Diabetes mellitus management...

1. Type 2 Diabetes
Mellitus
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2. Etiology
• Insulin resistance:
– decrease peripheral utilization of glucose
 elevated PPG
- Increase liver glucose output -> elevated
FBS
• Beta cell dysfunction
• Alpha cell dysfunction – lack suppression of
glucagon secrection

5. Pathophysiology of Diabetes
FBS 2Hr PP Insulin Insulin Treatment
Resistance Secretion
Phase 1 Normal Normal increased increased none
OGTT
Phase 2 Normal or increased Markedly increased Diet, a-
increased increased glucosidase,
metformin
Phase 3 increased increased increased increased OHA, insulin

6. diagnosis
• Any of: (ADA, 2008)
Symptoms of DM + RBS >200
FBS > 126
(normal: <100)
IFG: 100 – 125
75 gm OGTT
a) 2hr Plasma glucose: > 200  DM
normal: <140
b) 2hr Plasma Glucose: 140 – 199  IGT

7. Goals of treatment
HBA1C: <7
Preprandial plasma glucose: 90 – 130
Peak post-prandial plasma glucose: < 180
Hospitalized patient:
– Critically ill: kept as close to 110; gen. <140;
insulin needed
– Non-critical: FBS <126; RBS<180

8. Goals of treatment
BP: <130/80
LDL: <100
Triglycerides: <150
HDL: >140

9. DM Management
• All DM with HPN ACEI or ARB
• Annual influenza vaccine
• Atleast 1 lieftime pneumococcal vaccine
• >40yo: give statin to achieve LDL reduction
of 30-40%
• <40yo: medical tx if diet modification is
failed
• Aspirin tx

10. DM Management
Monotx: for FBS<140; 2PPBS<180
1st line:
1. metformin: dec liver glucose output
2. Sulfonylurea: inc insulin secretion
3. TZD: inc insulin sensitivity

11. Alternative tx:
1. Non-SU insulin secretagogue: inc insulin
secretion
2. Glucosidase inhibitor: delays GI absortion
of carbohydrates

12. Combination TX: if FBS>140; 2PPBS>180
1. If on SU: add metfomin or TZD
2. If on metformin: add SU or TZD
3. If on TZD: add SU or metformin
Insulin TX: if blood sugar is not controlled

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