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Master Diabetes Management: Dr. Mona Yehia M. Family Medicine Specialist
Master Diabetes Management: Dr. Mona Yehia M. Family Medicine Specialist
Master Diabetes Management: Dr. Mona Yehia M. Family Medicine Specialist
Master Diabetes
Management
Dr. Mona Yehia M.
Family Medicine Specialist
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Type 1 or
type 2?
DM2 DM1
BMI < 25 -
Obesity
Rapid wt loss
Signs of DKA may be 1st
insulin presentation
resistance
Children > 6m,
Age >50 adolescents,
young adults
FH of
Personal or
DM2
family h.o.
autoimmune dis.
Confirmation of
type 1
Early late
Check at 24 – 28 wks
75 gm Oral glucose
tolerance test (OGTT)
FBS ≥ 92 mg/dl
Or 1 hr postprandial ≥ 180 mg/dl
Or 2 hr postprandial ≥ 153 mg/dl
50 gm Glucose
loading test (OLT)
No fasting required
If after 1 hr ≥ 140 mg/dl
Start with Insulin if A1c level > 10%, blood glucose level ≥ 300
mg/dl, or evidence of ongoing catabolism (wt loss)
Biguanides
Maximum 25 mg Maximum 10 mg
Metformin
- SGLT2i
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DPP4i
Metformin
- DPP4i
Twice daily
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Is my patient
controlled?
if can be
In children achieved
and safely in
adolescent adults
s
8 7.5 7 6.5 6
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Check patient adherence to management plan,
medication side effects or complex regimen
Biguanides: DPP4i:
Diarrhea, nausea, joint pain - risk of
vit B12 deficiency acute pancreatitis
Common Side
effects of Non-
insulin agents
TZD: GLP-1 RA:
Edema – CHF - wt NVD, injection site rn
gain - fractures thyroid C-cell tumor
SGLT2i:
Genitourinary infection – DKA -
volume depletion - LDL
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Types of insulin analogue regimen
Monitor plasma glucose level 8 times daily, before and 2 weeks after
insulin initiation: pre and post prandial, bed time, and around 3 A.M.
“Fix fasting first”, start basal insulin, then add prandial gradually
(start by one dose prior to largest meal, or with highest PP reading)
Basal
Prandial
Premixed
Basal +
GLP-
1RA
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Screen and prevent complications
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