal of <6%
Gestational diabetes
Fasting goal <=95mg/dl
1hr PP <=140 mg/dl
2 hr PP <=120mg/dl
initial discovery from apple tree bark
decrease renal reabsorption of 30-50% of glucose.
Natriuresis is the bonus feature.
Has a role in improving heart failure outcomes even in patients without diabetes
SGLt2 inhibitors
These statins are designed to aggressively lower LDL cholesterol levels, aiming for a reduction of 50% or more.
High intensity statins- Atorva & Rosuva
Metformin to be stopped when GFR is less than
30 ml/min
WHEN YOU WANT PATIENTS TO GET DIABETES RELATED EDUCATION
LC DIETICIAN DSMT
What is LADA ?
LATENT AUTOIMMUNE DIABETES IN ADULTS
C peptide with Glucose , GAD ab .
other Ab tests available are
Stimulates GIP and GLP-1 receptors in pancreas
Pts with obesity, lost 26% weight over 84 weeks
Has CV benefit
Tirzepatide - Mounjaro /Zepbound
GUIDELINE FOR STARTING ___________INSULIN
A1C < 8%-0.1-0.2u/kg
A1C > 8% -0.2-0.3u/kg
BASAL INSULIN
In patients with CKD and type 2 diabetes, treatment with .............. & ..........resulted in lower risks of CKD progression and cardiovascular events than placebo
Fineronone & SGLt2 inhibitors
WHEN YOU WANT PATIENTS TO GET EXERCISE COACHING
LC EXERCISE AND WELL NESS
In the present era of continuous glucose monitors, What is the term used when 17 hours in a day, the glucose is in the range of 70-180 mg/dl ?
what is the goal for time in range in continuous glucose monitor
T in Range ->70%
TAR - 181-240= level 1 =<25%
>241=level 2 = <5%
TBR 55-70 =level 1= <4%
<55 = level 2 = <1%
Reduces insulin resistance in the liver and peripheral tissues
approved for Prediabetes
causes edema - worsening CHF and weight gain
Pioglitazone -Thiazolidinedione
What TO DO next, if Basal Insulin is dosed at> 0.5 units/kg/day and the patient is still having hyperglycemia?
Add Prandial insulin /GLP-1A
Relative 5 yr risk of mortality after limb amputation is
68%
WHEN YOU WANT PATIENT WITH PREDIABETS OR HIGH RISK FOR DEVELOPING DIABETES BUT A1C <5.6
DIABETES PREVENTION PROGRAM
Pt comes to Ortho clinic for follow up on Knee OA and to get her 3rd steroid injection to her knee. Pt has h/o well controlled diabetes on Ozempic and Metformin. But is now complaining of multiple hypoglycemias throughout the day. What could be the reason for Hypoglycemias?
Hypocortisolemia
Gut peptides that are secreted after nutrient intake
Stimulates insulin secretion
inhibits Glucagon release
Incretins
Target BP goal is <130/80 mm hg and LDL goal <55 - in this group of patients with Diabetes
If there is a higher CV risk with existing ASCVD or 10-year ASCVD risk of ≥15%
( CKD , PVD , LVH , CAD)
non statin lipid lowering treatment options are
Repatha - evolocumab
Zetia- Ezetimibe
Nexletol- Bempedoic acid
WHEN YOU WANT PATIENT TO GET MEDICAL WEIGHT LOSS THERAPY OR FOR BARIATRIC SURGERY
LC PROVIDER - COMMENT AS MEDICAL WEIGHT LOSS RX