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listlengths 384
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helps\tindividuals\tidentify\ttheir\tresponse\tto\tphysical\tactivities.\tTo\tmeet\ttheir\tindividual\tneeds,\n\tit\tis\nimportant\tto\tmodify\tgeneral\tguidelines\tto\treduce\tinsulin\tdoses\tbefore\t(or\tafter)\texercise.\nAdditionally,\tan\tindividual\tmay\tchoose\tto\tingest\tcarbohydrates\tbefore\t(or\tafter)\tany\tphysical\tactivity.
|
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Similar\tto\tthe\tgeneral\tpopulation\twithout\tdiabetes,\tit\tis\talso\timportant\tfor\tindividuals\twith\tdiabetes\nto\tstay\thydrated\twhen\tperforming\tphysical\tactivities.\nCarbohydrate\trecommendations\tfor\tinsulin\n\tor\tinsulin\tsecretagogue\tusers.\nDuring\tmoderate-intensity\texercise,\tglucose\tuptake\tis\tincreased\tby\t8\tto\t13\tg/hr;\tthis\tis\tthe\tbasis\tfor
|
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the\trecommendation\tto\tadd\t15\tg\tcarbohydrate\tfor\tevery\t30\tto\t60\tminutes\tof\tactivity\t(depending\ton\nthe\tintensity)\tover\tand\tabove\tnormal\troutines.\tModerate\texercise\tfor\tless\tthan\t30\tminutes\tusually\ndoes\tnot\trequire\tany\tadditional\tcarbohydrate\tor\tinsulin\tadjustment,\n\tunless\tthe\tindividual\tis
|
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unless\tthe\tindividual\tis\nhypoglycemic\tbefore\tthe\tstart\tof\texercise.\tAdded\tcarbohydrates\tshould\tbe\tingested\tif\tpreexercise\nglucose\tlevels\tare\tless\tthan\t100\tmg/dL\t(5.6\tmmol/L).\tSupplementary\tcarbohydrate\tis\tgenerally\tnot\nneeded\tin\tindividuals\twith\tT2DM\twho\tare\tnot\ttreated\twith\tinsulin\tor\tinsulin\tsecretagogues;\tit\tsimply\nadds\tunnecessary\tcalories\t(
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adds\tunnecessary\tcalories\t(\nADA,\t2018\n).\nIn\tall\tpeople,\tblood\tglucose\tlevels\n\tdecline\tgradually\tduring\texercise,\tand\tingesting\tcarbohydrate\nduring\tprolonged\texercise\tcan\timprove\tperformance\tby\tmaintaining\tthe\tavailability\tand\toxidation\tof\nblood\tglucose.\tFor\tthe\texerciser\twith\tdiabetes\twhose\tblood\tglucose\tlevels\tmay\tdrop\tsooner\tand
|
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] |
lower\tthan\tthe\texerciser\twithout\tdiabetes,\tingesting\tcarbohydrate\tafter\t40\tto\t60\tminutes\tof\texercise\nis\timportant\tand\talso\tmay\tassist\tin\tpreventing\n\thypoglycemia.\tDrinks\tcontaining\t2%\tto\t4%\tglucose\nempty\tfrom\tthe\tstomach\tas\tquickly\tas\twater\tand\thave\tthe\tadvantage\tof\tproviding\tboth\tneeded\tfluids\nand\tcarbohydrates\t(\nLeiper,\t2015
|
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] |
and\tcarbohydrates\t(\nLeiper,\t2015\n).\tConsuming\tcarbohydrates\timmediately\tafter\texercise\toptimizes\nrepletion\tof\tmuscle\tand\tliver\tglycogen\tstores.\tFor\tthe\texerciser\twith\tdiabetes,\tthis\ttakes\ton\tadded\nimportance\tbecause\tof\tincreased\trisk\tfor\tlate-onset\thypoglycemia.\nInsulin\tguidelines
|
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Insulin\tguidelines\nIt\tis\toften\tnecessary\tto\tadjust\tthe\tinsulin\tdosage\tto\tprevent\thypoglycemia.\tThis\toccurs\tmost\toften\nwith\tmoderate\tto\tstrenuous\tactivity\tlasting\tmore\tthan\t45\tto\t60\tminutes.\tFor\tmost\tpersons\ta\tmodest\ndecrease\t(of\tabout\t1\tto\t2\tunits)\tin\tthe\trapid-\t(or\tshort-)\tacting\tinsulin\tduring\tthe\tperiod\tof\texercise\tis
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-0.06888939440250397
] |
a\tgood\tstarting\tpoint.\tFor\tprolonged\tvigorous\texercise,\ta\tlarger\tdecrease\n\tin\tthe\ttotal\tdaily\tinsulin\ndosage\tmay\tbe\tnecessary.\tAfter\texercise,\tinsulin\tdosing\talso\tmay\thave\tto\tbe\tdecreased.\nPrecautions\tfor\tpersons\twith\tdiabetes\nPersons\twith\tT2DM\tmay\thave\ta\tlower\tVo\n2\nmax\tand\ttherefore\tneed\ta\tmore\tgradual\ttraining\tprogram.
|
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] |
2\nmax\tand\ttherefore\tneed\ta\tmore\tgradual\ttraining\tprogram.\nRest\tperiods\tmay\tbe\tneeded,\tbut\tthis\tdoes\tnot\timpair\tthe\ttraining\teffect\tfrom\tphysical\tactivity.\nExercise\trecommendations\nAdults\twith\tdiabetes\n\tshould\tbe\tadvised\tto\tperform\tat\tleast\t150\tmin/week\tof\tmoderate-intensity
|
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with\tvigorous\tmuscle-strengthening\tand\tbone-strengthening\tactivities\tat\tleast\t3\tdays/week\t(\nADA,\n2018\n).\nRoutine\tscreening\tpreexercise\tis\n\tnot\trecommended.\tProviders\tshould\tuse\tclinical\tjudgment\tin\tthis\narea.\tHigh-risk\tpatients\tshould\tbe\tencouraged\tto\tstart\twith\tshort\tperiods\tof\tlow-intensity\texercise
|
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] |
and\tincrease\tthe\tintensity\tand\tduration\tslowly\t(\nADA,\t2018\n).\nMedications\nA\tconsensus\tstatement\ton\tthe\tapproach\tto\tmanagement\tof\thyperglycemia\tin\tT2DM\thas\tbeen\npublished\tby\tthe\tADA\tand\tthe\tEuropean\tAssociation\tfor\tthe\tStudy\tof\tDiabetes\n\t(\nInzucchi\tet\tal,\t2015\n).
|
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] |
(\nInzucchi\tet\tal,\t2015\n).\nInterventions\tat\tthe\ttime\tof\tdiagnosis\tinclude\thealthy\teating,\tweight\tcontrol,\tphysical\tactivity,\tand\ndiabetes\teducation.\tMetformin\tis\tthe\tpreferred\tinitial\tpharmacologic\tagent\tfor\tT2DM,\teither\tin\naddition\tto\tlifestyle\tcounseling\tand\tphysical\tactivity,\tor\twhen\tlifestyle\tefforts\talone\thave\tnot\tachieved
|
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] |
includes\ta\tlong-acting\tinsulin\tdoes\tnot\tachieve\tA1C\tgoals,\ta\tmore\tcomplex\tinsulin\ttherapy\tinvolving\nmultiple\tdaily\tdoses\tis\tstarted—usually\tin\tcombination\twith\tone\tor\tmore\tnoninsulin\n\tagents.\tA\npatient-centered\tapproach\tis\talways\tideal,\tand\tshould\tinclude\tpatient\tpreferences,\tcost,\tand\npotential\tside\teffects\t(\nADA,\t2018
|
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potential\tside\teffects\t(\nADA,\t2018\n).\tThe\toverall\tobjective\tis\tto\tachieve\tand\tmaintain\tglycemic\tcontrol\nand\tto\tchange\tinterventions\t(including\tthe\tuse\tof\tinsulin)\twhen\ttherapeutic\tgoals\tare\tnot\tbeing\tmet.\nAll\tpeople\twith\tT1DM\tand\tmany\tpeople\twith\tT2DM\twho\tno\tlonger\tproduce\tadequate\tendogenous
|
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insulin\tneed\treplacement\tof\tinsulin.\tCircumstances\tthat\trequire\tthe\tuse\tof\tinsulin\tin\tT2DM\tinclude\nthe\tfailure\tto\tachieve\tadequate\tcontrol\twith\tadministration\tof\tglucose-lowering\tmedications\tand\nperiods\tof\tacute\tinjury,\tinfection,\textreme\theat\texposure,\tsurgery,\tor\tpregnancy.\nGlucose-lowering\tmedications\tfor\ttype\t2\tdiabetes
|
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] |
when\tthere\tis\tinsufficient\tinsulin\tavailable\tto\tmaintain\teuglycemia,\tand\tas\tinsulin\tdeficiency\nprogresses,\tmedications\tand\teventually\tinsulin\twill\tbe\trequired\tto\tachieve\tglycemic\n\tgoals.\nGlucose-lowering\tmedications\ttarget\tdifferent\taspects\tof\tthe\tpathogenesis\tof\tT2DM—insulin
|
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0.045937493443489075,
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0.05728255584836006,
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0.04063937067985535,
0.013251833617687225,
-5.776763956077957e-8,
0.13193164765834808,
-0.024599691852927208,
0.015330160968005657,
-0.011834916658699512,
-0.013944018632173538,
-0.008539577946066856,
0.018191924318671227,
0.033204060047864914,
0.027604665607213974,
-0.06557437032461166,
0.012428258545696735,
0.15051798522472382,
-0.03161125257611275,
-0.07710188627243042,
0.08018108457326889,
0.028287174180150032,
-0.06082545220851898,
0.12385497987270355,
-0.015104624442756176,
-0.03889518231153488,
-0.07353437691926956,
0.011843256652355194,
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0.013926307670772076,
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0.010095509700477123,
0.061287231743335724,
0.023257393389940262,
0.04061175137758255,
0.0013162438990548253,
0.056968025863170624,
-0.02559618093073368,
0.03499923646450043,
0.012696104124188423,
-0.0370568111538887,
0.04150065779685974,
0.007714521139860153,
0.003780864179134369,
0.0051318686455488205,
0.044834818691015244,
-0.007599893491715193,
-0.054994795471429825,
-0.04388803988695145,
0.069807268679142,
0.04523751512169838,
-0.04439987242221832,
0.027523955330252647,
0.054316580295562744,
0.045595500618219376,
-0.012946367263793945,
-0.03981020674109459,
0.08329489082098007,
-0.03000599890947342,
-0.03511850908398628,
-0.031009528785943985,
0.029070435091853142,
-0.022079119458794594,
-0.019862782210111618,
0.0016068881377577782,
-0.05332745239138603,
0.02723214589059353,
0.03483797237277031,
0.11272139847278595,
-0.03792819380760193
] |
resistance\tat\tthe\tcellular\tlevel,\tincretin\tsystem\tdefects,\tendogenous\tinsulin\tdeficiency,\televated\nlevels\tof\tglucagon,\tand\texcessive\thepatic\tglucose\trelease.\tBecause\tthe\tmechanisms\tof\taction\tdiffer,\nthe\tmedications\tcan\tbe\tused\talone\tor\tin\tcombination.\t\nTable\t29.5\n\tlists\tthe\tgeneric\tand\tbrand\tnames\nof
|
[
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0.0506196953356266,
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0.0702715739607811,
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0.04579803720116615,
0.014695030637085438,
0.019648896530270576,
0.047132156789302826,
0.07211962342262268,
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0.004891572054475546,
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0.1246262639760971,
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0.05568431317806244,
0.09626234322786331,
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2.192727489089555e-33,
0.054907914251089096,
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0.026460716500878334,
0.0348704531788826,
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0.05918305367231369,
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0.03309240937232971,
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0.15459485352039337,
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0.047740232199430466,
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0.004361720755696297,
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0.021510636433959007,
0.02036259137094021,
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0.04304477572441101,
0.010506603866815567,
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0.012772860005497932,
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0.007904132828116417,
0.034101251512765884,
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0.0010598500957712531,
0.01027240976691246,
0.06901311129331589,
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0.05912657082080841,
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0.014008908532559872,
0.05460002273321152,
0.009805252775549889,
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0.06401877850294113,
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0.03947455435991287,
0.04058564081788063,
0.05193180963397026,
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0.039743829518556595,
0.055701304227113724,
0.01693594828248024,
0.019499344751238823,
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0.0719180777668953,
0.009078972041606903,
0.00826702918857336,
0.07653690874576569,
0.016649659723043442,
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0.042910248041152954,
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0.0830608382821083,
0.0387704074382782,
0.00994166824966669,
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0.015897437930107117,
0.07424423098564148,
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0.03245757892727852,
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0.02782551944255829,
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0.008524571545422077,
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0.029392287135124207,
0.029699163511395454,
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0.042776793241500854,
0.00007115709013305604,
0.05242335796356201,
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0.03981754183769226,
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0.009832683950662613,
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0.04391489177942276,
0.039901118725538254,
0.04930363595485687,
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0.051879096776247025,
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0.10921479761600494,
0.07700313627719879,
-4.414453158574361e-8,
0.02739478088915348,
-0.0013766871998086572,
0.02007894776761532,
-0.052220605313777924,
0.03357338905334473,
0.05194661021232605,
0.03114447556436062,
-0.005096320062875748,
-0.04245779663324356,
-0.08352472633123398,
0.04205068200826645,
0.11943679302930832,
-0.040916524827480316,
-0.03414224833250046,
0.099424347281456,
0.060713984072208405,
-0.055078886449337006,
0.030088776722550392,
-0.036138761788606644,
-0.07397584617137909,
-0.042285311967134476,
0.06485892087221146,
-0.010764756239950657,
0.005624605342745781,
-0.030070042237639427,
0.0027609383687376976,
0.0048583876341581345,
0.002455425215885043,
0.00399656780064106,
0.03889203816652298,
0.03504359349608421,
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-0.009138825349509716,
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0.09495978057384491,
-0.025266248732805252,
-0.02010958641767502,
-0.029061008244752884,
0.11422886699438095,
-0.04511206969618797,
-0.038237541913986206,
-0.029316851869225502,
0.06660491228103638,
0.07874640822410583,
-0.053001683205366135,
-0.014978192746639252,
0.09479738771915436,
-0.03063032403588295,
-0.09996325522661209,
0.010578193701803684,
0.07891843467950821,
-0.0089791938662529,
-0.05188987776637077,
-0.08584874123334885,
0.037470798939466476,
0.04101589322090149,
0.014479932375252247,
-0.012537644244730473,
-0.03264322131872177,
0.06606657058000565,
0.022854875773191452,
0.12936189770698547,
0.01119513250887394
] |
Table\t29.5\n\tlists\tthe\tgeneric\tand\tbrand\tnames\nof\n\tglucose-lowering\tmedications\tand\ttheir\tprincipal\tsites\tof\taction\tfor\tpersons\twith\tT2DM.\t\nAppendix\n13\n\tlists\tthe\tnutrition\timplications\tof\tcommon\tdrugs.\nTABLE\t29.5\nGlucose-Lowering\tMedications\tfor\tType\t2\tDiabetes\nClass\nCompound(s)\nMechanism(s)\nEffects/\tConsiderations\nBiguanides\nMetformin
|
[
0.00011247786460444331,
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0.032686762511730194,
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0.007098550442606211,
0.07203956693410873,
0.05923321470618248,
0.003286354709416628,
0.07495152205228806,
0.10146736353635788,
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0.024008190259337425,
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0.010206816717982292,
0.03494083136320114,
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0.0208800807595253,
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0.0630464106798172,
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0.0274649690836668,
0.09509781002998352,
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0.06387396156787872,
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0.020284663885831833,
0.028324466198682785,
0.037161361426115036,
0.02133442834019661,
0.01015720795840025,
0.05220552906394005,
0.005514644086360931,
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0.04251369088888168,
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0.03193633630871773,
0.0023356641177088022,
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0.11287806928157806,
0.03072688728570938,
0.032267387956380844,
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0.04020880162715912,
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2.296968491410552e-33,
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] |
Compound(s)\nMechanism(s)\nEffects/\tConsiderations\nBiguanides\nMetformin\n(Glucophage)\nMetformin\nExtended\nRelease\n(Glucophage\nXR)\nDecrease\thepatic\nglucose\nproduction\nLow\tcost,\tpotential\tASCVD\tbenefit,\ncontraindicated\tw/eGFR\t<30,\ngastrointestinal\tside\teffects\ncommon\t(nausea,\tdiarrhea),\npotential\tfor\tvitamin\tB\n12\n\tand\tfolate\ndeficiency
|
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0.029107823967933655,
0.12209001928567886,
0.13429830968379974,
0.013609444722533226
] |
potential\tfor\tvitamin\tB\n12\n\tand\tfolate\ndeficiency\nSulfonylureas\t(2nd\ngeneration)\nGlipizide\t(Glucotrol)\nGlipizide\n(Glucotrol\nXL)\nGlyburide\n(Glynase\nPresTabs)\nGlimepiride\n(Amaryl)\nIncrease\tinsulin\nsecretion\nLow\tcost,\thypoglycemia,\tweight\tgain,\nglyburide\tnot\trecommended\twith\ndiabetic\tkidney\tdisease,\tFDA\tspecial\nwarning\ton\tincreased\trisk\tof
|
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] |
diabetic\tkidney\tdisease,\tFDA\tspecial\nwarning\ton\tincreased\trisk\tof\ncardiovascular\tmortality\nMeglitinides\n(Glinides)\nRepaglinide\n(Prandin)\nNateglinide\n(Starlix)\nIncreases\tinsulin\nsecretion\nHypoglycemia\nThiazolidinediones\nPioglitazone\t(Actos)\nRosiglitazone\n(Avandia)\nIncreases\tinsulin\nsensitivity\nLow\tcost,\tweight\tgain,\tpotential
|
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] |
Increases\tinsulin\nsensitivity\nLow\tcost,\tweight\tgain,\tpotential\nASCVD\tbenefit\t(pioglitazone),\ngenerally\tnot\trecommended\tin\trenal\nimpairment,\tfluid\tretention\t(edema,\nheart\tfailure),\tFDA\tblack\tbox:\tMay\ncause\tor\tworsen\tcongestive\theart\nfailure,\tbenefit\tin\tNASH,\trisk\tof\nbone\tfractures,\tbladder\tcancer\n(pioglitazone),\traises\tLDL
|
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] |
bone\tfractures,\tbladder\tcancer\n(pioglitazone),\traises\tLDL\ncholesterol\t(rosiglitazone)\nGlucagon-like\npeptide-1\t(GLP-\n1)\treceptor\nagonists\nExenatide\t(Byetta)\nExenatide\nExtended\nRelease\n(Bydureon)\nLiraglutide\n(Victoza)\nAlbiglutide\n(Tanzeum)\nDulaglutide\n(Trulicity)\nIncreases\tglucose-\ndependent\tinsulin\nsecretion\nSuppresses\nglucagon\nsecretion\n(glucose
|
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dependent\tinsulin\nsecretion\nSuppresses\nglucagon\nsecretion\n(glucose\ndependent)\nSlows\tgastric\nemptying\nIncreases\nsatiety/activates\nGLP-1\treceptors\nHigh\tcost,\tweight\tloss,\tbenefit\tASCVD\nand\tprogression\n\tof\tDKD\n(liraglutide),\tincreased\trisk\tof\tside\neffect\tin\tpatients\twith\trenal\nimpairment,\tFDA\tblack\tbox:\tRisk\tof\nthyroid\tC-cell\ttumors,
|
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] |
impairment,\tFDA\tblack\tbox:\tRisk\tof\nthyroid\tC-cell\ttumors,\ngastrointestinal\tside\teffects\ncommon\t(nausea,\tvomiting,\ndiarrhea),\tinjection\tsite\treactions,\nacute\tpancreatitis\trisk\nDipeptidyl\npeptidase-4\n(DPP-4)\ninhibitors\nSitagliptin\t(Januvia)\nSaxagliptin\n(Onglyza)\nLinagliptin\n(Tradjenta)\nAlogliptin\n(Nesina)\nIncreases\tinsulin\nsecretion\t(glucose
|
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] |
(Tradjenta)\nAlogliptin\n(Nesina)\nIncreases\tinsulin\nsecretion\t(glucose\ndependent)\tand\ndecreases\tglucagon\nsecretion\t(glucose\ndependent)/Inhibits\nDPP-4\tactivity,\nincreasing\npostprandial\tincretin\n(GLP-1,\tGIP)\nconcentrations\nHigh\tcost,\tCHF\tpotential\trisk\n(saxagliptin,\talogliptin),\tcan\tbe\tused\nin\trenal\timpairment,\tpotential\trisk
|
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in\trenal\timpairment,\tpotential\trisk\nof\tacute\tpancreatitis,\tjoint\tpain
|
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0.013290748000144958,
0.10394597798585892,
0.05681924521923065,
0.0057738181203603745,
-0.03039153479039669,
0.10452767461538315,
-0.03314041718840599,
0.0025028977543115616,
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0.01502744760364294,
0.09134726226329803,
0.05290105566382408,
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0.06633948534727097,
0.02595951408147812,
0.09092883765697479,
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] |
Bile\tacid\nsequestrants\nColesevelam\n(Welchol)\nDecreases\thepatic\nglucose\tand\nincreases\tincretin\nlevels/Binds\tbile\nacids\tin\tintestinal\ntract,\tincreasing\nhepatic\tbile\tacid\nproduction\nDo\tnot\tuse\tif\thistory\tof\tbowel\nobstruction,\ttriglycerides\t>500,\nor\tpancreatitis.\tCan\tdecrease\nabsorption\tof\tcertain\tmeds,\tsoluble\nvitamins.\nSide\teffects\tGI\tin\tnature
|
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] |
vitamins.\nSide\teffects\tGI\tin\tnature\nDopamine-2\nagonists\nBromocriptine\nquick\trelease\tQR\n(Cycloset)\nModulates\thypothalamic\nregulation\tof\nmetabolism,\nincreases\tinsulin\nsensitivity/activates\ndopaminergic\nreceptors\nSide\teffects:\tnausea,\theadache,\nfatigue,\thypotension,\tsyncope,\nsomnolence\nAlpha\tglucosidase\ninhibitors\nAcarbose\t(Precose)\nMiglitol\t(Glyset)
|
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] |
Alpha\tglucosidase\ninhibitors\nAcarbose\t(Precose)\nMiglitol\t(Glyset)\nInhibits\tintestinal\talpha\nglucosidase/slows\nintestinal\ncarbohydrate\ndigestion\tand\nabsorption\nDiarrhea,\tgas,\tand\tnausea\nIf\tmild\tto\tmoderate\thypoglycemia\noccurs\tin\tcombination\twith\nanother\tantidiabetic\tdrug\tsuch\nas\ta\tsulfonylurea\n\tor\tinsulin,\tthe\nhypoglycemia\tshould\tbe\ttreated
|
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] |
as\ta\tsulfonylurea\n\tor\tinsulin,\tthe\nhypoglycemia\tshould\tbe\ttreated\nwith\toral\tglucose\t(dextrose)\ninstead\tof\tsucrose\t(table\tsugar)\nbecause\tthe\tdrug\tblocks\tthe\ndigestion\tof\tsucrose\tto\tglucose.\nAmylin\tmimetics\nPramlintide\n(Symlin)\nDecreases\tglucagon\nsecretion,\tslows\ngastric\temptying,\nincreases\nsatiety/activates\namylin\treceptors
|
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] |
gastric\temptying,\nincreases\nsatiety/activates\namylin\treceptors\nFDA\tblack\tbox:\tsevere\thypoglycemic\nrisk\t3\thours\tpost\tinjection,\tconsider\ndecreasing\n\tinsulin\tdose\twhen\nstarting.\tSide\teffects:\tnausea,\nweight\tloss\nSodium-glucose\ntransport\t2\ninhibitors\n(SGLT2)\nCanagliflozin\n(Invokana)\nDapagliflozin\n(Farxiga)\nEmpagliflozin\n(Jardiance)
|
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] |
(Invokana)\nDapagliflozin\n(Farxiga)\nEmpagliflozin\n(Jardiance)\nBlocks\treabsorption\tof\nglucose\tin\tthe\nkidneys,\tincreasing\nglucosuria/SGLT2\ninhibition\tin\tthe\nproximal\tnephron\nHigh\tcost,\tweight\tloss,\tbenefits\nASCVD/CHF/progression\tof\tDKD\n(canagliflozin\tnot\t<45\teGFR,\nempagliflozin\n\tcontraindicated\twith\neGFR\t<30),\tFDA\tblack\tbox:\trisk\tof
|
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0.02678685635328293
] |
empagliflozin\n\tcontraindicated\twith\neGFR\t<30),\tFDA\tblack\tbox:\trisk\tof\namputation\t(canagliflozin),\trisk\tof\nbone\tfractures\t(canagliflozin),\tDKA\nrisk\t(rare\tin\tT2DM),\trisk\tof\tvolume\ndepletion/hypotension,\traises\tLDL\ncholesterol,\tgenitourinary\tinfections\nInsulins\nSee\t\nTable\t29.6\nIncreases\tglucose\ndisposal,\tdecreases\nhepatic\tglucose\nproduction,
|
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Increases\tglucose\ndisposal,\tdecreases\nhepatic\tglucose\nproduction,\nsuppresses\nketogenesis/activates\ninsulin\treceptors\nHuman\tinsulin-low\n\tcost,\tanalogs-high\ncost,\thypoglycemia\t(higher\trisk\twith\nhuman\tinsulin),\tweight\tgain,\tlower\ndose\trequired\twith\tdecreased\neGFR,\tinjection\tsite\treactions
|
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0.05226892977952957,
0.05594131350517273,
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0.01769140549004078
] |
dose\trequired\twith\tdecreased\neGFR,\tinjection\tsite\treactions\nModified\tfrom\tAmerican\tDiabetes\tAssociation:\tPharmacologic\tapproaches\tto\tglycemic\ttreatment:\tStandards\tof\tmedical\tcare\tin\tdiabetes—2018,\nDiabetes\tCare\n\t41(S1):S77,\tS79-80,\t2018.\nBiguanides\nMetformin\tis\tthe\tmost\twidely\tused\tfirst-line\ttype\n\t2\tmedication.\tIt\tsuppresses\thepatic\tglucose
|
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] |
2\tmedication.\tIt\tsuppresses\thepatic\tglucose\nproduction,\tis\tnot\tassociated\twith\thypoglycemia,\tmay\tcause\tsmall\tweight\tlosses\twhen\ttherapy\nbegins,\tand\tis\trelatively\tinexpensive.\tThe\tmost\tcommon\tside\teffects\tare\tgastrointestinal\t(GI),\twhich\noften\tdisappear\twith\ttime.\tTo\tminimize\tthese\teffects,\tthe\tmedication\tshould\tbe\ttaken\twith\tfood
|
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] |
consumption\tand\tthe\tsmallest\tdose\t(500\tmg)\tgiven\ttwice\ta\tday\tfor\n\ta\tweek\tand\tgradually\tincreased\tto\nmaximum\tdoses.\tIf\tthat\tdoes\tnot\thelp,\tMetformin\tXR\t(or\textended\trelease)\tis\ta\tgood\talternative\tthat\ncan\thelp\tminimize\tGI\tside\teffects.\tThis\tshould\talso\tbe\ttaken\twith\tmeals\t(\nLevy\tet\tal,\t2010\n).\tA\trare\tside
|
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] |
Levy\tet\tal,\t2010\n).\tA\trare\tside\neffect\tof\tMetformin\tis\tsevere\tlactic\tacidosis,\twhich\tcan\tbe\tfatal.\tThe\tacidosis\tusually\toccurs\tin\npatients\twho\tuse\talcohol\texcessively,\thave\trenal\tdysfunction,\n\tor\thave\tliver\timpairments.\tMetformin\nmay\talso\tcause\ta\tdecrease\tin\tB\n12\n,\tso\tpatients\tneed\tto\tmake\tsure\tto\thave\tadequate\tintake\t(\nADA,\n2018\n).\nSulfonylureas
|
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] |
ADA,\n2018\n).\nSulfonylureas\nThe\tsulfonylureas\t(glyburide\t[DiaBeta],\tglipizide\t[Glucotrol],\tglimepiride\t[Amaryl])\tare\tinsulin\nsecretagogues\tand\tpromote\tinsulin\tsecretion\tby\tthe\tbeta-cells\tof\tthe\tpancreas.\tFirst-\tand\tsecond-\ngeneration\tsulfonylurea\tdrugs\tdiffer\tfrom\tone\n\tanother\tin\ttheir\tpotency,\tpharmacokinetics,\tand
|
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] |
another\tin\ttheir\tpotency,\tpharmacokinetics,\tand\nmetabolism.\tDisadvantages\tof\ttheir\tuse\tinclude\tweight\tgain,\tGI\tside\teffects—nausea,\tdiarrhea,\tand\nconstipation—and\tthe\tpotential\tto\tcause\thypoglycemia.\tThey\talso\thave\tthe\tadvantage\tof\tbeing\ninexpensive.\nThiazolidinediones\t(TZDs)
|
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] |
inexpensive.\nThiazolidinediones\t(TZDs)\nThiazolidinediones\t(TZDs)\tor\tglitazones\t(pioglitazone\t[Actos]\tand\trosiglitazone\t[Avandia])\tdecrease
|
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insulin\tresistance\n\tin\tperipheral\ttissues\tand\tthus\tenhance\tthe\tability\tof\tmuscle\tand\tfat\tcells\tto\ttake\tup\nglucose.\tTZDs\talso\thave\ta\tfavorable\teffect\ton\tlipids\tand\tdo\tnot\tindependently\tcause\thypoglycemia.\nAdverse\teffects\tinclude\tweight\tgain,\tfluid\tretention\tleading\tto\tedema\tand/or\theart\tfailure,\tand\nincreased\trisk\tof\tbone\tfractures.
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increased\trisk\tof\tbone\tfractures.\nGlucagon-like\tpeptide-1\t(GLP-1)\treceptor\tagonists\nIncretins\n\tare\thormones\tmade\n\tby\tthe\tGI\ttract\tand\tinclude\tGLP-1.\tGLP-1\tis\treleased\tduring\tnutrient\nabsorption,\twhich\tincreases\tglucose-dependent\tinsulin\tsecretion,\tslows\tgastric\temptying,\tdecreases
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glucagon\tproduction,\tand\tenhances\tsatiety.\tExenatide\t(Byetta)\tand\tliraglutide\t(Victoza)\tare\tsynthetic\ndrugs\tthat\thave\tmany\tof\tthe\tsame\tglucose-lowering\teffects\tas\tthe\tbody’s\tnaturally\toccurring\nincretin,\tGLP-1.\tA\tprimary\tbenefit\tis\n\tweight\tloss\t(liraglutide\thas\talso\tbeen\tapproved\tas\ta\tweight-loss
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] |
weight\tloss\t(liraglutide\thas\talso\tbeen\tapproved\tas\ta\tweight-loss\ndrug).\tTypically\texenatide\tis\tinjected\ttwice\ta\tday,\tat\tbreakfast\tand\tat\tthe\tevening\tmeal,\tand\nliraglutide\tis\tinjected\tonce\ta\tday,\tat\tany\ttime,\tindependent\tof\tmeals.\tThere\tare\tthree\tonce-weekly
|
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] |
injection\tGLP-1s:\texenatide\textended\t(Bydureon),\tdulaglutide\t(Trulicity),\tand\tsemaglutide\t(Ozempic).\nDipeptidyl\tpeptidase\t4\tinhibitors\n\t(DPP-4)\nGLP-1\tand\tglucose-dependent\tinsulinotropic\tpeptide\t(GIP),\tthe\tmain\tintestinal\tstimulants\tof\tinsulin\nare\trapidly\tdegraded\tby\tthe\tenzyme\tDPP-4.\tAs\ta\tresult,\tincretins\thave\tvery\tshort\thalf-lives\tof\t2\tto\t3
|
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] |
minutes.\tDPP-4\tinhibitors\tprolong\ttheir\thalf-lives.\tOral\tDPP-4\tinhibitors\tare\tsitagliptin\t(Januvia),\nsaxagliptin\t(Onglyza),\tlinagliptin\t(Tradjenta),\tand\talogliptin\t(Nesina).\tThey\thave\ta\n\tmodest\teffect\ton\nA1C;\thowever,\tadvantages\tinclude\tbeing\tweight\tneutral\tand\trelatively\twell\ttolerated.\tFurthermore,
|
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they\tdo\tnot\tcause\thypoglycemia\twhen\tused\tas\tmonotherapy.\nAlpha\tglucosidase\tinhibitors\nAcarbose\t(Precose)\tand\tmiglitol\t(Glyset)\tare\talpha-glucosidase\tinhibitors\tthat\twork\tin\tthe\tsmall\nintestine\tto\tinhibit\tenzymes\tthat\tdigest\tcarbohydrates,\tthereby\tdelaying\tcarbohydrate\tabsorption
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and\tlowering\tpostprandial\tglycemia.\tThey\tdo\tnot\tcause\thypoglycemia\tor\tweight\tgain\twhen\tused\nalone,\tbut\tthey\tcan\tfrequently\tcause\tflatulence,\tdiarrhea,\tcramping,\tor\tabdominal\tpain.\tSymptoms\nmay\tbe\talleviated\tby\tinitiating\ttherapy\tat\ta\tlow\tdose\tand\tgradually\tincreasing\tthe\tdose\tto\ntherapeutic\tlevels.\nMeglitinides\t(glinides)
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therapeutic\tlevels.\nMeglitinides\t(glinides)\nThe\tmeglitinides\trepaglinide\t(Prandin)\tand\tnateglinide\t(Starlix)\tdiffer\n\tfrom\tthe\tsulfonylureas\tin\tthat\nthey\thave\tshort\tmetabolic\thalf-lives,\twhich\tresult\tin\tbrief\tepisodic\tstimulation\tof\tinsulin\tsecretion.\nThey\tare\tgiven\tbefore\tmeals,\tdecreasing\tpostprandial\tglucose\texcursions\tand\tless\trisk\tof
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0.027620796114206314,
-0.023769209161400795,
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0.08999401330947876,
0.030289342626929283,
-0.08628252893686295,
0.01783488318324089,
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-0.04895429313182831,
-0.06671043485403061,
-0.08512356877326965,
0.04613767936825752,
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0.026675362139940262,
0.02170725353062153,
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0.06282051652669907,
0.05311551317572594,
0.09406451880931854,
0.02815120853483677
] |
hypoglycemia.\tNateglinide\tonly\tworks\tin\tthe\tpresence\tof\tglucose\tand\tis\ta\tsomewhat\tless\tpotent\nsecretagogue.\tPossible\tweight\tgain\tis\tsimilar\tto\tsulfonylureas.\nSodium-glucose\n\ttransporter\t2\t(SGLT-2)\tinhibitors\nCanagliflozin\t(Invokana),\tdapagliflozin\t(Farxiga),\tempagliflozin\t(Jardiance),\tand\tertugliflozin
|
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] |
(Steglatro)\tare\tdrugs\tin\ta\tnew\tclass\tthat\ttarget\tblood\tglucose–lowering\taction\tin\tthe\tkidneys.\tSGLT-2\ninhibitors\tblock\ta\ttransporter\tprotein\tthat\treturns\tglucose\tto\tthe\tbloodstream\tafter\tit\tis\tfiltered\nthrough\tthe\tkidneys.\tBlocking\tthis\tprotein\tcauses\tmore\tglucose\tto\n\tbe\tflushed\tout\tin\tthe\turine.\tUsed
|
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be\tflushed\tout\tin\tthe\turine.\tUsed\nindependently\tit\tdoes\tnot\tcause\thypoglycemia\tor\tweight\tgain.\nAmylin\tagonists\t(pramlintide)\nPramlintide\t(Symlin)\tis\ta\tsynthetic\tanalog\tof\tthe\thormone\t\namylin\n,\ta\thormone\tnormally\tcosecreted\nwith\tinsulin\tby\tthe\tbeta-cell\tin\tresponse\tto\tfood\tthat\tis\tdeficient\tin\tpeople\twith\tT1DM\tand\tT2DM.\tIt\tis
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injected\tbefore\tmeals,\tslowing\tgastric\temptying\tand\tinhibiting\tglucagon\n\tproduction\tand\tresulting\tin\na\tdecrease\tin\tpostprandial\tglucose\texcursions,\twhich\tis\trelated\tto\ta\tdecrease\tin\tglucagon\tproduction\nfrom\tthe\tpancreatic\talpha\tcells.\tIt\tmust\tbe\tinjected\tseparately\tfrom\tinsulin.\nInsulin
|
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Insulin\nInsulin\tstrategies\tfor\tpersons\twith\tT2DM\tmay\tbegin\twith\tbasal\tinsulin\tat\tbedtime\tto\tsuppress\nnocturnal\thepatic\tglucose\tproduction\tand\tto\tnormalize\tfasting\tglucose\tlevels.\tGlucose-lowering\nmedications\tusually\tare\tcontinued\tduring\tthe\tday.\tThe\tnext\tstep\tis\tto\tadd\tone\tmealtime\trapid-acting
|
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] |
insulin\twith\tthe\tbasal\tinsulin\tor\tuse\tof\tpremixed\tinsulin,\twhich\tis\ta\tcombination\tof\ttwo\tinsulins\tmixed\ntogether,\ttwice\tdaily.\tPremixed\tinsulin\tis\ttypically\ta\tcombination\tof\ta\tshort\tor\trapid-acting\tinsulin\nand\tan\tintermediate\tor\tlong-acting\tinsulin.\tIf\tA1C\tgoals\tare\tnot\tachieved,\tmealtime\n\trapid-acting
|
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] |
rapid-acting\ninsulin\tis\tused\tbefore\teach\tmeal.\tInsulin\tsecretagogues\tusually\tare\tstopped,\tbut\tother\tglucose-\nlowering\tagents\tmay\tbe\tcontinued.\nInsulin\thas\tthree\tcharacteristics:\tonset,\tpeak,\tand\tduration\t(\nTable\t29.6\n).\tU-100\tis\tthe\tconcentration
|
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] |
Table\t29.6\n).\tU-100\tis\tthe\tconcentration\nof\tinsulin\tused\tin\tthe\tUnited\tStates.\tThis\tmeans\tit\thas\t100\tunits\tof\tinsulin\tper\tmilliliter\tof\tfluid\t(100\nunits/mL).\tU-100\tsyringes\tdeliver\tU-100\tinsulin;\n\thowever,\tinsulin\tpens\tare\tnow\tbeing\tused\tmore\nfrequently\tas\tan\talternative\tto\tthe\ttraditional\tsyringe-needle\tunits.\tHumulin\tR\tU-500\t(500\tunits/mL)
|
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] |
is\tuseful\tin\tthe\ttreatment\tof\tinsulin-resistant\tpatients\twho\trequire\tdaily\tdoses\tmore\tthan\t200\tunits.
|
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] |
TABLE\t29.6\nAction\tTimes\tof\tHuman\tInsulin\tPreparations\nType\tof\tInsulin\nOnset\tof\nAction\nPeak\nAction\nUsual\nEffective\nDuration\nMonitor\nEffect\nIn\nRapid-Acting\nInsulin\tlispro\n<0.25-0.5\thr\n0.5-2.5\thr\n3-6.5\thr\n1-2\thr\nInsulin\taspart\n<0.25\thr\n0.5-1.0\thr\n3-5\thr\n1-2\thr\nInsulin\tglulisine\n<0.25\thr\n1-1.5\thr\n3-5\thr\n1-2\thr\nInhaled\tinsulin\nShort-Acting\nHuman\tRegular
|
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] |
1-1.5\thr\n3-5\thr\n1-2\thr\nInhaled\tinsulin\nShort-Acting\nHuman\tRegular\n0.5-1\thr\n2-3\thr\n3-6\thr\n4\thr\t(next\nmeal)\nIntermediate-Acting\tAnalogs\nHuman\tneutral\tprotamine\thagedorn\t(NPH)\n2-4\thr\n4-10\thr\n10-16\thr\n8-12\thr\nBasal\tInsulin\tAnalogs\nInsulin\tglargine\t(Lantus)\n2-4\thr\nPeakless\n20-24\n\thr\n10-12\thr\nInsulin\tdetemir\t(Levemir)\n0.8-2\thr\t(dose\ndependent)\nPeakless
|
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] |
10-12\thr\nInsulin\tdetemir\t(Levemir)\n0.8-2\thr\t(dose\ndependent)\nPeakless\n12-24\thr\t(dose\ndependent)\n10-12\thr\nDegludec\nPremixed\tInsulin\tProducts\n70/30\t(70%\tNPH,\t30%\tregular)\n0.5-1\thr\nDual\n10-16\thr\nHumalog\tMix\t(Lispro)\t75/25\t(75%\tneutral\nprotamine\tlispro\t[NPL],\t25%\tlispro)\n<0.25\thr\nDual\n10-16\thr\nHumalog\tMix\t(Lispro)\t50/50\t(50%\tprotamine
|
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<0.25\thr\nDual\n10-16\thr\nHumalog\tMix\t(Lispro)\t50/50\t(50%\tprotamine\nlispro,\t50%\tlispro)\n<0.25\thr\nDual\n10-16\n\thr\nNovoLog\tMix\t70/30\t(70%\tneutral\tprotamine\naspart\t[NPA],\t30%\taspart)\n<0.25\thr\nDual\n15-18\thr\nData\tfrom\tAmerican\tDiabetes\tAssociation:\tPharmacologic\tapproaches\tto\tglycemic\ttreatment:\tStandards\tof\tmedical\tcare\tin\tdiabetes—2018,\nDiabetes\tCare
|
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Diabetes\tCare\n\t41(S1):S80,\t2018.\nRapid-acting\tinsulins\tinclude\tlispro\t(Humalog),\tinsulin\taspart\t(Novolog),\tand\tinsulin\tglulisine\n(Apidra)\tand\tare\tused\tas\tbolus\n\t(premeal\tor\tprandial)\tinsulins.\tThey\tare\tinsulin\tanalogs\tthat\tdiffer\nfrom\thuman\tinsulin\tin\tamino\tacid\tsequence\tbut\tbind\tto\tinsulin\treceptors\tand\tthus\tfunction\tin\ta
|
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] |
manner\tsimilar\tto\thuman\tinsulin.\tTo\tdetermine\tthe\taccuracy\tof\tthe\tdose,\tblood\tglucose\tchecking\tis\ndone\tbefore\tmeals\tand\t2\thours\tafter\tthe\tstart\tof\tthe\tmeals.\nRegular\tinsulin\tincludes\tshort-acting\tinsulin\twith\ta\tslower\tonset\tof\taction\n\tand\tlater\tactivity\tpeak.
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] |
and\tlater\tactivity\tpeak.\nFor\tbest\tresults\tthe\tslow\tonset\tof\tregular\tinsulin\trequires\tit\tto\tbe\ttaken\t30\tto\t60\tminutes\tbefore\nmeals.\nNeutral\tprotamine\thagedorn\t(NPH)\tis\tthe\tonly\tavailable\tintermediate-acting\tinsulin\tand\tis\tcloudy\nin\tappearance.\tThis\ttype\tof\tinsulin\tcontains\tsubstrates\tthat\twork\tover\ta\tlong\tperiod\tof\ttime,\tusually
|
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] |
with\tan\teffective\tduration\tof\t10\tto\t16\thours.\nLong-acting\tinsulins\n\tinclude\tinsulin\tglargine\t(Lantus)\tand\tinsulin\tdetemir\t(Levemir).\tInsulin\nglargine\tis\tan\tinsulin\tanalog\tthat,\tbecause\tof\tits\tslow\tdissolution\tat\tthe\tinjection\tsite,\tresults\tin\ta\nrelatively\tconstant\tand\tpeakless\tdelivery\tover\t24\thours.\tBecause\tof\tits\tacidic\tpH,\tit\tcannot\tbe\tmixed
|
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] |
with\tany\tother\tinsulin\tin\tthe\tsame\tsyringe\tbefore\tinjection\tand\tusually\tis\tgiven\tat\tbedtime.\tHowever,\nglargine\tcan\tbe\n\tgiven\tbefore\tany\tmeal.\tKeep\tin\tmind\tthat\tconsistency\tis\tkey,\tas\tthe\tdose\tmust\tbe\nadministered\tconsistently\tat\twhichever\ttime\tis\tchosen.\tBasal\tinsulin\tanalogs\tdecrease\tthe\tchances\tof\nhypoglycemia,\tespecially\tnocturnal\thypoglycemia.
|
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hypoglycemia,\tespecially\tnocturnal\thypoglycemia.\nPremixed\tinsulins\tinclude\t70%\tNPH/30%\tregular,\t75%\tlispro\tprotamine\t(NPL\t[addition\tof\tneutral\nprotamine\tto\tlispro\tto\tcreate\tan\tintermediate-acting\tinsulin])/25%\tlispro,\n\t50%\tlispro\tprotamine\tand\n50%\tlispro,\tand\t70%\tprotamine\t(addition\tof\tneutral\tprotamine\tto\taspart\tto\tcreate\tan\timmediate-
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acting\tinsulin)/30%\taspart\t(\nADA,\t2018\n).\tPeople\tusing\tpremixed\tinsulins\tmust\teat\tat\tspecific\ttimes\nand\tbe\tconsistent\tin\tcarbohydrate\tintake\tto\tprevent\thypoglycemia.\nInsulin\tregimens\nAll\tpersons\twith\tT1DM\tand\tthose\twith\tT2DM\twho\tno\tlonger\tproduce\tadequate\tendogenous\tinsulin
|
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] |
need\treplacement\tof\tinsulin\tthat\tmimics\tnormal\tinsulin\taction.\tAfter\tindividuals\twithout\tdiabetes\teat,\ntheir\tplasma\tglucose\tand\tinsulin\tconcentrations\tincrease\trapidly,\tpeaking\tin\t30\tto\t60\tminutes,\tand\nreturn\tto\tbasal\tconcentrations\twithin\t2\tto\t3\thours.\tTo\tmimic\tthis,\trapid-acting\t(or\tshort-acting)
|
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insulin\tis\tgiven\tbefore\tmeals,\tand\tthis\tis\treferred\tto\tas\tbolus\tor\tmealtime\tinsulin.\nMealtime\tinsulin\n\tdoses\tare\tadjusted\tbased\ton\tthe\tamount\tof\tcarbohydrate\tin\tthe\tmeal.\tAn\tinsulin-\nto-carbohydrate\tratio\tcan\tbe\testablished\tfor\tan\tindividual\tthat\twill\tguide\tdecisions\ton\tthe\tamount\tof
|
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Basal\tinsulin\talso\tlimits\tlipolysis\tand\texcess\tflux\tof\tfree\tfatty\tacids\tto\tthe\tliver.\tLong-acting\tinsulins
|
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] |
are\tused\tfor\tbasal\tinsulin\t(\nFig.\t29.2\n).\nFIG.\t29.2\nTime\tactions\tof\tflexible\tinsulin\tregimens.\n\t\nSource:\n\t(Modified\tfrom\tKaufman\tFR,\teditor:\t\nMedical\tmanagement\tof\ntype\t1\tdiabetes,\n\ted\t6,\tAlexandria,\tVA,\t2012,\tAmerican\tDiabetes\tAssociation.)\nThese\tphysiologic\tinsulin\tregimens\tallow\tincreased\tflexibility\tin\tthe\ttype\tand\ttiming\tof\tmeals.\tFor
|
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nonobese\tpersons\twith\tT1DM,\tthe\trequired\tinsulin\tdosage\tis\tabout\t0.5\tto\t1\tunit/kg\tof\tbody\tweight\nper\tday.\tAbout\t50%\tof\tthe\ttotal\tdaily\tinsulin\tdose\tis\tused\tto\tprovide\tfor\tbasal\tor\tbackground\tinsulin\nneeds.\tThe\tremainder\t(rapid-acting\tinsulin)\tis\tdivided\tamong\tthe\tmeals\teither\tproportionately\tto\tthe
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carbohydrate\tcontent\tor\tby\tgiving\tabout\t1\tto\t1.5\tunits\tof\tinsulin\tper\t10\tto\t15\tg\tof\tcarbohydrates\nconsumed\t(\ninsulin\tto\tcarbohydrate\tratio\n).\tAs\ta\tresult\tof\tthe\tpresence\tin\tthe\tmorning\tof\thigher\nlevels\tof\tcounterregulatory\thormones,\tmany\tindividuals\tmay\trequire\tlarger\tdoses\tof\tmealtime\tinsulin
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0.07893674820661545,
-0.0412980392575264
] |
for\tcarbohydrates\tconsumed\tat\tbreakfast\tthan\tmeals\tlater\tin\tthe\tday.\tPersons\twith\tT2DM\tmay\nrequire\tinsulin\tdoses\tin\tthe\trange\tof\t0.5\tto\t1.2\tunits/kg\tof\tbody\tweight\tdaily.\tLarge\tdoses,\teven\tmore\nthan\t1.5\tunits/kg\tof\tbody\tweight\tdaily,\tmay\tbe\trequired\tat\tleast\tinitially\tto\tovercome\tprevailing\ninsulin
|
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] |
insulin\n\tresistance.\tThe\ttype\tand\ttiming\tof\tinsulin\tregimens\tshould\tbe\tindividualized,\tbased\ton\teating\nand\texercise\thabits\tand\tblood\tglucose\tconcentrations.\nInsulin\tregimens:\tContinuous\tsustained\tinsulin\tinfusion\t(csii)\tor\tinsulin\tpump\ttherapy\nThe\tinsulin\t(usually\ta\trapid-acting\tinsulin)\tis\tpumped\tcontinuously\tby\ta\tmechanical\tdevice\tin\tmicro
|
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] |
amounts\tthrough\ta\tsubcutaneous\tcatheter\t(\nFig.\t29.3\n).\tThe\n\tpump\tdelivers\tinsulin\tin\ttwo\tways:\tin\ta\nsteady,\tmeasured,\tand\tcontinuous\tdose\t(basal\tinsulin)\tand\tas\ta\tsurge\t(bolus)\tdose\tbefore\tmeals.\nFIG.\t29.3\nA\tchild\tis\twearing\tan\tinsulin\tpump.\n\t\nSource:\n\t(From\t\t\nwww.istockphoto.com\n.)
|
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] |
Source:\n\t(From\t\t\nwww.istockphoto.com\n.)\nThe\tindividual\talso\tshould\tbe\teducated\tabout\tcarbohydrate\tcounting/estimation.\tMealtime\tboluses\nare\tdependent\ton\tcarbohydrate\tintake\tas\twell\tas\tcircadian\tvariation\tin\tinsulin\tsensitivity,\tcurrent\nblood\tglucose\tlevels,\tand\tplanned\tphysical\tactivity.\tRegularly\tscheduled\toutpatient\tfollow-up\twith
|
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benefits,\tincluding\teliminating\tthe\tneed\tfor\tindividual\tinsulin\tinjections.\tUsing\tan\tinsulin\tpump\tmay\nalso\tresult\tin\tfewer\tlarge\tswings\tin\tblood\tglucose\tlevels\tas\twell\tas\tallow\tusers\tto\tbe\tmore\tflexible\nabout\twhen\tand\twhat\n\tthey\teat.\nSelf-management\teducation
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about\twhen\tand\twhat\n\tthey\teat.\nSelf-management\teducation\nDiabetes\tmanagement\tis\ta\tteam\teffort.\tPersons\twith\tdiabetes\tmust\tbe\tat\tthe\tcenter\tof\tthe\tteam\nbecause\tthey\thave\tthe\tresponsibility\tfor\tday-to-day\tmanagement.\tRDNs,\tnurses,\tphysicians,\tand\nother\thealth\tcare\tproviders\tcontribute\ttheir\texpertise\tto\tdeveloping\ttherapeutic\tregimens\tthat\thelp
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the\tperson\twith\tdiabetes\tachieve\tthe\tbest\tmetabolic\tcontrol\tpossible.\n\tThe\tgoal\tis\tto\tprovide\tpatients\nwith\tthe\tknowledge,\tskills,\tand\tmotivation\tto\tincorporate\tself-management\tinto\ttheir\tdaily\tlifestyles.\nThe\tAND\tEBNPG\trecommends\tthat\tindividuals\twith\tdiabetes\tbe\treferred\tfor\tMNT\tearly\tafter\tthe
|
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] |
diagnosis\tof\tdiabetes.\tMNT\tis\tto\tbe\tprovided\tby\tan\tRDN\tin\tan\tinitial\tseries\tof\tthree\tto\tfour\nencounters,\teach\tlasting\t45\tto\t90\tminutes.\tThis\tseries\tshould\tbe\tcompleted\twithin\n\t3\tto\t6\tmonths,\tand\nthe\tRDN\tshould\tdetermine\twhether\tadditional\tencounters\tare\tneeded\tafter\tthe\tinitial\tseries\tbased
|
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] |
on\tthe\tnutrition\tassessment\tof\tlearning\tneeds\tand\tprogress\ttoward\tdesired\toutcomes.\tAt\tleast\tone\nfollow-up\tencounter\tis\trecommended\tannually\tto\treinforce\tlifestyle\tchanges\tand\tto\tevaluate\tand\nmonitor\toutcomes\tthat\taffect\tthe\tneed\tfor\tchanges\tin\tMNT\tor\tmedication(s).\tThe\tRDN\tshould\n\tagain
|
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] |
again\ndetermine\twhether\tadditional\tMNT\tencounters\tare\tneeded.\tAlthough\tglycemic\tcontrol\tis\tthe\tprimary\nfocus\tfor\tdiabetes\tmanagement,\tcardioprotective\tnutrition\tinterventions\tfor\tthe\tprevention\tand\ntreatment\tof\tCVD\talso\tshould\tbe\timplemented\tin\tthe\tinitial\tseries\tof\tencounters\t(\nAND,\t2008a\n;\t\nFranz\net\tal,\t2010\n).
|
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] |
AND,\t2008a\n;\t\nFranz\net\tal,\t2010\n).\nDietitians\tcan\tdemonstrate\ttheir\tspecialized\tdiabetes\tknowledge\tby\tobtaining\tcertification\n\tbeyond\nthe\tRDN\tcredential.\tTwo\tdiabetes\tcare\tcertifications\tavailable\tto\tregistered\tdietitians\t(RDs)\tare\tthe\nCDE,\ta\tspecialty\tcertification,\tand\tboard\tcertified-advanced\tdiabetes\tmanagement\t(BC-ADM),\tan
|
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] |
advanced\tpractice\tcertification.\nMonitoring\nThe\thealth\tcare\tteam,\tincluding\tthe\tindividual\twith\tdiabetes,\tshould\twork\ttogether\tto\timplement\nblood\tglucose\tmonitoring\tand\testablish\tindividual\n\ttarget\tblood\tglucose\tgoals\t(see\t\nTable\t29.4\n).\nSeveral\tmethods\tare\tavailable\tto\tassess\tthe\teffectiveness\tof\tthe\tdiabetes\tmanagement\tplan\ton
|
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] |
glycemic\tcontrol:\tSMBG\tor\t\ncontinuous\tglucose\tmonitoring\t(CGM)\n\tof\tinterstitial\tglucose\tand\nA1C.\tSMBG\tis\tused\ton\ta\tday-to-day\tbasis\tto\tmanage\tdiabetes\teffectively\tand\tsafely;\thowever,\nmeasurement\tof\tA1C\tlevels\tprovides\tthe\tbest\tavailable\tindex\tof\toverall\tdiabetes\n\tcontrol.\nSelf-monitoring\tof\tblood\tglucose\t(SMBG)
|
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] |
control.\nSelf-monitoring\tof\tblood\tglucose\t(SMBG)\nThe\tADA\trecommendations\tstate\tthat\tpersons\ton\tmultiple-dose\tinsulin\t(MDI)\tor\tinsulin\tpump\ntherapy\tshould\tdo\tSMBG\tbefore\tmeals\tand\tsnacks,\toccasionally\tpostprandially\tat\tbedtime,\tbefore\nexercise,\twhen\tthey\tsuspect\tlow\tblood\tglucose,\tafter\ttreating\tlow\tblood\tglucose\tuntil\tthey\tare
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normoglycemic,\tand\tbefore\tcritical\ttasks\tsuch\tas\tdriving.\tFor\tpeople\n\tusing\tless-frequent\tinsulin\ninjections\tor\tnoninsulin\ttherapies,\tSMBG\tresults\tmay\tbe\thelpful\tto\tguide\ttreatment\tdecisions\t(\nADA,\n2018\n).\nThe\tAND\tEBNPG\tfor\tdiabetes\treviewed\tthe\tevidence\ton\tglucose\tmonitoring\tand\trecommended
|
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0.11205010861158371,
0.04841265454888344,
0.05002394691109657,
0.001473429729230702
] |
that\tfor\tpersons\twith\tT1DM\tor\tT2DM\ton\tinsulin\ttherapy,\tat\tleast\tthree\tto\tfour\tglucose\ttests\tper\tday\nare\tneeded\tto\tdetermine\tthe\taccuracy\tof\tthe\tinsulin\tdose(s)\tand\tto\tguide\tadjustments\n\tin\tinsulin\ndose(s),\tfood\tintake,\tand\tphysical\tactivity.\tOnce\testablished\tsome\tinsulin\tregimens\trequire\tless-
|
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] |
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