Diabetes
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| Glucagon | Stimulate glycolysis; Stimulate hepatic gluconeogenesis and ketogenesis
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| Insulin | Stimulate Glu uptake by muscles and adipose tissue; Suppress glucagon secretion; Stimulate glycogen, protein, and fat synthesis; Stimulate Glu use as energy
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| Amylin | Suppress glucagon secretion; Slow gastric emptying; Reduce food intake and body weight
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| GLP-1 | Stimulate Glu-dependent insulin release; Suppress glucagon secretion; Slow gastric emptying; Reduce food intake and body weight; Promote beta-cell health
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| ADA | American Diabetes Association
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| AACE/ACE | American Association of Clinical Endocrinologists/American College of Endocrinology
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| Diagnostic criteria for Pre-DM | Fasting: 100-125
Postprandial: 140-199
A1C: 5.7-6.4% (ADA) or 5.5-6.4% (AACE)
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| ADA Targets | Fasting: 80-130
Postprandial: <180
A1C: 7%
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| AACE/ACE Targets | Fasting: <110
Postprandial: <140
A1C: <6.5%
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| DCCT | T1DM: Aggressive Glu control (>3 shots/day or pump) decreases microvascular complications
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| UKPDS | T2DM: Each 1% decrease in A1C = 35% reduction in microvascular complications; No impact on macrovascular; Metformin decreased macrovascular risk in obese populations
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| ACCORD | T2DM: Ended early due to increased rate of mortality in intensive glycemic control group (A1C <6%)
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| ADVANCE | T2DM: Intensive control (A1C <6.5%) decreased risk of renal events, but no difference in major macrovascular events
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| VADT | T2DM: No difference in macrovascular events or mortality
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| Macrovascular | Brain (stroke)
Heart (CAD)
Extremities (PVD)
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| Microvascular | Eyes (retinopathy)
Kidney (nephropathy)
Nerves (neuropathy)
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| HTN Management | Screening: annually
Goal: <140/90
Treatment: lifestyle modifications and ACEI/ARB
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| Lipid Management | Screening: at diagnosis and every 5 years
Treatment: <40 and no risk factors = none; >40 and no risk factors = moderate; risk factors or ASCVD = high
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| High intensity statins | Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg
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| Antiplatelet Therapy | Primary Px: ASA if >50 + risk factor(s)
Secondary Px: ASA 75-162 mg/day
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| Nephropathy | Screening: annually
Goal: urine albumin/Cr <30
Treatment: ACEI/ARB; protein restriction (0.8 g/kg/day)
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| Peripheral Neuropathy | Screening: annual w/monofilament
Treatment: TCAs, gabapentin, pregabalin, duloxetine, tapentadol
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| Retinopathy | Screening: annual w/dilation
Treatment: refer to ophthalmologist
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| Immunizations | Annual flu vaccine
Pneumococcal vaccine
Hepatitis B vaccine
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| NICE-SUGAR | Inpatient DM: Less stringent Glu control (<180) had decreased mortality and decreased hypogylcemia
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Created by:
kcapizzi
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