1 Unit bolus of insulin lowers glucose approximately 20 to 60 mgdl Determine

1 unit bolus of insulin lowers glucose approximately

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1 Unit bolus of insulin lowers glucose approximately 20 to 60 mg/dl. Determine CHO to insulin ratio.
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insulin Split basal insulin needs and bolus insulin needs evenly (50% each). Generally, 50% to 75% of daily insulin is given as an intermediate or long- acting form of insulin. Initial dose of insulin is 0.3 to 0.5 Units/kg/day in divided doses. Drug Therapy for Type 2 Begins w/ lifestyle modification & diabetes self-management education; monotherapy initiates when no improvement after 3 mo Metformin: first-line therapy for most patients o Weight loss, low risk of hypoglycemia o Add second drug if target not met in 3 months Sulfonylurea: weight gain and hypoglycemia Thiazolidinediones (TZDs): weight gain, edema, heart failure (HF) Dipeptidyl peptidase-4 (DPP-4): weight neutral Glucagon-like peptide (GLP) receptor agonists: weight loss, low risk of hypoglycemia Insulin: weight gain, hypoglycemia Prevention & manageme nt of complicati ons in DM & obesity ADA Recommendations ASA (81-162mg) for prevention of increased DVD risk in Type 1 & 2 DM (men 50+, female 60+ & in additional risk factors (FHx, smoking, dyslipidemia, or albuminuria) o ASA is contraindicated, clopidogrel (Plavix) 75mg Metformin improves lipid profile but for HF, increase frequency of lactic acidosis ACEIs & ARBs (or non-dihydropyridine CCBs) reduce significantly diabetic nephropathy Aggressive lipid management reduces macrovascular dz, & mortality in DM (type 1 DM diagnosed in childhood will show high risk of early sub/clinical CVD) o Statin HMG-Co-A reductase inhibitors, if >100 or multiple CVD risk factors Controlling HTN reduces the rate of progression of diabetic nephropathy & hypertensive cerebrovascular dz Diabetic Autonomic neuropathy (DAN) o Cardiovascular autonomic dysfunction (CAN) is clinically significant component of DAN Tachycardia >100bpm Orthostasis (SBP 20 mm Hg fall upon standing w/o HR changes) Exercise intolerance, silent MI o GI dysfunction: gastroparesis, constipation, & diarrhea Metoclopramide (Reglan) o GU: Neurogenic bladder (urinary stasis) --Bethanechol (Urecholine) Erectile dysfunction—sildenafil (Viagra), Tadalafil (Cialis) retrograde ejaculation, loss of vaginal lubrication o Distal Symmetric Polyneuropathy (DPN): loss of sensation, pain, muscle weakness o Neuropathy: TCAs, Gabapentin Retinopathy: strict BP control & ophthalmologist examination needed Glycemic Control Hb A1C: baseline data & ongoing eval of glycemic control Self-monitoring of BG (SMBG): initial management
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  • Spring '14
  • Henrikson,J
  • c Criteria

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