Professional Documents
Culture Documents
CPG DM 2015: 5 Edition
CPG DM 2015: 5 Edition
5th edition
Screening
Asymptomatic Symptomatic
Fasting Random
<5.6 >5.6
RBG FBG
normal
• But
A1c not appropriate for diagnosis DM in:
- ↓ A1c 1.5%
• ↓ A1c 0.4-1.6%
GLP-1
• Two forms: immediate release and extended release
• Given subcutaneous.
• Reduce A1c 0.5-1.0%
• If pt on MTF + SU with A1c <10% addition of GLP-1 may
give similar glycaemic control compare to insulin glargine
without any increase risk of hypoglycemia and weight gain
• Progressive weight loss seen
• SGLT2 inhibitor
- inhibit transporter in proximal tubule thus
reduce glucose reabsorption
- Reduce A1c 0.2-0.8%
- Benefit: weight loss
- *not suitable for CKD GFR <60mL/min/1.73
Onset of action Peak action(hours) Duration of action(hours) Timing of administration of
Prandial insulin
Short acting 30-60 min 2-4 6-10 30min before meal
Actrapid
Humulin R
Insuman R
Insugen R
Basal
Intermediate acting, NPH 1-2hour 4-8 8-12 Prebreakfast/prebed
Insulatard
Humulin N
Insuman N
Insugen N
Premixed insulins
Mixtard 30/70 30min Dual 16-18 30-60min before meal
Novomix 30 10-20min 1-4 16-20 5-15min before meal
Diabetic Emergencies
• Hypoglycemia defined as either one of:
- plasma glucose level <4.0
- autonomic or neuroglycopenic symptoms which are reversed
with caloric intake
Autonomic Neuroglycopenic
• Trembling • Difficulty concentrating
• Palpitations • Confusion
• Sweating • Weakness
• Hunger • Drowsiness
• Nausea • Vision changes
• tingling • Difficulty speaking
• Dizziness
Severity of hypoglycemia
Mild Autonomic symptoms
Moderate Autonomic and neuroglycopenic sx
but patient able to self treat
Severe Require assistance of another
person.
May become unconscious
• Mild to moderate ingest 15g of simple carb (1 tbs honey, ¾
cup of juice, 3 tea spoon of sugar)
repeat GM 15 minutes later if <4.0 mmol/L ingest another
15g of carbohydrate
• Diagnosis criteria:
1. Hypovoluemia
2. Marked hyperglycaemia >30 mmol/L
3. Osmolality >320 mosmol/kg
No significant hyperketonemia (<3.0 mmol/L) or
acidosis
Aspirin for primary prevention of
cardiovascular disease ??
• Aspirin low dose (100mg) not recommended in
patients with diabetes unless age ≥ 65years old.
• MGTT:
Diagnosis FPG 2HPP
GDM ≥ 5.1 ≥ 7.8
• GM: 15