Initiation and Adjustment of Insulin Regimens
|
|
- Frederick James
- 8 years ago
- Views:
Transcription
1 Start with bedtime intermediateacting insulin or bedtime or morning long-acting insulin (can initiate with 10 units or 0.2 units per kg) Initiation and Adjustment of Insulin Regimens Insulin regimens should be designed taking lifestyle and meal schedule into account. The algorithm can only provide basic guidelines for initiation and adjustment of insulin. Check fasting glucose (fingerstick) usually daily and increase dose, typically by 2 units every 3 days until fasting levels are consistently in target range ( mmol/l [ mg/dl]). Can increase dose in larger increments e.g.., by 4 units every 3 days, if fasting glucose is > 10 mmol/l (180mg/dl) If hypoglycemia occurs, or fasting glucose level <3.9 mmol/l (70mg/dl), reduce bedtime dose by 4 units or 10%--- whichever is greater A1C 7% after 2-3 months No Pre-lunch bg out of range, add rapidacting insulin at breakfastª Yes If fasting bg is in range ( mmol/l [ mg/dl]), check bg before lunch, dinner, and bed. Depending on bg results, add second injection as below. Can usually begin with ~4 units and adjust by 2 units every 3 days until bg is in range Pre-dinner bg out of range, add NPH insulin at breakfast, or rapid-acting at lunch Pre-bed bg out of range, add rapid-acting insulin at dinnerª Continue regimen, check A1C every 3 mo No Recheck pre-meal bg levels and if out of range, may need to add another injection. If A1C continues to be out of range, check 2 h postprandial levels and adjust preprandial rapid-acting insulin Yes A1C 7% after3 months Adapted from the Diabetes Care Consensus Statement, Diabetes Care, Volume 32, Number 1, January 2009
2 Algorithm for Type 2 Tier 1: Well Validated At dx: Lifestyle Metformin Basal Insulin Sulfonylurea STEP 1 STEP 2 STEP 3 Intensive insulin Tier 2: Less wellvalidated Pioglitazone GLP-1 agonist Pioglitazone Sulfonylurea basal insulin Adapted from the Diabetes Care Consensus Statement, Diabetes Care, Volume 32, Number 1, January 2009
3 Lipid Algorithm For Type 1 and Type 2 Diabetes Mellitus in Adults FLP Goals: LDL-C <100 mg/dl (<70 with CVD, CVA, or PVD) HDL-C > 40 mg/dl TG <150 mg/dl Determine Fasting Lipid Profile (FLP) yearly Abnormal fasting lipids: Initial therapy with TLC & Intensive Glucose Control (with A1c goal < 6%) Evaluate and treat secondary causes of dyslipidemia: alcohol, estrogen, anabolic steroids, corticosteroids, hypothyroidism, hepatic disease, nephrotic syndrome, chronic renal failure. LDL-C is the primary target of therapy unless TG > 400 mg/dl, at which point TG then becomes the primary treatment target Elevated LDL-C or LDL-C at goal with at least one additional CV risk factor present Start statin, titrate to goal, reinforce TLC Goal: LDL-C <100 (<70 if history of CVD, CVA, or PVD) Elevated TG > 400 Isolated low HDL-C (with LDL-C & TG at target) Optimize TLC Optimize TLC, smoking cessation, Optimize TLC, smoking cessation, When TG < 400, reassess LDL-C Optimize TLC, smoking cessation, fibrate, niacin, fish oil or statin¹ LDL-C not at goal, follow elevated LDL-C guideline¹ If LDL-C remains above goal and/or patient does not tolerate statin, then add bile acid resin, ezetimibe, niacin or Orlistat If not at goal Refer to Lipid Specialist Definitions: TLC = Therapeutic Lifestyle Changes Statin = HMG Co-A Reductase Inhibitor TG = Triglycerides Footnotes: ¹ If a fibrate is combined with a statin, then fenofibrate is preferred rather than gemfibrozil due to risk of myositis and rhabdomyolysis. Adapted from the Texas Diabetes Council and the Texas Department of State Health Services
4 Lipid Algorithm For Type 1 and Type 2 Diabetes Mellitus in Adults Revised FLP Goals: LDL-C <100 mg/dl (<70 with CVD, CVA, or PVD) HDL-C > 40 mg/dl TG <150 mg/dl Determine Fasting Lipid Profile (FLP) yearly Abnormal fasting lipids: Initial therapy with TLC & Intensive Glucose Control (with A1c goal < 6%) Evaluate and treat secondary causes of dyslipidemia: alcohol, estrogen, anabolic steroids, corticosteroids, hypothyroidism, hepatic disease, nephrotic syndrome, chronic renal failure. LDL-C is the primary target of therapy unless TG > 400 mg/dl, at which point TG then becomes the primary treatment target. Elevated LDL-C or LDL-C at goal with at least one additional CV risk factor present Start statin, titrate to goal, reinforce TLC Goal: LDL-C <100 (<70 if history of CVD, CVA, or PVD) If LDL-C remains above goal and/or patient does not tolerate statin, then add bile acid resin, ezetimibe, niacin or Orlistat Elevated TG > 400 If not at goal Isolated low HDL-C (with LDL-C & TG at target) Optimize TLC Optimize TLC, smoking cessation, Optimize TLC, smoking cessation, When TG < 400, reassess LDL-C Optimize TLC, smoking cessation, fibrate, niacin, fish oil or statin¹ LDL-C not at goal, follow elevated LDL-C guideline¹ Refer to Lipid Specialist Footnotes: ¹ If a fibrate is combined with a statin, then fenofibrate is preferred rather than gemfibrozil due to risk of myositis and rhabdomyolysis. Definitions: TLC = Therapeutic Lifestyle Changes (refer to TDC Medical Nutrition, Weight Loss, and Exercise Algorithms) Statin = HMG Co-A Reductase Inhibitor TG = Triglycerides Publication # (Page 1 of 3) See web site ( for latest version and disclaimer.
5 Revised Lipid Algorithm For Type 1 and Type 2 Diabetes Mellitus in Adults HMG Co-A Reductase Inhibitors LDL-C Equivalency in Patients with Hypercholesterolemia* Fluvastatin Pravastatin Lovastatin Simvastatin Atorvastatin Rosuvastatin Ezetimbe/ Simvastatin Approximate %LDL 20 mg 10 mg 10 mg mg 20 mg 20 mg 5-10 mg XL mg 40 mg 20 mg 10 mg mg 40 mg 20 mg 5-10 mg 10/10 mg mg 40 mg 20 mg 10/20 mg mg 40 mg 10/40 mg /80 mg >59 Footnote: *this information is not based on head to head comparison (Page 2 of 3)
6 Revised References: Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet Jun 14;361(9374): Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet Jul 6;360(9326):7-22. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.lancet Aug 21-27;364(9435): Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association.Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation Jul 13; 110(2): Jones P, Kafonek S, Laurora I, Hunninghake D.Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia (the CURVES study) Am J Cardiol Mar 1;81(5): Jones PH, Davidson MH. Reporting rate of rhabdomyolysis with fenofibrate statin versus gemfibrozil any statin.am J Cardiol Jan 1;95(1): Maeda K, Noguchi Y, Fukui T.The effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: a metaanalysis. Prev Med Oct;37(4): Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, Forder P, Pillai A, Davis T, Glasziou P, Drury P, Kesäniemi YA, Sullivan D, Hunt D, Colman P, d'emden M, Whiting M, Ehnholm C, Laakso M; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet Nov 26;366(9500): Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH, Linares E, Schaefer EJ, Schectman G, Wilt TJ, Wittes J.Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med Aug 5; 341(6): Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, Armitage J, Baigent C.Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a metaanalysis. Lancet Jan 12;371(9607): (Page 3 of 3)
Algorithms for Glycemic Management of Type 2 Diabetes
KENTUCKY DIABETES NETWORK, INC. Algorithms for Glycemic Management of Type 2 Diabetes The Diabetes Care Algorithms for Type 2 Diabetes included within this document are taken from the American Association
More informationHigh Blood Cholesterol
National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour
More informationStatin Template Guidance Use of statins in primary and secondary prevention of vascular disease Endorsed by ABHB MTC for use in Gwent (October 2012)
Statin Template Guidance Use of statins in primary and secondary prevention of vascular disease Endorsed by ABHB MTC for use in Gwent (October 2012) Notes relating to this guidance This guidance serves
More informationPrimary Care Management of Women with Hyperlipidemia. Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing
Primary Care Management of Women with Hyperlipidemia Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing Objectives: Define dyslipidemia in women Discuss the investigation process leading
More informationHYPERCHOLESTEROLAEMIA STATIN AND BEYOND
HYPERCHOLESTEROLAEMIA STATIN AND BEYOND Andrea Luk Division of Endocrinology Department of Medicine & Therapeutics The Chinese University of Hong Kong HA Convention 4 May 2016 Statins reduce CVD and all-cause
More informationWelchol (colesevelam HCl) Receives FDA Approval to Reduce Blood Glucose in Adults with Type 2 Diabetes
For Immediate Release Company name: DAIICHI SANKYO COMPANY, LIMITED Representative: Takashi Shoda, President and Representative Director (Code no.: 4568, First Section, Tokyo, Osaka and Nagoya Stock Exchanges)
More informationMANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES
MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING
More informationManagement of Lipids in 2015: Just Give them a Statin?
Management of Lipids in 2015: Just Give them a Statin? James H. Stein, M.D. Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Stone NJ, et al. Circulation
More informationPRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION
Hull & East Riding Prescribing Committee PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION For guidance on Primary Prevention please see NICE guidance http://www.nice.org.uk/guidance/cg181
More informationLipid Management in Diabetic Patients (June 2014 version)
(June 2014 version) Background Accelerated atherosclerosis is multifactorial and begins years/decades prior to the diagnosis of type 2 diabetes: Risk for atherosclerotic events is two to four-fold greater
More informationStatins for Hyperlipidemia (High Cholesterol)
Statins for Hyperlipidemia (High Cholesterol) Examples of statin drugs Brand Name Mevacor Pravachol Zocor Lescol, Lescol XL Lipitor Crestor Chemical Name lovastatin pravastatin sodium simvastatin fluvastatin
More informationTreatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).
Complete Summary GUIDELINE TITLE (1)Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment
More informationINSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT
INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT APIRADEE SRIWIJITKAMOL DIVISION OF ENDOCRINOLOGY AND METABOLISM DEPARTMENT OF MEDICINE FACULTY OF MEDICINE SIRIRAJ HOSPITOL QUESTION 1 1. ท านเคยเป นแพทย
More informationHow To Treat Dyslipidemia
An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates
More informationMany asymptomatic individuals
Facts, myths and misconceptions about LDL-C and HDL-C By Michael B. Clearfield, DO Many asymptomatic individuals will succumb to cardiovascular disease (CVD), which is the leading cause of death and loss
More informationInsulin switch & Algorithms Rotorua GP CME June 2011. Kingsley Nirmalaraj FRACP Endocrinologist BOPDHB
Insulin switch & Algorithms Rotorua GP CME June 2011 Kingsley Nirmalaraj FRACP Endocrinologist BOPDHB Goal of workshop Insulin switching make the necessary move Ensure participants are confident with Recognising
More informationTherapy Insulin Practical guide to Health Care Providers Quick Reference F Diabetes Mellitus in Type 2
Ministry of Health, Malaysia 2010 First published March 2011 Perkhidmatan Diabetes dan Endokrinologi Kementerian Kesihatan Malaysia Practical guide to Insulin Therapy in Type 2 Diabetes Mellitus Quick
More informationThe basal plus strategy. Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE
The basal plus strategy Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE ADA/EASD guidelines recommend use of basal insulin as early as the second step
More informationLipid-lowering: Can ezetimibe help close the treatment gap?
REVIEW CME CREDIT RYAN C. NEAL, MD* Assistant Professor of Medicine, Baylor College of Medicine, Houston, Texas PETER H. JONES, MD Associate Professor of Medicine, Baylor College of Medicine, Houston,
More informationPrescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003 2012
NCHS Data Brief No. 77 December 4 Prescription Cholesterol-lowering Medication Use in Adults Aged 4 and Over: United States, 3 2 Qiuping Gu, M.D., Ph.D.; Ryne Paulose-Ram, Ph.D., M.A.; Vicki L. Burt, Sc.M.,
More informationINPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco
INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco CLINICAL RECOGNITION Background: Appropriate inpatient glycemic
More informationOmega-3 Fatty Acid Products
Omega-3 Fatty Acid Products Policy Number: 5.01.563 Last Review: 7/2016 Origination: 6/2014 Next Review: 7/2017 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for the
More informationHEALTH SERVICES POLICY & PROCEDURE MANUAL
Page 1 of 5 PURPOSE To assure that DOP inmates with Diabetes, who require insulin therapy, are receiving high quality Primary Care for their condition. POLICY All DOP Primary Care Providers are to follow
More informationTHE THIRD REPORT OF THE EXpert
SPECIAL COMMUNICATION Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
More informationInitiating & titrating insulin & switching in General Practice Workshop 1
Initiating & titrating insulin & switching in General Practice Workshop 1 Workshop goal To make participants comfortable in the timely initiation and titration of insulin Progression of Type 2 Diabetes
More informationA Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or
A Simplified Approach to Initiating Insulin When to Start Insulin: 1. Fasting plasma glucose (FPG) levels >250 mg/dl or 2. Glycated hemoglobin (A1C) >10% or 3. Random plasma glucose consistently >300 mg/dl
More informationInsulin Therapy In Type 2 DM. Sources of support. Agenda. Michael Fischer, M.D., M.S. The underuse of insulin Insulin definition and types
Insulin Therapy In Type 2 DM Michael Fischer, M.D., M.S. Sources of support NaRCAD is supported by a grant from the Agency for Healthcare Research and Quality My current research projects are funded by
More informationDiabetes Mellitus Type 2
Diabetes Mellitus Type 2 What is it? Diabetes is a common health problem in the U.S. and the world. In diabetes, the body does not use the food it digests well. It is hard for the body to use carbohydrates
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More informationDiabetes: When To Treat With Insulin and Treatment Goals
Diabetes: When To Treat With Insulin and Treatment Goals Lanita. S. White, Pharm.D. Director, UAMS 12 th Street Health and Wellness Center Assistant Professor of Pharmacy Practice, UAMS College of Pharmacy
More informationType II diabetes: How to use the new oral medications
Type II diabetes: How to use the new oral medications A TWO-PART INTERVIEW WITH NANCY J.V. BOHANNON, MD, BY DAVID B. JACK, MD Several new oral drugs have been approved for the management of type II diabetes.
More informationROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE
ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.
More informationJournal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
More informationCholesterol and Triglycerides What You Should Know
Cholesterol and Triglycerides What You Should Know Michael T. McDermott MD Professor of Medicine Endocrinology Practice Director Division of Endocrinology, Metabolism and Diabetes University of Colorado
More informationJNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014
JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates January 30, 2014 GOALS Review key recommendations from recently published guidelines on blood pressure and cholesterol management Discuss
More informationAACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM
AACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM 2013 TASK FORCE Alan J. Garber, MD, PhD, FACE, Chair Martin J. Abrahamson, MD Joshua I. Barzilay, MD, FACE Lawrence Blonde, MD, FACP, FACE Zachary T. Bloomgarden,
More informationASN DIALYSIS ADVISORY GROUP ASN DIALYSIS CURRICULUM
ASN DIALYSIS ADVISORY GROUP ASN DIALYSIS CURRICULUM Management of Traditional Cardiovascular Risk Factors in ESRD (Hypertension, Dyslipidemia, Glycemic Control) ROBERT D. TOTO, M.D. PROFESSOR OF MEDICINE
More informationAssociate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland
Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland 14:00-14:55 WS #45: New Therapies for Lipid Management 15:05-16:00 WS #57: New Therapies for
More informationIndividual Study Table Referring to Part of Dossier: Volume: Page:
2.0 Synopsis AbbVie Inc. Name of Study Drug: Trilipix (ABT-335) Name of Active Ingredient: choline salt of fenofibric acid Individual Study Table Referring to Part of Dossier: Volume: Page: (For National
More informationStatins and Risk for Diabetes Mellitus. Background
Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration
More informationInsulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust
Insulin or GLP1 How to make this choice in Practice Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Workshop Over View Considerations/barriers to treatments in type 2
More informationCardiovascular Risk and Dyslipidemia Management Clinician Guide MAY 2015
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Cardiovascular Risk and Dyslipidemia Management Clinician Guide MAY 2015 Introduction This Clinician Guide was developed to assist Primary Care physicians
More informationIntensifying Insulin Therapy
Intensifying Insulin Therapy Rick Hess, PharmD, CDE, BC-ADM Associate Professor Gatton College of Pharmacy, Department of Pharmacy Practice East Tennessee State University Johnson City, Tennessee Learning
More informationInsulin Initiation and Intensification
Insulin Initiation and Intensification ANDREW S. RHINEHART, MD, FACP, CDE MEDICAL DIRECTOR AND DIABETOLOGIST JOHNSTON MEMORIAL DIABETES CARE CENTER Objectives Understand the pharmacodynamics and pharmacokinetics
More informationDiabetes Mellitus 1. Chapter 43. Diabetes Mellitus, Self-Assessment Questions
Diabetes Mellitus 1 Chapter 43. Diabetes Mellitus, Self-Assessment Questions 1. A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than
More informationCardiovascular Disease in Diabetes
Cardiovascular Disease in Diabetes Where Do We Stand in 2012? David M. Kendall, MD Distinguished Medical Fellow Lilly Diabetes Associate Professor of Medicine University of MInnesota Disclosure - Duality
More informationADJUSTING INSULIN DOSES CONFLICTS OF INTEREST
ADJUSTING INSULIN DOSES CONFLICTS OF INTEREST Vahid Mahabadi, MD Research grants from Sanofi and Amylin Pharmaceutical Companies Mayer B. Davidson, MD Advisory Board Sanofi Pharmaceutical Company Chief
More informationEducation. Panel. Triglycerides & HDL-C
Triglycerides & HDL-C Thomas Dayspring, MD, ACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph s s Hospital, Paterson, NJ Certified
More informationDiabetes and the Elimination of Sliding Scale Insulin. Date: April 30 th 2013. Presenter: Derek Sanders, D.Ph.
Diabetes and the Elimination of Sliding Scale Insulin Date: April 30 th 2013 Presenter: Derek Sanders, D.Ph. Background Information Epidemiology and Risk Factors Diabetes Its Definition and Its Impact
More informationDefinition of Diabetes Mellitus
Definition of Diabetes Mellitus Diabetes mellitus consists of a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. U.S. Diabetes
More informationAdd: 2 nd generation sulfonylurea or glinide or Add DPP-4 inhibitor Start or intensify insulin therapy if HbA1c goals not achieved with the above
Guidelines for Type Diabetes - Diagnosis Fasting Plasma Glucose (confirm results if borderline) HbAIC Normal FPG < 00 < 5.5 Impaired Fasting Glucose (IFG) 00 to < 5.7%-.5% Diabetes Mellitus (or random
More informationManaging Hyperlipidemia: An Evidence-Based Approach
Managing Hyperlipidemia: An Evidence-Based Approach John Varras, MD For a CME/CEU version of this article please go to http://www.namcp.org/cmeonline.htm, and then click the activity title. Summary To
More informationNEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? LAUREN HYNICKA, PHARMD, BCPS MOHAMED SARG, PHARMD, BCPS
NEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? LAUREN HYNICKA, PHARMD, BCPS MOHAMED SARG, PHARMD, BCPS NEW GUIDELINES FOR CHOLESTEROL MANAGEMENT: WHAT HAS CHANGED? ACTIVITY DESCRIPTION Cholesterol
More informationCardiovascular Effects of Drugs to Treat Diabetes
Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationAACE/ACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM
ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been accepted for publication in an issue of Endocrine Practice. This version
More informationInitiate Atorvastatin 20mg daily
Type 2 Diabetes Patient Objectives Stopping Smoking BMI > 25 kg m² Control BP to
More informationTYPE 2 DIABETES SEQUENTIAL INSULIN STRATEGIES
TYPE 2 DIABETES SEQUENTIAL INSULIN STRATEGIES Non-insulin regimes Basal insulin only (usually with oral agents) Number of injections 1 Regimen complexity Low Basal insulin +1 meal-time rapidacting insulin
More informationPrimary and Secondary Prevention Strategy for Cardiovascular Disease in Diabetes Mellitus
Primary and Secondary Prevention Strategy for Cardiovascular Disease in Diabetes Mellitus Sundararajan Srikanth, MD a, Prakash Deedwania, MD b, * KEYWORDS Diabetes mellitus Cardiovascular disease Primary
More informationWorkshop A Tara Kadis
Workshop A Tara Kadis Considerations/barriers in decision making about insulin verses GLP-1 use in people with type 2 diabetes Which Insulin regimes should we consider? Diabetes is a progressive multi-system
More informationOverview and update of modern type 2 Diabetes philosophy and management. Dr Steve Stanaway Consultant Endocrinologist BCU
Overview and update of modern type 2 Diabetes philosophy and management Dr Steve Stanaway Consultant Endocrinologist BCU Diabetes economics 2009: 2.6M adults with DM in UK (90% type 2) 2025: est. > 4M
More informationdiabetes and I think things are pretty much what they were but there have been some confusion that
MARY T. KORYTKOWSKI,, M.D. 1 Good morning. Thank you very much for inviting me to speak at this year s conference, update in internal medicine. And as was said, I will talk to you about what may not be
More informationIR Conference Call on PCSK9
IR Conference Call on PCSK9 SAR236553/REGN727 PCSK9 Antibody for Hypercholesterolemia Phase 3 ODYSSEY Program Underway November 5, 2012 1 Safe Harbor Statement This presentation contains forward-looking
More informationInsulin Dose Adjustment REAL-Time CGMS Guidelines for Subjects on Pump Therapy
Insulin Dose Adjustment REAL-Time CGMS Guidelines for Subjects on Pump Therapy In addition to using the blood sugar logs to adjust your insulin doses every week, you should also use your continuous glucose
More informationRisk factors for peripheral artery disease
www.tasc-2-pad.org Risk factors for peripheral artery disease Based on the Inter-Society Consensus Edited by Dr Denis Clement University Hospital, Ghent, Belgium Supported by an educational grant from
More informationInsulin Therapy. Endocrinologist. H. Delshad M.D. Research Institute For Endocrine Sciences
Insulin Therapy H. Delshad M.D Endocrinologist Research Institute For Endocrine Sciences Primary Objectives of Effective Management A1C % 9 8 Diagnosis SBP mm Hg LDL mg/dl 7 145 130 140 100 Reduction of
More informationHalf-dose ezetimibe add-on to statin therapy is effective in improving resistant hyperlipidaemia in Asian patients with ischaemic heart disease
Original Article Singapore Med J 2011; 52(6) : 400 Half-dose ezetimibe add-on to statin therapy is effective in improving resistant hyperlipidaemia in Asian patients with ischaemic heart disease Chong
More informationDiabetes Management Tube Feeding/Parenteral Nutrition Order Set (Adult)
Review Due Date: 2016 May PATIENT CARE ORDERS Weight (kg) Known Adverse Reactions or Intolerances DRUG No Yes (list) FOOD No Yes (list) LATEX No Yes ***See Suggestions for Management (on reverse)*** ***If
More informationINSULIN INTENSIFICATION: Taking Care to the Next Level
INSULIN INTENSIFICATION: Taking Care to the Next Level By J. Robin Conway M.D., Diabetes Clinic, Smiths Falls, ON www.diabetesclinic.ca Type 2 Diabetes is an increasing problem in our society, due largely
More informationAdult Diabetes Clinician Guide
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction JANUARY 2016 This evidence-based guideline summary is based on the 2016 National Diabetes Guideline.
More informationThe Canadian Association of Cardiac
Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a
More information2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2
More informationWhen and how to start insulin: strategies for success in type 2 diabetes
1 When and how to start insulin: strategies for success in type diabetes Treatment of type diabetes in 199: with each step treatment gets more complex Bruce H.R. Wolffenbuttel, MD PhD Professor of Endocrinology
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationType 2 diabetes mellitus
Type 2 diabetes mellitus CLINICAL PRACTICE Management Guidelines for initiating insulin therapy BACKGROUND Insulin is often indicated for patients with suboptimally controlled type 2 diabetes mellitus,
More informationSecondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence
Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for
More informationESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease
Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening
More informationDrug Class Review on HMG-CoA Reductase Inhibitors (Statins)
Drug Class Review on HMG-CoA Reductase Inhibitors (Statins) Final Report September 2005 The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles
More informationPotential Clinical and Economic Impact of Statin Formulary Management
Potential Clinical and Economic Impact of Statin Formulary Management Karol E. Watson, MD Summary The evidence is clear that aggressive management of cardiac risk factors is beneficial and generally safe
More informationComparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians
Clinician Research Summary Diabetes Type 2 Diabetes Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians A systematic review of 166 clinical studies published between
More informationHarmony Clinical Trial Medical Media Factsheet
Overview Harmony is the global Phase III clinical trial program for Tanzeum (albiglutide), a product developed by GSK for the treatment of type 2 diabetes. The comprehensive program comprised eight individual
More informationAnti-Atheroscrerotic Drugs
Anti-Atheroscrerotic Drugs Masuko Ushio-Fukai, PhD, FAHA Dept. of Pharmacology University of Illinois at Chicago Anti-Atherogenic Drugs: Treatment of Hyperlipidemias Knowledge Objectives: 1) Know the mechanism
More informationDiabetes Medications: Insulin Therapy
Diabetes Medications: Insulin Therapy Courtesy Univ Texas San Antonio Eric L. Johnson, M.D. Department of Family and Community Medicine Diabetes and Insulin Type 1 Diabetes Autoimmune destruction of beta
More informationCardiovascular Risk in Diabetes
Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,
More informationCalculating Insulin Dose
Calculating Insulin Dose First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This
More informationInsulin Algorithm for Type 2 Diabetes Mellitus in Children and Adults
Insulin Algorithm for Type 2 Diabetes Mellitus in Children and Adults Stock # 45-11647 Revised 10/28/10 Glycemic Goals 1,2 Individualize goal based on patient risk factors A1c 6%
More informationInsulin therapy in type 2 diabetes
Med Clin N Am 88 (2004) 865 895 Insulin therapy in type 2 diabetes Trent Davis, MD, Steven V. Edelman, MD* Section of Diabetes/Metabolism, Veterans Affairs San Diego HealthCare System, 3350 La Jolla Village
More informationInsulin: Breaking Barriers Enhancing Therapies. Jerry Meece, RPh, FACA, CDE jmeece12@cooke.net
Insulin: Breaking Barriers Enhancing Therapies Jerry Meece, RPh, FACA, CDE jmeece12@cooke.net Questions To Address Who are candidates for insulin? When do we start insulin? How do the different types of
More informationType 2 Diabetes Adult Outpatient Insulin Guidelines Sutter Medical Foundation. February 2011.
Type 2 Diabetes Adult Outpatient Insulin Guidelines. GENERAL RECOMMENDATIONS Start insulin if A1C and glucose levels are above goal despite optimal use of other diabetes medications. (Consider insulin
More informationCASE A1 Hypoglycemia in an Elderly T2DM Patient with Heart Failure
Hypoglycemia in an Elderly T2DM Patient with Heart Failure 1 I would like to introduce you to Sophie, an elderly patient with long-standing type 2 diabetes, who has a history of heart failure, a common
More informationNCT00272090. sanofi-aventis HOE901_3507. insulin glargine
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription Sponsor/company: Generic drug name:
More informationManagement of Diabetes: A Primary Care Perspective. Presentation Outline
Management of Diabetes: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Presentation Outline
More informationInitiation and Adjustment of Insulin Regimens for Type 2 Diabetes
PL Detail-Document #300128 This Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER January 2014 Initiation and Adjustment of Insulin Regimens for Type
More informationTreatment of Type 2 Diabetes
Improving Patient Care through Evidence Treatment of Type 2 Diabetes This information is based on a comprehensive review of the evidence for best practices in the treatment of type 2 diabetes and is sponsored
More informationRECOMMENDATIONS Screen for CVD risk beginning at age 40 for men and 50 for women
PREVENTION AND MANAGEMENT OF CARDIOVASCULAR DISEASE RISK IN PRIMARY CARE Clinical Practice Guideline February 2015 OBJECTIVE Alberta primary care clinicians and their teams offer primary and secondary
More informationHealth Professional s. Guide to INSULIN PUMP THERAPY
Health Professional s Guide to INSULIN PUMP THERAPY Table of Contents Introduction Presenting Insulin Pump Therapy to Your Patients When Your Patient Chooses the Pump Estimates for Starting Insulin Pump
More informationInsulin/Diabetes Calculations
Insulin/Diabetes Calculations Dr. Aipoalani St Lukes Endocrinology Goals Describe various calculations for insulin dosing Understand importance of the total daily dose (TDD) of insulin Be able to calculate
More informationMedical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy
DOI 10.1007/s00125-008-1157-y CONSENSUS STATEMENT UPDATE Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy A consensus
More informationDavid Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010
David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010 Objectives At the end of the talk, the participants will be able to: 1. Identify the increasing prevalence of type 2 diabetes
More informationEvidence for Statins in
Evidence for Statins in Secondary & Primary Prevention Jennifer G. Robinson, MD, MPH Professor, Departments of Epidemiology & Medicine (Cardiology) Co Director, Prevention Intervention Center University
More information