1. DIABETES MELLITUS Rabia Tahir, Pharm.D. Department of Veterans Affairs NYHHCS

5. Characteristics Mild symptoms, progressing gradually, but Pts may often be asymptomatic Moderate to severe symptoms, usually progressing rapidly Clinical presentation Rare, unless under stress (e.g. infection) Common History of ketoacidosis Common (60-90%) Uncommon Obesity Strong Generally not strong Family history Usually >40years old but growing prevalence among obese children Usually childhood or adolescent, but can occur at any age Age at onset 90% 10% Percentage Type 2 Type 1

35. Summary of Recommendations for Adults with DM < 200 mg/dl Tot. Chol. BMI ≤ 25 kg/m² Weight < 130/80 mmHg BP 100- 120 mg/dl Bedtime glucose < 140 mg/dl 2hrPG < 120 mg/dl Preprandial glucose < 7% HbA1C Target Endpoint ≤ 1 oz ethanol/day Alcohol intake Cessation Smoking ≤ 6g NaCl/d or ≤ 2g Na/d Salt intake < 150 mg/dl TGs Female > 55 mg/dl Male > 45 mg/dl HDL < 100 mg/dl LDL Target Endpoint

44. Sulfonylureas 1-8mg (QD) 1-2mg QD Glimepiride (Amaryl ®) 1-12mg (QD) 1.5mg QD Micronized Glyburide (Glynase ®) 1.25-20mg (QD or BID) 2.5mg QD (1.25mg QD for elderly) Glyburide (DiaBeta ®) 5-20mg (QD) 5mg QD Glipizide XL (Glucotrol XL ®) 2.5-40mg (QD or BID) 5mg QD (2.5mg QD for elderly) Glipizide (Glucotrol ®) 0.1-0.5g (QD) 100-250mg QD Chlorpropramide (Diabinese ®) 0.25-3g (BID or TID) 1.0-2.0g QD or BID Tolbutamide (Orinase ®) 0.2-1g (QD or BID) 100-250mg QD Tolazamide (Orinase ®) 0.25-1.5g (QD-BID) 250-500mg QD Acetohexamide (Dymelor ®) Usual total daily dose Initial dose

53. Thiazolidinediones 15-45mg (QD) 15-30mg QD Pioglitazone (Actos ®) 4-8mg (QD or BID) 4mg QD Rosiglitazone (Avandia ®) Maintenance Dose TDD Initial Dose Dosing: Titrate dose every 4 weeks. May take with or without food

57. Combination Medications 8 of rosiglitazone, 2000 of metformin FDA- 2 nd line, but can be used as initial 1-2/500 twice a day 1/500 2/500 4/500 2/1000 4/1000 Rosiglitazone/ metformin Avandamet ® 20 of glipizide, 2000 of metformin FDA- initial therapy 2.5-5/500 2.5/250 2.5/500 5/500 Glipizide/ metformin Metaglip ® 20 of glyburide, 2000 of metformin FDA- initial therapy 2.5-5/500 1.25/250 2.5/500 5/500 Glyburide/ metformin Glucovance ® Maximum Dose Initial Dose Doses Brand

69. Drugs That Can Alter Blood Glucose Levels Nicotinic acid Sympathomimetics Quinine, quinidine Phenytoin Pentamidine (initially) Pentamidine (later on) Insulin, SU Protease inhibitors Ethanol Corticosteroids ACE inhibitors Diuretics Beta blockers Beta blockers ↓ Blood Glucose ↑ Blood Glucose

71. Monitoring Patients With Diabetes Adverse effects of medications Fasting lipid profile Q 6 months Foot exam Q year BP Q 3-6 months Confirm adherence to diet and exercise regimens Urinalysis for glucose, protein, and ketone content Opthalmologic exam Q year HbA1C Q 3 months Renal function (SCr, BUN) FPG every visit and at home