Question

if the patient's glocose level is 475 (mg/dL) what he can do to reduce it per week or day to reach normal range which is 70-110 (mg/dL) ... specify amount of mg needed to be lost, in how long on how many mg a day ....

Answer 1

Diabetes mellitus is one of the common condition which leads to hyperglycemia. There are type-1 and type-2 DM.

GLYCEMIC TARGET

HbA1c <7%

Pre-prandial PG <130 mg/dl

Post prandial PG < 180

ANTI-HYPERGLYCEMIC THERAPY

· THERAPEUTIC OPTION :

· LIFE STYLE

Weight optimization

Healthy diet

Increased activity level

· ORAL AGENTS AND NON-INSULIN INJECTABLES

Metformin                         -      Meglitinides

Sulfonylureas                    -      Alpha-glucosidase inhibitors

Thiazolidinediones           -       Bile acid sequestrants

DPP-4 inhibitors                -       Dopamine-2 agonists

GLP-1 receptor agonists -       Amylin mimetics

· THERAPEUTIC OPTION

• INSULIN
• NPH(neutral protamine hagedron)
• Regular
• Basal analogue(glargine,detemir)
• Rapid analogues(Lispro,aspart,glulisine)
• Pre-mixed varieties
• Implementation strategy
• Initial therapy
• Advancing to dual combination therapy
• Advancing to triple combination
• Transitions to and titration of insulin

INITIAL DRUG MONOTHERAPY:

METFORMIN

TWO DRUG COMBINATIONS:

METFORMIN +SULFONYLUREA or THIAZOLIDINEDIONE or DPP-4 INHIBITOR or GLP-1 RECEPTOR AGONIST or INSULIN(BASAL) or SULFONYLUREA or THIAZOLIDINEDIONE or DPP-4 INHIBITOR or GLP-1 RECEPTOR AGONIST or INSULIN(BASAL)

THREE DRUG COMBINATION:

• METFORMIN+SULFONYLUREA+TZD or DPP-4-1 or GLP-1-RA or INSULIN
• METFORMIN+THIAZOLIDINEDIONE+SU or DPP-4-1 or DPP-4-1 or GLP-1-RA or INSULINE
• METFORMIN+DPP-4 INHIBITOR+ SUor TZD or INSULINE
• METFORMIN+GLP-1 receptor agonist+SU or TZD or INSULINE
• METFORMINE+INSULIN+TZD or DPP-4-1 or GLP-1-RA

NON-INSULIN REGIMENS:

• BASAL INSULIN ONLY(usually with oral agents)
• basal insulin+1(meal timerapid-acting insulin injection) or premixed insulin twice daily
• basal insulin +>2 (meal time) rapid acting insulin injection

OTHER CONSIDERATION:

• age
• weight
• sex/racial/ethnic/genetic difference
• comorbidities:

coronary artery disease

heart failure

chronic kidney disease

hypoglycemia