University:
West Coast University
Course:
PHAR 840 | Immunologic Conditions and Special Populations
Academic year:

2024
Views:

275

Pages:

15
Author:

Asal A.

Couple things to review… Screening Item Initial Follow up Urinary albumin (albumin-to-creatinine ratio [ACR], eGFR) T1DM: 5 years after onset T2DM: at the time of diagnosis Once a year or twice a year for patients with ACR > 30 mg/g or eGFR < 60 ml/min/1.73𝑚 Comprehensive eye exam Diabetic peripheral neuropathy T1DM: 5 years after onset T2DM: at the time of diagnosis Comprehensive foot exam (podiatrist) --------------------- Foot inspection (injury, sensation lost) -Inspect by the patient Daily Dental exam Twice a year Once a year The Diagnostic Criteria Normal Pre-Diabetes Diabetes A1C <5.7% 5.7-6.4% ≥ 6.5% FBG (8 hours fasting) <100 mg/dL 100-125mg/dL ≥ 126mg/dL 2 hour PPBG (after 75g OGTT) <140 mg/dL 140-199md/dL ≥ 200 mg/dL **Random Glucose (DM diagnostic criteria) ≥ 200mg/dL + CLASSICAL s/sx DM (polyuria, polydipsia, polyphagia) Treatment Goals A1C < 7% * FBG 80-130 mg/dl 2 hours PPBG <180 mg/dl (post prandial) Every 1% change in A1C = 30 mg/dL change in BG *A1C <8%, FBG 110-160mg/dl, 2 hour PPBG < 210mg/dl * A1C < 6.5%, FBG 65-100 mg/dL, 2 hour PPBG < 165mg/dL • *Individualized A1C Goal should be based on:  Duration of DM  Age/life expectancy  Comorbid conditions  Known CVD/advanced micro/macro-vascular complications  Severe hypoglycemic episodes  Motivation Pre-DM and metformin…who needs it? • - aged 25–59 years with BMI greater or equal to 35 kg/m2, • -higher fasting plasma glucose (e.g., greater or equal to 110 mg/dL [greater or equal to 6 mmol/L]), and higher A1C (e.g., greater 6.0% [ greater 42 mmol/mol]), a • -nd in individuals with prior gestational diabetes mellitus DM and CHF…. • Which class is the best? SGLT-2!! Weight gain • Insulin • SU – beta cell burn out Which lab measures albuminuria? • ACR ( albumin creatinine ratio) • ACR > 30 = albuminuria GLP-1 • Long acting • Exenatide extended release (Bydureon), • Liraglutide(Victoza), • Dulaglutide (Trulicity) • Semaglutide (Ozempic) • Semaglutide (Rybelsus)- PO daily • Tirzepatide ( Zepbound) • Short acting • Exenatide (Byetta) • Lixisenatide (Adlyxin) Insulin adjustment • Depend…. • 10-20% • 10% (close to goal…) for example, FBG 80-130s ( sub 200s 10% increase) • 20% ( far from goals)… Basal insulin • Long acting insulin ( 24 hours)  Lantus, toujeo, Levemir, basaglar - Ultra long acting insulin ( 36 hours)  Tresiba When should you start insulin? When to initiate insulin? •A1C >10% •BG > 300 •T1DM Vitamin B12 lab—oooh My…. • Not every patient!!!! • Indicated for pt with > Long duration of T2DM + s/sx peripheral neuropathy Metformin and eGFR • Dose reduction 30-44 ml/min/m2 • CI < 30 ml/min/m2 Which HTN agent has kidney benefit? • ACEI/ARB