DIABETES MELLITUS

TREATMENT
GUIDELINES

By Manish Nirala

INTRODUCTION
Diabetes
mellitus
is
clinical
syndrome
characterised
by
increase in plasma blood
glucose.

COMMON TYPE OF DM
1.Type -1 DM
2.T ype-2 DM
3.Gestational
diabetes

Type-1DM
Patient present as
a. Fever
b. Pain abdomen
c. Polyuria
d. Weight loss
This diabetes usually affect children and
young adult.
Often mistaken for an acute infective
illness.

Type-2 DM
Patient present as
a.
b.
c.
d.
e.

Polyuria
Polydipsia
Weight loss
Skin infection
Pruritus vulva in woman

Common form of DM seen in adult and

obese person.

Gestational DM
Hyperglycemia during pregnancy.

DIAGNOSTIC CRITERIA FOR

Normal
glucose
tolerance

DM

Fasting plasma
glucose(mg%)

100

Diabet
es
mellitu
s
126

Random plasma
glucose(mg%)
Two hours after
glucose(mg%)

<140

200

<140

200

TREATMENT
Nutritional therapy
Exercise
Pharmacological
therapy
Education

Nutritional therapy
Caloric intake -30kcal/kg body wt.
Carbohydrate intake -55 to 60% of total
calorie intake.
Protein intake -10 to 20% of max total
caloric
intake.
Fat intake -15 to 30%of total caloric
intake.

PHARMACOTHERAPY
Pharmacotherapy depend upon the type of
diabetes.
Treatment of Type-1DMand Gestational DM is
insulin.

ORAL DRUG THERAPY

Drugs available
a. Sulphonylureas
Glimepiride -tablet size 1mg ,2mg, 4mg
Daily dose 1 to 6mg

Glipizide (5mg, 10mg) 2.5 to 20mg in

two dose

b. Metformin(500mg ,800mg),500to
2000mg
per day
c. Acarbose 25to 50mg with major
meal.
d. Miglitol 25mg with major meal.
e. Thiazolidinediones
Rosiglitazone (2to 8mg)
Piaglitazone (15to 30mg)

ALGORITHM FOR TREATMENT OF

TYPE 2PATIENT
DM DIAGNOSED AS A CASE
OF DM
FASTING BLOOD GLUCOSE
>126-180mg/dl
PP BLOOD GLUCOSE >200250mg/dl
Start mono therapy
Tablet metformin 1500mg/day

FASTING BG >200-300mg/dl
PP BLOOD GLUCOSE 250 300mg/dl
Combination therapy
Add on Glimipride 1-2 mg/day
OR Glipizide 2.5-5 MG/DAY

Re evaluate target FASTING = 120 2O mg/dl and PP =

140 20 mg/dl
TARGET NOT ACHIVED ,ADD ROSIGLITAZONE2-8mg.
IF INADEQUATE CONTROL ADD ACARBOSE 25-50mg OR
INSULIN
Re evaluate target FASTING = 120 2O mg/dl and PP =
140 20 mg/dl

COMPLICATION OF DM

Acute complication
a.Hypoglycemia
b.DKA

Chronic complication
a.Coronary artery disease
b.Cerbrovascular disease
c.Peripheral vascular disease
d.Diabetic retinopathy
e.Diabeticnephropathy
f.Diabetic foot
g.Peripheral neuropathy

MANAGEMENT OF DIABETES
KETOACIDOSIS

Commonly seen in TYPE -1 DM.

Pt presents with vomitting, pain
abdomen, thrust, polyuria, &
altered sensorium.
O/E :- Tachycardia, kaussmauls
breathing.
O/I :- hyperglycemia, KB in
urine , metabolic acidosis,
bicarbonate < 10 mmol/L,

EMERGENCY Mx OF DKA
Regular insulin 10 unit IV stat, followed by IV
infusion @ 0.1U/kg/hr.
IV fluids initially 2-3 Lit NS over 1 to 3 hr
followed by N/2 NS @ 150-300 ml/hr.
If plasma glucose under 250 mg/dl = start 5
% dextrose with N/2 NS.
pH < 7.0 start bicarbonate 50 -100 ml
When serum potassium < 4.5 meq/lit start
KCL @10 meq/hr
Start appropriate antibiotics.

REFERRAL CRITERIA
TYPE-1 DM
Diabetes with pregnancy.
Diabetes with complication
Diabetic foot
CAD
Diabetic nephropathy
Uncontrolled hyperglycemia on oral drugs
Patient with severe infection
At least once in a year for a detail assessment of the
target
organ involvement and investigation.

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YOU