Pregnancy slowedstopped weight gain dont want to cut

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Unformatted text preview: ggressive treatment of hypertension and blood glucose led to fewer complications • dose- response effect: o the more they decreased HbA1c, the fewer the complications Treatment Goals 1. Normalize glucose levels 2. Prevent Complications • even patients with well- controlled blood sugar levels are at a higher risk of micro- and macro- vascular complications • diet: o important to prevent heart disease o want to prevent atherosclerosis o low sodium, healthy fats Preventing Complications • vascular protection o screening and treatment for high BP goal 130/80 mm Hg o screening and treatment for hyperlipidemia • renal protection o screen for albumin in urine – sign of leaky capillaries o treat with ACE inhibitor or similar – high BP often complicating factor in kidney disease • retinopathy, neuropathy: screening o regular eye examinations o foot care (by nurse) – want to decrease complications “Curing” Diabetes • pre- diabetic o diet, exercise, losing weight prevents development of diabetes, or can prolong period before development of type 2 • type 1 o islet cell transplant take beta cells from someone else and transplant them – beta cells will start making insulin works in ~50% of cases problems: not a lot of islets available for transplant, need to take strong immunosuppressant drugs, immune system trying to kill islet cells brittle type 1 DM – insulin not managing diabetes very well – transplant may be preferable • type 2 o bariatric surgery part of small intestine removed – cure happens within days of surgery there seems to be a signalling mechanism in that section of the intestine removed that affects insulin sensitivity Who Needs Insulin • all type 1 • all pre- existing DM in pregnancy • type 2 – may require insulin (mixed therapy) • GDM that cannot attain control with diet and exercise Forms of Insulin • insulin analogues o synthetic “human” insulin that has been slightly modified • forms differ by onset and duration of action • bolus – rapid acting, used at meals • basal – intermediate to long acting, once a day Insulins • rapid- acting – right before or after a meal • short- acting • intermediate- acting – twice a day • long- acting – once a day Insulin Delivery • needles – several times a day • pens/jet injectors – several times a day • discreet, easier to learn • pens loaded with pre- determined amount • pump – continuous basal infusion with bolus pre- meal o enter CHO to be consumed o high end ones also measure blood glucose Common Insulin Regimes Types of Regimens • conventional therapy o fixed doses o diet matched to insulin o generally start with this o very rigid schedule – both insulin and diet o very restrictive • sliding scale o insulin adjusted to blood glucose, reactive o adjust insulin if blood glucose high or low • intensive insulin therapy o start with CHO in diet o determine insulin required per g CHO consumed o basal and bolus o need frequent blood samples pre and post meal Insulin Risks • hypoglycemia o those with type 1 DM carry juice, dextrose tablets, hard candies or rockets • weight gain with poor management • eating disorders o insulin abuse – stop taking as much insulin as they need – lose weight high risk of complications starving cells happens in teenage girls with type 1 Oral Medication • those with type 2 diabetes who diabetes can’t be controlled with diet and exercise alone o started immediately if HbA1c is greater than 9% o start 2- 3 months after unsuccessfu...
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