Types of Diabetes

Size: px
Start display at page:

Download "Types of Diabetes"

Transcription

1 Anti-Diabetic Drugs Bassim I Mohammad Specialist Physician-Assistant Professor College of Pharmacy/ Al Qadisiyah University Iraq

2 Diabetes Mellitus (Definition) DM is an elevated blood glucose level associated with absent, or inadequate pancreatic insulin secretion, with or without concurrent impairment insulin action

3 Diabetes Mellitus (Classification) TYPE 1: characterized by beta cell destruction and severe or absolute insulin deficiency (immune form) TYPE 2: characterized by tissue resistance to the action of insulin combined with a relative deficiency in insulin secretion TYPE 3: refers to multiple other specific causes of an elevated blood glucose: pancreatectomy, pancreatitis, drug therapy etc) TYPE 4:Gestational diabetes is defined as any abnormality in glucose levels noted for the first time during pregnancy

4 Diabetes Mellitus (Clinical Features) Polyuria Polydipsia Polyphagia Weight loss

5 Criteria for the Diagnosis of Diabetes A1C 6.5% OR Fasting plasma glucose (FPG) 126 mg/dl (7.0 mmol/l) OR 2-h plasma glucose 200 mg/dl (11.1 mmol/l) during an OGTT OR A random plasma glucose 200 mg/dl (11.1 mmol/l) ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl 1):S9; Table 2.1

6 Categories of Increased Risk for Diabetes (Prediabetes)* FPG mg/dl ( mmol/l): IFG OR 2-h plasma glucose in the 75-g OGTT mg/dl ( mmol/l): IGT OR A1C % *For all three tests, risk is continuous, extending below the lower limit of a range and becoming disproportionately greater at higher ends of the range. ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl 1):S10; Table 2.3

7 DM (Complications) 1) Acute Complications: Diabetic ketoacidosis Nonketotic hyperosmolar coma 2) Chronic Complications: (micro/macrovascular)

8 Diabetes Mellitus (Treatment Strategies) Type 1: Insulin is a must, education and nutrition control Type 2: education, Food control, exercise, OAD (1) Increase insulin secretion; (2) Increase the sensitivity of target organs to insulin; (3) Decrease glucose absorption (4) Insulin needed serious complications or an emergency Gestational Diabetes (Insulin)

9 Diabetes Mellitus (Treatment) Insulin Oral Anti-Diabetic Agents

10 Insulin Chemistry, Physiology Pharmacological Effect Mechanism of action Clinical Uses Types and Preparations and mixtures Delivery systems Complications

11 Insulin (Chemistry and Physiology) Insulin is a small protein contains 51 amino acids arranged in two chains (A and B) linked by disulfide bridges. Proinsulin in the Golgi apparatus of beta cells, packaged into granules, and hydrolyzed into insulin and C-peptide by removal of four amino acids Insulin and C-peptide (has no physiological action) are secreted in equimolar amounts in response to all insulin secretagogues.

12 Insulin (Chemistry and Physiology) Insulin is released from pancreatic beta cells at a low basal rate and at a much higher stimulated rate in response to a variety of stimuli, especially glucose. Oral glucose elicits more insulin secretion than dose IV glucose; because oral administration of glucose elicits gut hormones which augment the insulin response

13 Insulin release Stimulators/ Inhibitors Stimulators Glucose (most important) β-adrenergic stimulation Amino acid Cholecystokinin Elevated intracellular Ca2+ Drugs (eg sulfonylureas) Inhibitors α-adrenergic stimulation inhibits release (most important) Glucagon Somatostation Leptin Hypoxia Drugs ( eg e diazoxide, colchicine)

14 Insulin (Degradation) The liver and kidney are the two main organs that remove insulin from the circulation Endogenous insulin: 60% liver, 40% kidney Exogenous insulin: 60% kidney,40% liver The half-life of circulating insulin (endogenous) is 3 5 minutes Is not teratogenic

15 Insulin (Pharmacological effects) Carbohydrate metabolism: reducing blood glucose levels by glycogenolysis, glycogen synthesis, gluconeogenesis (ketone badies ) Lipid metabolism: fat synthesis, lipolysis, plasma FFA Protein metabolism: active transport of aa, incorporation of amino acids into protein, protein catabolism HR, myocardial contractility, renal blood flow Potassium: k+ uptake into cells

16 Action of Insulin on Various Tissues Liver Muscle Adipose glucose production Glucose transport glucose transport glycolysis glycolysis lipogenesis& lipoprotein lipase activity TG synthesis glycogen deposition intracellular lipolysis Protein synthesis protein synthesis

17 Insulin (Mechanism of action) Insulin binds to specialized receptors (found on the membranes of most tissues particularly target tissues, ie, liver, muscle, and adipose tissue) with high specificity and affinity. Insulin receptor consists of two subnits. An α subunit, which constitutes the recognition site and β subunits, which contains a tyrosine kinase.

18 Insulin (Mechanism of action) The binding of an insulin molecule to the α subunits activates the receptor and through a conformational change, facilitates mutual phosphorylation of tyrosine residues on the β subunits and tyrosine kinase activity. These process results in multiple effects, including increase in glucose uptake (translocation of GLUT 4), increased glycogen synthase activity and increased glycogen formation; multiple effects on protein synthesis, lipolysis, and lipogenesis..etc

19 Effect of insulin on glucose uptake and metabolism. Insulin binds to its receptor (1) which in turn starts many protein activation cascades (2). These include: translocation of Glut-4 transporter to the plasma membrane and influx of glucose (3), glycogen synthesis (4), glycolysis (5) and fatty acid synthesis (6). 19

20 Insulin (Clinical uses) Insulin-dependent patients with diabetes mellitus (type 1 diabetes mellitus) Insulin-independent patients: failure to other drugs Diabetic complications: diabetic, hyperosmotic nonketotic coma Critical (stress) situations of diabetic patients: fever, severe infection, pregnancy, trauma, operation Others: promotion of K+ uptake into the cells, pshychiatric disorders

21 Insulin (Available Preparations) Commercial insulin preparations differ in a number of ways, recombinant DNA production techniques, amino acid sequence, concentration, solubility, and the time of onset and duration of their biologic action

22 Insulin (4 Injectable Available Preparations) 1. Rapid (Ultra-short) acting (very fast onset and short duration) 2. Short-acting (Regular) (rapid onset of action) 3. Intermediate-acting 4. Long-acting (slow onset of action)

23 Insulin (Available Preparations) Rapid acting and short-acting insulins are dispensed as clear solutions at neutral ph and contain small amounts of zinc to improve their stability and shelf life Intermediate-acting NPH insulin have been modified to provide prolonged action and are dispensed as a turbid suspension at neutral ph with protamine in phosphate buffer (neutral protamine Hagedorn [NPH] insulin) Insulin glargine and insulin detemir are clear, soluble long-acting insulins

24 Rapid-acting Insulin Three rapid-acting Insulin analogs Are Commercially Available (Insulin lispro, Insulin aspart, Insulin glulisine) Permit more physiologic prandial insulin replacement because their rapid onset and early peak action more Their duration of action is 4 5 hours, which decreases the risk of late postmeal hypoglycemia Have the lowest variability of absorption (approximately 5%) of all available commercial insulins

25 Short-acting (Regular) Insulin Its effect appears within 30 minutes, peaks between 2-3 hours after subcutaneous injection, and generally lasts 5 8 hours The hexameric nature of regular insulin causes a delayed onset and prolongs the time to peak action After S/C injection, the insulin hexamersare too large and bulky to be transported across the vascular endothelium into the bloodstream. As the hexamers break down into dimers and finally monomers. This results in three rates of absorption of the injected insulin, with the final monomeric phase having the fastest uptake out of the injection

26 Short-acting (Regular) Insulin Clinically, when regular insulin is administered at mealtime, the blood glucose rises faster than the insulin with resultant early postprandial hyperglycemia and an increased risk of late postprandial hypoglycemia. Therefore, regular insulin should be injected or more minutes before the meal to minimize the mismatching

27 Short-acting (Regular) Insulin The delayed absorption, dose-dependent duration of action, and variability of absorption ( 25%) of regular human insulin frequently results in a mismatching of insulin availability with need, and its use is declining It is particularly useful for IV therapy in the management of DKA and when the insulin requirement is changing rapidly, such as after surgery or during acute infections. Limitations of regular insulin, namely, highly dose dependent PKs and PDs profiles, and variability in absorption

28 Intermediate-acting NPH (neutral protamine Hagedorn, or isophane) Insulin NPH insulin is an intermediate-acting insulin is a suspension of crystalline zinc insulin combined with protamine (a polypeptide). The conjugation with protamine delays its onset of action and prolongs it effectiveness. Has an onset of approximately 2 5 hours and duration of 4 12 hours and is usually mixed with regular, lispro, aspart, or glulisine insulin The action of NPH is highly unpredictable, and its variability of absorption is over 50%

29 Long-acting Insulin (Glargine) Insulin glargine is a soluble, peakless (ie, having a broad plasma concentration plateau), long-acting insulin analog Achieves a maximum effect after 4 6 hours. This maximum activity is maintained for hours or longer. Glargine is usually given once daily Should not be mixed with other insulins (separate syringes must be used)

30 Profile of Insulin Glargine vs NPH NPH Glargine 30

31 Long-acting Insulin (Insulin detemir) This insulin is the most recently developed long-acting insulin analog Has the most reproducible effect of the intermediate- and long-acting insulins, and its use is associated with less hypoglycemia than NPH insulin Has a dose-dependent onset of action of 1 2 hours and duration of action of more than 12 hours. It is given twice daily to obtain a smooth background insulin level.

32 Mixtures (combinations) Of Insulins Because NPH insulins require several hours to reach adequate therapeutic levels, their use in diabetic patients usually requires supplements of rapid- or short-acting insulin before meals. These are often mixed together in the same syringe before injection. Insulin lispro, aspart, and glulisine can be acutely mixed (ie, just before injection) with NPH insulin without affecting their rapid absorption. Premixed formulations of 70%/30% NPH/regular continue to be available. These preparations have all the limitations of regular insulin, namely, highly dose dependent PKs and PDs profiles, and variability in absorption

33 Insulin Delivery Systems Standard Delivery (conventional disposable syringes) Portable Pen Injectors Continuous Subcutaneous Insulin Infusion Devices ( Insulin Pumps) Inhaled Insulin (dry powder formulation) used in adult, peak level reached 15 minutes and last for 3 hours (faster onset and shorter duratio than SC )

34 Insulin Delivery Systems

35 Complications of Insulin Therapy 1) Hypoglycemia: is the most common complication of insulin therapy. They usually result from (Overdose of insulin, Excessive (unusual) physical exercise, meal is missed) Mild Hypoglycemia and conscious patient treated by dextrose tab, glucose gel or any sugar containing food or beverages Severe hypoglycemia and disoriented or unconscious patient best treated by IV ml of 50% glucose over 2-3 minutes. Alternatively SC or IM 1mg of glucagon. If patient still stuporus or glucagon not available, small amount of honey or syrup can be inserted into buccal pouch.

36 Complications of Insulin Therapy 2) Immunopathology of Insulin Therapy: Local or systemic allergic reactions Immune insulin resistance, A low titer of circulating IgG anti-insulin antibodies that neutralize the action of insulin to a negligible extent develops in most insulin-treated patients. 3) Lipodystrophy at Injection Sites (with new prparation, atrophy less, hypertrophy more) 4) Weight gain

37 Promising

38 Thank You

Abdulaziz Al-Subaie. Anfal Al-Shalwi

Abdulaziz Al-Subaie. Anfal Al-Shalwi Abdulaziz Al-Subaie Anfal Al-Shalwi Introduction what is diabetes mellitus? A chronic metabolic disorder characterized by high blood glucose level caused by insulin deficiency and sometimes accompanied

More information

CLASS OBJECTIVES. Describe the history of insulin discovery List types of insulin Define indications and dosages Review case studies

CLASS OBJECTIVES. Describe the history of insulin discovery List types of insulin Define indications and dosages Review case studies Insulins CLASS OBJECTIVES Describe the history of insulin discovery List types of insulin Define indications and dosages Review case studies INVENTION OF INSULIN 1921 The first stills used to make insulin

More information

INSULIN PRODUCTS. Jack DeRuiter

INSULIN PRODUCTS. Jack DeRuiter INSULIN PRODUCTS Jack DeRuiter The number and types of insulin preparations available in the United States is constantly changing, thus students should refer to recent drug resources for a current list

More information

Basal Insulin Analogues Where are We Now?

Basal Insulin Analogues Where are We Now? 232 Medicine Update 41 Basal Insulin Analogues Where are We Now? S CHANDRU, V MOHAN Insulin is a polypeptide secreted by the beta cells of pancreas and consists of 51 amino acids (AA). It has two polypeptide

More information

DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES

DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES Page 1 DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES Drugs to know are: Actrapid HM Humulin R, L, U Penmix SUNALI MEHTA The three principal hormones produced by the pancreas are: Insulin: nutrient metabolism:

More information

Diabetes mellitus. Lecture Outline

Diabetes mellitus. Lecture Outline Diabetes mellitus Lecture Outline I. Diagnosis II. Epidemiology III. Causes of diabetes IV. Health Problems and Diabetes V. Treating Diabetes VI. Physical activity and diabetes 1 Diabetes Disorder characterized

More information

ETIOLOGIC CLASSIFICATION. Type I diabetes Type II diabetes

ETIOLOGIC CLASSIFICATION. Type I diabetes Type II diabetes DIABETES MELLITUS DEFINITION It is a common, chronic, metabolic syndrome characterized by hyperglycemia as a cardinal biochemical feature. Resulting from absolute lack of insulin. Abnormal metabolism of

More information

Management of Clients with Diabetes Mellitus

Management of Clients with Diabetes Mellitus Management of Clients with Diabetes Mellitus Black, J.M. & Hawks, J.H. (2005) Chapters 47, (pp 1243-1288) 1288) Baptist Health School of Nursing NSG 4037: Adult Nursing III Carole Mackey, MNSc,, RN, PNP

More information

INJEX Self Study Program Part 1

INJEX Self Study Program Part 1 INJEX Self Study Program Part 1 What is Diabetes? Diabetes is a disease in which the body does not produce or properly use insulin. Diabetes is a disorder of metabolism -- the way our bodies use digested

More information

Insulin: A Powerful Weapon in the Diabetic Arsenal. Diana Cowell, PharmD PGY-1 Pharmacy Resident

Insulin: A Powerful Weapon in the Diabetic Arsenal. Diana Cowell, PharmD PGY-1 Pharmacy Resident Insulin: A Powerful Weapon in the Diabetic Arsenal Diana Cowell, PharmD PGY-1 Pharmacy Resident Objectives Identify the mechanism of action of insulin Describe the onset and duration for the various types

More information

PANCREATIC HORMONES, ANTIDIABETIC AGENTS: INSULIN AND ORAL ANTIDIABETICS- handout Iwona Zaporowska-Stachowiak

PANCREATIC HORMONES, ANTIDIABETIC AGENTS: INSULIN AND ORAL ANTIDIABETICS- handout Iwona Zaporowska-Stachowiak PANCREATIC HORMONES, ANTIDIABETIC AGENTS: INSULIN AND ORAL ANTIDIABETICS- handout Iwona Zaporowska-Stachowiak The endocrine pancreas (the islets of Langerhans) consists of four types of endocrine cells:

More information

MANAGEMENT OF TYPE - 1 DIABETES MELLITUS

MANAGEMENT OF TYPE - 1 DIABETES MELLITUS MANAGEMENT OF TYPE - 1 DIABETES MELLITUS INVESTIGATIONS AND TREATMENT MANSI NAIK VII SEMESTER INVESTIGATIONS FASTING BLOOD SUGAR PLASMA GLUCOSE HEMOGLOBIN A 1c SYMPTOMS OF TYPE 1 DIABETES MELLITUS Polyuria

More information

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College Regulation of Metabolism By Dr. Carmen Rexach Physiology Mt San Antonio College Energy Constant need in living cells Measured in kcal carbohydrates and proteins = 4kcal/g Fats = 9kcal/g Most diets are

More information

Diabetes Fundamentals

Diabetes Fundamentals Diabetes Fundamentals Prevalence of Diabetes in the U.S. Undiagnosed 10.7% of all people 20+ 23.1% of all people 60+ (12.2 million) Slide provided by Roche Diagnostics Sources: ADA, WHO statistics Prevalence

More information

Department Of Biochemistry. Subject: Diabetes Mellitus. Supervisor: Dr.Hazim Allawi & Dr.Omar Akram Prepared by : Shahad Ismael. 2 nd stage.

Department Of Biochemistry. Subject: Diabetes Mellitus. Supervisor: Dr.Hazim Allawi & Dr.Omar Akram Prepared by : Shahad Ismael. 2 nd stage. Department Of Biochemistry Subject: Diabetes Mellitus Supervisor: Dr.Hazim Allawi & Dr.Omar Akram Prepared by : Shahad Ismael. 2 nd stage. Diabetes mellitus : Type 1 & Type 2 What is diabestes mellitus?

More information

The diagram below summarizes the effects of the compounds that cells use to regulate their own metabolism.

The diagram below summarizes the effects of the compounds that cells use to regulate their own metabolism. Regulation of carbohydrate metabolism Intracellular metabolic regulators Each of the control point steps in the carbohydrate metabolic pathways in effect regulates itself by responding to molecules that

More information

ALL ABOUT INSULIN J I L L E. V O L L B R E C H T, M D

ALL ABOUT INSULIN J I L L E. V O L L B R E C H T, M D ALL ABOUT INSULIN J I L L E. V O L L B R E C H T, M D COURSE OBJECTIVES Review the function of insulin. Review currently available forms of insulin. Review current ADA guidelines for initiating insulin

More information

Diabetes mellitus 1 عبد هللا الزعبي. pharmacology. Shatha Khalil Shahwan. 1 P a g e

Diabetes mellitus 1 عبد هللا الزعبي. pharmacology. Shatha Khalil Shahwan. 1 P a g e Diabetes mellitus 1 pharmacology عبد هللا الزعبي 1 P a g e 4 Shatha Khalil Shahwan Diabetes mellitus The goals of the treatment of diabetes 1. Treating symptoms 2. Treating and Preventing acute complications

More information

Insulin Therapy. Endocrinologist. H. Delshad M.D. Research Institute For Endocrine Sciences

Insulin 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 information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: PC - Apidra, Levemir Therapeutic Class: Hormones and Synthetic Substitutes Therapeutic Sub-Class: Antidiabetic Agents Client: CA, CO, NV, OK, OR, WA and AZ Approval

More information

There seem to be inconsistencies regarding diabetic management in

There seem to be inconsistencies regarding diabetic management in Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Review of the consensus statement and additional

More information

Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies)

Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Leann Olansky, MD, FACP, FACE Cleveland Clinic Endocrinology Glucose Tolerance Categories FPG Diabetes

More information

Glucose Tolerance Categories. Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies)

Glucose Tolerance Categories. Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Leann Olansky, MD, FACP, FACE Cleveland Clinic Endocrinology Glucose Tolerance Categories FPG Diabetes

More information

INSULINThere are. T y p e 1 T y p e 2. many different insulins for

INSULINThere are. T y p e 1 T y p e 2. many different insulins for T y p e 1 T y p e 2 INSULINThere are many different insulins for Characteristics The three characteristics of insulin are: Onset. The length of time before insulin reaches the bloodstream and begins lowering

More information

Diabetes: When To Treat With Insulin and Treatment Goals

Diabetes: 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 information

Diabetes Medications: Insulin Therapy

Diabetes 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 information

INPATIENT 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 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 information

Intensifying Insulin Therapy

Intensifying 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 information

INSULIN REGIMENS in type 2 diabetes

INSULIN REGIMENS in type 2 diabetes A review of INSULIN and INSULIN REGIMENS in type 2 diabetes a Joshi P, PhD, FRCP,FRS Med, FICA Joshi S, MBChB, MSc(Pharm) Med(UL) Diabetes Care Centre, Louis Pasteur Medical Centre, Pretoria a Emeritus

More information

Diabetes may be classified as. i) Type - I Diabetes mellitus. Type - II Diabetes mellitus. Type - 1.5 Diabetes mellitus. Gestational Diabetes INSULIN

Diabetes may be classified as. i) Type - I Diabetes mellitus. Type - II Diabetes mellitus. Type - 1.5 Diabetes mellitus. Gestational Diabetes INSULIN HYPOGLYCEMIC AGENT Diabetes mellitus is a chronic metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting

More information

Insulin and Other Glucose-Lowering Drugs

Insulin and Other Glucose-Lowering Drugs Insulin and Other Glucose-Lowering Drugs I. OVERVIEW The pancreas is both an endocrine gland that produces the peptide hormones insulin, glucagon, and somatostatin and an exocrine gland that produces digestive

More information

2. What Should Advocates Know About Diabetes? O

2. What Should Advocates Know About Diabetes? O 2. What Should Advocates Know About Diabetes? O ften a school district s failure to properly address the needs of a student with diabetes is due not to bad faith, but to ignorance or a lack of accurate

More information

Insulin 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. 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 information

10 to 30 minutes ½ to 3 hours 3 to 5 hours. 30 60 minutes 1 to 5 hours 8 hours. 1 to 4 hours

10 to 30 minutes ½ to 3 hours 3 to 5 hours. 30 60 minutes 1 to 5 hours 8 hours. 1 to 4 hours Insulin Action There are several types of insulin. They are classified by how long they act: very fast, fast, slow and very slow acting. Each type of insulin has a certain time period in which it works.

More information

PERIOPERATIVE INSULIN MANAGEMENT

PERIOPERATIVE INSULIN MANAGEMENT G E N E R A L A N A E S T H E S I A Tutorial 327 PERIOPERATIVE INSULIN MANAGEMENT Dr. Jeffrey B Dobyns, DO, CMQ Assistant Professor of Anesthesiology and Perioperative Medicine Associate Medical Director,

More information

Discovery and history of Insulin

Discovery and history of Insulin Discovery and history of Insulin In Germany, Oskar Minkowski and Joseph von Mering observed that total pancreatectomy in experimental animals leads to the development of severe diabetes mellitus and begun

More information

Insulin T Y P E 1 T Y P E 2

Insulin T Y P E 1 T Y P E 2 T Y P E 1 T Y P E 2 INSULIN There are many different insulins for many different situations and lifestyles. This section should help you and your doctor decide which insulin or insulins are best for you.

More information

Insulin Pens & Improving Patient Adherence

Insulin Pens & Improving Patient Adherence Insulin Pens & Improving Patient Adherence Bonnie Pepon, RN, BSN, CDE Certified Diabetes Educator Conemaugh Diabetes Institute Kip Benko, MD FACEP Asst Clinical Professor University of Pittsburgh School

More information

Mind the Gap: Navigating the Underground World of DKA. Objectives. Back That Train Up! 9/26/2014

Mind the Gap: Navigating the Underground World of DKA. Objectives. Back That Train Up! 9/26/2014 Mind the Gap: Navigating the Underground World of DKA Christina Canfield, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cleveland Clinic Respiratory Institute Objectives Upon completion of this activity

More information

INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL

INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL Presented by: Leyda Callejas PGY5 Endocrinology, Diabetes and Metabolism Acknowledgements: Dr. P Orlander Dr. V Lavis Dr. N Shah

More information

Insulin: A Practice Update. Department of Nursing Staff Development Elizabeth Borgelt, MS, RN

Insulin: A Practice Update. Department of Nursing Staff Development Elizabeth Borgelt, MS, RN Insulin: A Practice Update Department of Nursing Staff Development Elizabeth Borgelt, MS, RN Learning Outcome The learner will be able to identify the different types of insulins available, their actions,

More information

Intensive Insulin Therapy in Diabetes Management

Intensive Insulin Therapy in Diabetes Management Intensive Insulin Therapy in Diabetes Management Lillian F. Lien, MD Medical Director, Duke Inpatient Diabetes Management Assistant Professor of Medicine Division of Endocrinology, Metabolism, & Nutrition

More information

Antidiabetic Drugs. Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Antidiabetic Drugs. Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antidiabetic Drugs Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Diabetes Mellitus Two types Type 1 Type 2 Type 1 Diabetes Mellitus Lack of insulin production

More information

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT?

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? MARTHA M. BRINSKO, MSN, ANP-BC CHARLOTTE COMMUNITY HEALTH CLINIC CHARLOTTE, NC Diagnosed and undiagnosed diabetes in the United

More information

Therapy Insulin Practical guide to Health Care Providers Quick Reference F Diabetes Mellitus in Type 2

Therapy 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 information

PowerPoint Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY. 12a. FOCUS ON Your Risk for Diabetes. Copyright 2011 Pearson Education, Inc.

PowerPoint Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY. 12a. FOCUS ON Your Risk for Diabetes. Copyright 2011 Pearson Education, Inc. PowerPoint Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY 12a FOCUS ON Your Risk for Diabetes Your Risk for Diabetes! Since 1980,Diabetes has increased by 50 %. Diabetes has increased by 70 percent

More information

Actions of Hormones on Target Cells Page 1. Actions of Hormones on Target Cells Page 2. Goals/ What You Need to Know Goals What You Need to Know

Actions of Hormones on Target Cells Page 1. Actions of Hormones on Target Cells Page 2. Goals/ What You Need to Know Goals What You Need to Know Actions of Hormones on Target Cells Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com) Page 1. Actions of Hormones on Target Cells Hormones

More information

Diabetes and Obesity in Children. Janie Berquist, RN, BSN, MPH, CDE Children s Mercy Hospitals and Clinics Kansas City, MO

Diabetes and Obesity in Children. Janie Berquist, RN, BSN, MPH, CDE Children s Mercy Hospitals and Clinics Kansas City, MO Diabetes and Obesity in Children Janie Berquist, RN, BSN, MPH, CDE Children s Mercy Hospitals and Clinics Kansas City, MO Diabetes and Obesity in Children What is Diabetes? How are Diabetes and Obesity

More information

FYI: (Acceptable range for blood glucose usually 70-110 mg/dl. know your institutions policy.)

FYI: (Acceptable range for blood glucose usually 70-110 mg/dl. know your institutions policy.) How Insulin Works: Each type of insulin has an onset, a peak, and a duration time. Onset is the length of time before insulin reaches the bloodstream and begins lowering blood Peak is the time during which

More information

EFFIMET 1000 XR Metformin Hydrochloride extended release tablet

EFFIMET 1000 XR Metformin Hydrochloride extended release tablet BRAND NAME: Effimet XR. THERAPEUTIC CATEGORY: Anti-Diabetic PHARMACOLOGIC CLASS: Biguanides EFFIMET 1000 XR Metformin Hydrochloride extended release tablet COMPOSITION AND PRESENTATION Composition Each

More information

INSULIN INTENSIFICATION: Taking Care to the Next Level

INSULIN 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 information

Diabetic Emergencies. David Hill, D.O.

Diabetic Emergencies. David Hill, D.O. Diabetic Emergencies David Hill, D.O. Class Outline Diabetic emergency/glucometer training Identify the different signs of insulin shock Diabetic coma, and HHNK Participants will understand the treatment

More information

50% INSULIN LISPRO PROTAMINE SUSPENSION AND 50% INSULIN LISPRO INJECTION (rdna ORIGIN) 100 UNITS PER ML (U-100)

50% INSULIN LISPRO PROTAMINE SUSPENSION AND 50% INSULIN LISPRO INJECTION (rdna ORIGIN) 100 UNITS PER ML (U-100) 1 HUMALOG Mix50/50TM 50% INSULIN LISPRO PROTAMINE SUSPENSION AND 50% INSULIN LISPRO INJECTION (rdna ORIGIN) 100 UNITS PER ML (U-100) DESCRIPTION Humalog Mix50/50 [50% insulin lispro protamine suspension

More information

Diabetes Mellitus. Melissa Meredith M.D. Diabetes Mellitus

Diabetes Mellitus. Melissa Meredith M.D. Diabetes Mellitus Melissa Meredith M.D. Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose resulting from defects in insulin secretion, insulin action, or both Diabetes is a chronic,

More information

The first injection of insulin was given on

The first injection of insulin was given on EFFECTIVE USE OF INSULIN THERAPY IN TYPE 2 DIABETES * Bernard Zinman, MDCM ABSTRACT Type 2 diabetes is a progressive disease; an individual s ability to secrete insulin in increasing amounts to overcome

More information

Types of insulin and How to Use Them

Types of insulin and How to Use Them Diabetes and Insulin Pumps Amy S. Pullen Pharm.D ISHP Spring Meeting April 2012 Objectives Describe the different types of insulin used in diabetes Identify the types of insulin that are compatible with

More information

Onset Peak Duration Comments

Onset Peak Duration Comments Rapid- Acting 5-15 minutes 0.5-3 hours 3-5 hours Meal should be available before administering, ideally taking within 10 minutes of eating). Good in refrigerator (36-46 F) until expiration date. Protect

More information

Insulin therapy in various type 1 diabetes patients workshop

Insulin therapy in various type 1 diabetes patients workshop Insulin therapy in various type 1 diabetes patients workshop Bruce H.R. Wolffenbuttel, MD PhD Dept of Endocrinology, UMC Groningen website: www.umcg.net & www.gmed.nl Twitter: @bhrw Case no. 1 Male of

More information

Guidelines for Education and Training

Guidelines for Education and Training Aim These protocols aim to provide the necessary guidance to enable insulin to be initiated safely and effectively Objectives 1. To provide the suggested procedure for the initiation of insulin for people

More information

polyuria. polydipsia. polyphagia

polyuria. polydipsia. polyphagia Diabetes Hormones of the Pancreas o Alpha Cells glucagon Secreted in response to blood glucose, protein intake, exercise, low CHO diet o Delta Cells somatostatin Inhibits glucagons and insulin o Beta Cells

More information

Disclosures. Types of Diabetes Mellitus. Type 1 Diabetes Mellitus. Principles of Basal-Bolus Insulin Therapy and Carbohydrate Counting

Disclosures. Types of Diabetes Mellitus. Type 1 Diabetes Mellitus. Principles of Basal-Bolus Insulin Therapy and Carbohydrate Counting Principles of Basal-Bolus Insulin Therapy and Carbohydrate Counting Disclosures I do not have any relevant financial relationships with any commercial interests. Henry K. Driscoll, MD, FACP Huntington

More information

Parenteral Dosage of Drugs

Parenteral Dosage of Drugs Chapter 11 Parenteral Dosage of Drugs Parenteral Route of administration other than gastrointestinal Intramuscular (IM) Subcutaneous (SC) Intradermal (ID) IV Parenteral Most medications prepared in liquid

More information

Antidiabetics drugs. Prof. Hanan Hagar

Antidiabetics drugs. Prof. Hanan Hagar Antidiabetics drugs Prof. Hanan Hagar Outline of lecture What is diabetes? Types of diabetes Complications of diabetes Classification of antidiabetics Oral hypoglycemic drugs Insulin Types of diabetes

More information

Endocrine Disorders. Diabetes Meds Objectives. Diabetes Type 1 and Type 2. Insulin Dynamics. Insulin is all about timing! Rapid acting insulin O P D

Endocrine Disorders. Diabetes Meds Objectives. Diabetes Type 1 and Type 2. Insulin Dynamics. Insulin is all about timing! Rapid acting insulin O P D Endocrine Disorders Diabetes Meds Objectives Explain the action of the various types of insulin currently available Identify the relationship between insulin peak and risk for hypoglycemia Discuss rationale

More information

Right Insulin Regimen

Right Insulin Regimen Focus on CME at l Université McGill University de Montréal What is the Right Insulin Regimen for my Patient? Jean-Pierre Hallé, MD, FRCPC, and Donald Breton, MD, FRCPC What can I do to improve my patient

More information

A new insulin order form should be completed for subsequent changes to type of insulin and/or frequency of administration

A new insulin order form should be completed for subsequent changes to type of insulin and/or frequency of administration of nurse A new insulin order form should be completed for subsequent changes to type of insulin and/or frequency of administration 1. Check times for point of care meter blood glucose testing. Pre-Breakfast

More information

Initiation and Adjustment of Insulin Regimens for Type 2 Diabetes

Initiation 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 information

Endocrine Responses to Resistance Exercise

Endocrine Responses to Resistance Exercise chapter 3 Endocrine Responses to Resistance Exercise Chapter Objectives Understand basic concepts of endocrinology. Explain the physiological roles of anabolic hormones. Describe hormonal responses to

More information

Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol

Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol Ruth LaCasse Kalish, RPh Department of Pharmacy Objectives Review the current practice at UConn Health with sliding

More information

Chapter 25: Metabolism and Nutrition

Chapter 25: Metabolism and Nutrition Chapter 25: Metabolism and Nutrition Chapter Objectives INTRODUCTION 1. Generalize the way in which nutrients are processed through the three major metabolic fates in order to perform various energetic

More information

UW MEDICINE PATIENT EDUCATION. Using Insulin. Basic facts about insulin and self-injection. What is insulin? How does diabetes affect the body?

UW MEDICINE PATIENT EDUCATION. Using Insulin. Basic facts about insulin and self-injection. What is insulin? How does diabetes affect the body? UW MEDICINE PATIENT EDUCATION Using Insulin Basic facts about insulin and self-injection This handout explains what insulin is, the different types of insulin, how to store it, how to give an injection

More information

Insulin: 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 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 information

Everyday Practice: Diabetes Mellitus

Everyday Practice: Diabetes Mellitus THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 20, NO. 5, 2007 245 Everyday Practice: Diabetes Mellitus Insulin therapy for patients with type 2 diabetes mellitus NISHA R. S., E. BHATIA INTRODUCTION India

More information

Insulin Initiation and Intensification

Insulin 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 information

Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes

Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes Objectives Pathophysiology of Diabetes Acute & Chronic Complications Managing acute emergencies Case examples 11/24/2014 UWHealth

More information

Diagnosis, classification and prevention of diabetes

Diagnosis, classification and prevention of diabetes Diagnosis, classification and prevention of diabetes Section 1 1 of 4 Curriculum Module II 1 Diagnosis, classification and presentation of diabetes Slide 2 of 48 Polyurea Definition of diabetes Slide 3

More information

Pharmaceutical Management of Diabetes Mellitus

Pharmaceutical Management of Diabetes Mellitus 1 Pharmaceutical Management of Diabetes Mellitus Diabetes Mellitus (cont d) Signs and symptoms 2 Elevated fasting blood glucose (higher than 126 mg/dl) or a hemoglobin A1C (A1C) level greater than or equal

More information

"Effects of Insulin deficiency"

Effects of Insulin deficiency "Effects of Insulin deficiency" Diabetes mellitus-- most important disease involving endocrine pancreas: Major manifestations: inappropriate hyperglycemia metabolic disorders Two types: Type I diabetes

More information

Faculty. Program Objectives. Introducing the Problem. Diabetes is a Silent Killer. Minorities at Greater Risk of Having Type 2 Diabetes

Faculty. Program Objectives. Introducing the Problem. Diabetes is a Silent Killer. Minorities at Greater Risk of Having Type 2 Diabetes Diabetes: The Basics Understanding and Managing Diabetes (Part 1 of 3) Satellite Conference Tuesday, October 18, 2005 2:00-4:00 p.m. (Central Time) Produced by the Alabama Department of Public Health Video

More information

GLUCOSE HOMEOSTASIS-II: An Overview

GLUCOSE HOMEOSTASIS-II: An Overview GLUCOSE HOMEOSTASIS-II: An Overview University of Papua New Guinea School of Medicine & Health Sciences, Division of Basic Medical Sciences Discipline of Biochemistry & Molecular Biology, M Med Part I

More information

Diabetes DIABETES MELLITUS. Types of Diabetes. Classification of Diabetes 6. 10. 2013. Prediabetes: IFG, IGT, Increased A1C

Diabetes DIABETES MELLITUS. Types of Diabetes. Classification of Diabetes 6. 10. 2013. Prediabetes: IFG, IGT, Increased A1C Diabetes Diabetes mellitus is a chronic disease characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. A state of raised blood glucose (hyperglycaemia)

More information

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Overview of Diabetes Management By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Objectives: Describe the pathophysiology of diabetes. From a multiorgan systems viewpoint. Identify the types of diabetes.

More information

Everything You Wanted to Know about INSULIN!

Everything You Wanted to Know about INSULIN! Everything You Wanted to Know about INSULIN! What is Insulin? Life would not exist without insulin. In order to utilize the glucose (energy) found within the carbohydrate-laden foods we consume, insulin

More information

PANCREATIC HORMONES. Mr. D.Raju, M.pharm, Lecturer

PANCREATIC HORMONES. Mr. D.Raju, M.pharm, Lecturer PANCREATIC HORMONES Mr. D.Raju, M.pharm, Lecturer Insulin; Glucagon Diabetes Mellitus 2 types: - Type I; juvenile onset; IDDM - Type II; maturity onset; IIDM Symptomatology: -Early -Late Early manifestations:

More information

Insulin and Diabetes

Insulin and Diabetes Insulin What is Insulin? Insulin is a hormone produced by special cells in the pancreas These cells that are produced are called beta cells Insulin allows the glucose from food we eat to enter the cells

More information

Diabetes Mellitus: Type 1

Diabetes Mellitus: Type 1 Diabetes Mellitus: Type 1 What is type 1 diabetes mellitus? Type 1 diabetes is a disorder that happens when your body produces little or no insulin. The lack of insulin causes the level of sugar in your

More information

Copyright 2010 Pearson Education, Inc. Chapter Twenty Three 1

Copyright 2010 Pearson Education, Inc. Chapter Twenty Three 1 23.2 Glucose Metabolism: An Overview When glucose enters a cell from the bloodstream, it is immediately converted to glucose 6- phosphate. Once this phosphate is formed, glucose is trapped within the cell

More information

2010 Partners & Peers for Diabetes Care, Inc. www.partnersandpeers.org

2010 Partners & Peers for Diabetes Care, Inc. www.partnersandpeers.org Without a working knowledge of the way insulin works in your body it is very difficult to effectively manage diabetes... Kind of like driving a car without knowing how to use the gas pedal and brakes...

More information

Designer Insulins. History case 1. Follow up - case 1. Follow up - case 1. History - case 2. 24 hr glucose profile - case 1

Designer Insulins. History case 1. Follow up - case 1. Follow up - case 1. History - case 2. 24 hr glucose profile - case 1 History case 1 33 yr old male bank manager Designer Insulins Dr A Qureshi MB ChB (Edin), MD (Lon), CCT (Lon), FRCP (Lon) Consultant in Endocrinology, Diabetes and General Internal Medicine w w w. e n d

More information

Diabetes: Medications

Diabetes: Medications Diabetes: Medications Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (APS HCQU) May 2008 sh Disclaimer Information or education provided by the HCQU is not intended to replace medical

More information

DIABETES MEDICATION INSULIN

DIABETES MEDICATION INSULIN Section Three DIABETES MEDICATION INSULIN This section will tell you: About insulin. How to care and store your insulin. When to take your insulin. Different ways of taking insulin. WHAT IS INSULIN? Insulin

More information

Type 1 Diabetes. Pennington Nutrition Series. Overview. About Insulin

Type 1 Diabetes. Pennington Nutrition Series. Overview. About Insulin Pennington Nutrition Series Healthier lives through education in nutrition and preventive medicine Pub No. 32 Type 1 Diabetes Overview Type 1 Diabetes (DM) is usually diagnosed in children and young adults.

More information

CBT/OTEP 450 Diabetic Emergencies

CBT/OTEP 450 Diabetic Emergencies Seattle-King County EMS Seattle-King County Emergency Medical Services Division Public Health - Seattle/King County 401 5th Avenue, Suite 1200 Seattle, WA 98104 (206) 296-4693 January 2009 CBT/OTEP 450

More information

Algorithms for Glycemic Management of Type 2 Diabetes

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 information

Optimizing insulin regimens in type 1 diabetes How to help patients get control of their life

Optimizing insulin regimens in type 1 diabetes How to help patients get control of their life Optimizing insulin regimens in type 1 diabetes How to help patients get control of their life Nancy J. V. Bohannon, MD Dr Bohannon has been a consultant for or has received honoraria or research support

More information

PHARMACOTHERAPY HOW TO INJECT INSULIN. Living your life as normal as possible. www.lilly-pharma.de www.lilly-diabetes.de

PHARMACOTHERAPY HOW TO INJECT INSULIN. Living your life as normal as possible. www.lilly-pharma.de www.lilly-diabetes.de PHARMACOTHERAPY HOW TO INJECT INSULIN Living your life as normal as possible www.lilly-pharma.de www.lilly-diabetes.de In Germany about 1.9 million people with diabetes are being treated with insulin.

More information

My Doctor Says I Need to Take Diabetes Pills and Insulin... What Do I Do Now? BD Getting Started. Combination Therapy

My Doctor Says I Need to Take Diabetes Pills and Insulin... What Do I Do Now? BD Getting Started. Combination Therapy My Doctor Says I Need to Take Diabetes Pills and Insulin... What Do I Do Now? BD Getting Started Combination Therapy How Can Combination Therapy Help My Type 2 Diabetes? When you have type 2 diabetes,

More information

Nursing 113. Pharmacology Principles

Nursing 113. Pharmacology Principles Nursing 113 Pharmacology Principles 1. The study of how drugs enter the body, reach the site of action, and are removed from the body is called a. pharmacotherapeutics b. pharmacology c. pharmacodynamics

More information

An estimated 280 Australians develop diabetes every day. It is Australia s fastest-growing chronic disease.

An estimated 280 Australians develop diabetes every day. It is Australia s fastest-growing chronic disease. Diabetes and insulin Summary Even with the help of your doctor and diabetes nurse educator, it may take a while to find the right insulin dose to reduce your blood glucose to your target levels. Insulin

More information

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing

More information