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Old 04-05-2011
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Search Food for thought: Diabetes management, acute and chronic

Here, is a question to start the ball:
You have a patient with diabetes type II
A) Hgb A1C of 8 first visit
B) Hgb A1C of 8 already advised and seen 3 months ago.
----) with Renal disease
----) with obesity
----) liver failure
C) Hgb A1C of >9 after one medication
D) Hgb A1C<9 after one medication

for each of the cases, what is the next best step in management, if a medication, choose the best next option.
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Old 04-05-2011
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Idea! Medication for sure

HbA 1C is above 6 that shows glucose bounded HB is high enough for medication...HbA 1C indicates the high plasma glucose levels are lasting for a long time that glucose has bounded Hb subtype. And because Hb break down takes some time we can determine how long did it take The hiperglisemia by checking HBa 1C percent! The patient has obesity so you should advise %40-50 Carbonhydrate, %30-40 fat, %10-20 protein diet! And regular exercise(which they never do ) Medication should be determined acording to FASTING plasma Glucose levels... 150-160 mg/dl => no medication,which in this case its obvious medication is needed (HBa1C > 6). 160-200 mg/dl => Oral antihiperglisemics. above >200mg/dl =>Insulin!
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Old 04-05-2011
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For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues.[47] Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy.

Patient education and compliance with treatment is very important in managing the disease. Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes.
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Old 04-05-2011
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Arrow True, True, you are correct

So I thought this was a good subject to bring up because I struggle with it and kept getting questions wrong and was all confused when to give second hypoglycemic or switch to insulin and no where I found exact info so this is what my attending(teacher) gave as an algorithm and I love it, it works every time so just wanted to share
1. first visit, life style and diet modification as it was mentioned, so details are mentioned above.

2. FBG &/symptoms
---->symptomatic /FBG>240---> Insulin
----> Asymptomatic/FBG 140-240---> oral hypoglycemic--> always Metformin unless renal issues. Then you pick others based on symptoms and side effect profile.

3. If not at target with your first drug
---> HbA1C>9 &/ FBG>240 ----> Insulin
--->HbA1C<9 &/FBG<240---> ADD Second hypoglycemic (again based on needs and side effect profile)---> if next visit still Not on target for FBG &/ HbA1C---> Insulin

Hope this helps everyone like it helps me and I am no longer just guessing or wondering what to do for DM II
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Endocrinology-, Internal-Medicine-, Step-2-Questions

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