Sorry for your experience Dr Abdul Majeed on behalf of our doctors fraternity. All doctors are not bad , very few people will behave like that. Criteria for treatment of patients with Diabetes depends on somany factors. 1) Proper diagnosis of the case. Type of DM whether it is Type 1 DM or Type 2 DM or GDM or Secondary Diabetes. 2) Duration of diabetes and insulin secretion from betacells of pancreas and insulin resistance. 3) Exclude Diabetic emergencies like DKA, HHS, etc. 4) There are no hard and fast rules in the treatment. Methodical approach is necessary for control of blood sugars. 5) In Type 1 DM the drug of choice is only insulin for life time. 6) In GDM ( Gestational Diabetes mellitus) also, insulin is the only approved drug to treat Diabetes. 7) In secondary DM due to various causes e.g Chronic pancreatitis Pancreatic cancer Drug induced Diabetes like Steroids Anti hypertensive drugs like Atenolol Diuretics Antipsychotic drugs Retroviral drugs Statins ,etc. In such cases insulin is the only option. 8) The most common of all is Type 2 DM there are various modalities of treatment. Selection of Patient is important to initiate the antidiabetic drugs. 1) In obese or overweight , non obese Type 2 DM,the drug to start is Metformin along with LSM and TLC unless there are contraindications such as DKA Acute liver failure CCF Myocardial infarction GI intolerance DKD . Most of the cases require more than one OHA. .There are so many drugs like 2) Sulfonylureas like Glimipiride, Glipizide, Gliclazide, Glibenclamide etc 3) Alfa glucosidase inhibitors like voglibose, acarbose etc 4) Thiozolidinidiones like Pioglitazone 5) Non sulfonylureas like meglitinide, repaglinide etc . 6)DPP4 Inhibitors like Sitagliptin Linagliptin Vildagliptin Saxagliptin Alogliptin etc 7) SGLT2 Inhibitors like Empagliflozin DAPAGLIFLOZIN Canagliflozin Ertugliflozin Remogliflozin etc 8) GLP1 agonist s like Liraglutide Exenatide Semaglutide Dulaglutide etc 9) Human insulins like Regular insulin like Actrapid etc Basal Insulin is NPH , Insulatard etc Premixed biphasic human insulin like Human mixtard etc Novel analogue insulins like Novorapid/ Fiasp( Aspart) Novomix ( soluble Aspart and protamine crystalline aspart in 30: 70 ratio) Ryzodeg is Basal plus contains 30 % of soluble aspart and Degludec 70% Basal analogue insulins are Glargine Detemir Degludec Latest basal Insulin under phase 3 trial is Icodec . Prescription varies from person to person depending on so many factors , giving gist is very difficult .
The diabetologists don't have any valid explanation for precribing a particular drug to lower blood sugar. One gives metformin the other gives linaglyptin a third dr gives insulin. If you ask him the reason he gets irritated. He is more interested in his pp not the pt.There are very few who follow the ethics. I am myself a diabetic. This is my experience. Please excuse me if I am hurting any one
You asked about criteria for treatment of diabetes Nothing only one target to keep blood sugar in range as strictly as possible Either by insulins or oral antihyperglycemics There is advise for diet restrictions and exercise Change in lifestyle Yes there are protocols in different kind of diabetes with modalities Also considering age sex and stage or complications
DM-I .. NEED'S..INSULIN THERAPY.. DM-II .. NEED'S..OHA .. METFORMIN IS THE FIRST DRUG OF CHOICE IN.. TYPES TWO..DM.. OTHER MOLECULES.. ARE.. GLIMIPRIDE .. GLUMETZA .. VOGLIBOSE .. etc ..
Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.
DM a complete care not only blood glucose control.basing on age.wt.and comorbid state drug Rx differs
Thanks ma'm for explaining in detail.
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You can find here key changes in ADA guidelines. They are published in Diabetes Care once yearly in the month of January. GENERAL CHANGES The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the ADA has long been a leader in producing guidelines that capture the most current state of the field. To that end, the “Standards of Medical Care in Diabetes” now includes a dedicated section on Diabetes Technology, which contains preexisting material that was previously in other sections that has been consolidated, as well as new recommendations. SECTION 1. IMPROVING CARE AND PROMOTING HEALTH IN POPULATIONS Additional information was included on the financial costs of diabetes to individuals and society. Because telemedicine is a growing field that may increase access to care for patients with diabetes, discussion was added on its use to facilitate remote delivery of health-related services and clinical information. SECTION 2. CLASSIFICATION AND DIAGNOSIS OF DIABETES Based on new data, the criteria for the diagnosis of diabetes was changed to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from same sample). The section was reorganized to improve flow and reduce redundancy. Additional conditions were identified that may affect A1C test accuracy including the postpartum period. SECTION 3. PREVENTION OR DELAY OF TYPE 2 DIABETES This section was moved and is now located before the Lifestyle Management section to better reflect the progression of type 2 diabetes. The nutrition section was updated to highlight the importance of weight loss for those at high risk for developing type 2 diabetes who have overweight or obesity. Because smoking may increase the risk of type 2 diabetes, a section on tobacco use and cessation was added. SECTION 4. COMPREHENSIVE MEDICAL EVALUATION AND ASSESSMENT OF COMORBIDITIES On the basis of a new consensus report on diabetes and language, new text was added to guide health care professionals’ use of language to communicate about diabetes with people with diabetes and professional audiences in an informative, empowering, and educational style. A new figure from the ADA-European Association for the Study of Diabetes (EASD) consensus report about the diabetes care decision cycle was added to emphasize the need for ongoing assessment and shared decision making to achieve the goals of health care and avoid clinical inertia. A new recommendation was added to explicitly call out the importance of the diabetes care team and to list the professionals that make up the team. A recommendation was added to include the 10-year atherosclerotic cardiovascular disease (ASCVD) risk as part of overall risk assessment. The fatty liver disease section was revised to include updated text and a new recommendation regarding when to test for liver disease. SECTION 5. LIFESTYLE MANAGEMENT Evidence continues to suggest that there is NOT an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, more discussion was added about the importance of macronutrient distribution based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Additional considerations were added to the eating patterns, macronutrient distribution, and meal planning sections to better identify candidates for meal plans, specifically for low-carbohydrate eating patterns and people who are pregnant or lactating, who have or are at risk for disordered eating, who have renal disease, and who are taking sodium–glucose cotransporter 2 inhibitors. There is NOT a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized. A recommendation was modified to encourage people with diabetes to decrease consumption of both sugar sweetened and nonnutritive-sweetened beverages and use other alternatives, with an emphasis on water intake. The sodium consumption recommendation was modified to eliminate the further restriction that was potentially indicated for those with both diabetes and hypertension. Additional discussion was added to the physical activity section to include the benefit of a variety of leisure-time physical activities and flexibility and balance exercises. The discussion about e-cigarettes was expanded to include more on public perception and how their use to aide smoking cessation was not more effective than “usual care.” SECTION 6. GLYCEMIC TARGETS This section now begins with a discussion of A1C tests to highlight the centrality of A1C testing in glycemic management. To emphasize that the risks and benefits of glycemic targets can change as diabetes progresses and patients age, a recommendation was added to reevaluate glycemic targets over time. The section was modified to align with the living Standards updates made in April 2018 regarding the consensus definition of hypoglycemia. SECTION 7. DIABETES TECHNOLOGY This new section includes new recommendations, the self-monitoring of blood glucose section formerly included in Section 6 “Glycemic Targets,” and a discussion of insulin delivery devices, blood glucose meters, continuous glucose monitors (real-time and intermittently scanned, and automated insulin delivery devices. The recommendation to use self-monitoring of blood glucose in people who are not using insulin was changed to acknowledge that routine glucose monitoring is of limited additional clinical benefit in this population. SECTION 8. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES A recommendation was modified to acknowledge the benefits of tracking weight, activity, etc., in the context of achieving and maintaining a healthy weight. A brief section was added on medical devices for weight loss, which are not currently recommended due to limited data in people with diabetes. The recommendations for metabolic surgery were modified to align with recent guidelines, citing the importance of considering comorbidities beyond diabetes when contemplating the appropriateness of metabolic surgery for a given patient. SECTION 9. PHARMACOLOGIC APPROACHES TO GLYCEMIC TREATMENT The section on the pharmacologic treatment of type 2 diabetes was significantly changed to align, as per the living Standards update in October 2018, with the ADA-EASD consensus report on this topic. This includes consideration of key patient factors: (a) important comorbidities such as ASCVD, CKD, and HF, (b) hypoglycemia risk, (c) effects on body weight, (d) side effects, (e) costs, and (f) patient preferences. To align with the ADA-EASD consensus report, the approach to injectable medication therapy was revised. A recommendation that, for most patients who need the greater efficacy of an injectable medication, a GLP-1 agonist should be the first choice, ahead of insulin. A new section was added on insulin injection technique, emphasizing the importance of technique for appropriate insulin dosing and the avoidance of complications (lipodystrophy, etc.). The section on non-insulin pharmacologic treatments for DM1 was abbreviated, as these are not generally recommended. SECTION 10. CARDIOVASCULAR DISEASE AND RISK MANAGEMENT For the first time, this section is endorsed by the American College of Cardiology. Additional text was added to acknowledge heart failure as an important type of cardiovascular disease in people with diabetes for consideration when determining optimal diabetes care. The blood pressure recommendations were modified to emphasize the importance of individualization of targets based on cardiovascular risk. A discussion of the appropriate use of the ASCVD risk calculator was included, and recommendations were modified to include assessment of 10-year ASCVD risk as part of overall risk assessment and in determining optimal treatment approaches. The recommendation and text regarding the use of aspirin in primary prevention was updated with new data. For alignment with the ADA-EASD consensus report, two recommendations were added for the use of medications that have proven cardiovascular benefit in people with ASCVD, with and without heart failure. SECTION 11. MICROVASCULAR COMPLICATIONS AND FOOT CARE To align with the ADA-EASD consensus report, a recommendation was added for people with type 2 diabetes and chronic kidney disease to consider agents with proven benefit with regard to renal outcomes. The recommendation on the use of telemedicine in retinal screening was modified to acknowledge the utility of this approach, so long as appropriate referrals are made for a comprehensive eye examination. Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. The gastroparesis section includes a discussion of a few additional treatment modalities. The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone. SECTION 12. OLDER ADULTS A new section and recommendation on lifestyle management was added to address the unique nutritional and physical activity needs and considerations for older adults. Within the pharmacologic therapy discussion, de-intensification of insulin regimes was introduced to help simplify insulin regimen to match individual’s self-management abilities. SECTION 13. CHILDREN AND ADOLESCENTS Introductory language was added to the beginning of this section reminding the reader that the epidemiology, pathophysiology, developmental considerations, and response to therapy in pediatric-onset diabetes are different from adult diabetes, and that there are also differences in recommended care for children and adolescents with type 1 as opposed to type 2 diabetes. A recommendation was added to emphasize the need for disordered eating screening in youth with type 1 diabetes beginning at 10–12 years of age. Based on new evidence, a recommendation was added discouraging e-cigarette use in youth. The discussion of type 2 diabetes in children and adolescents was significantly expanded, with new recommendations in a number of areas, including screening and diagnosis, lifestyle management, pharmacologic management, and transition of care to adult providers. New sections and/or recommendations for type 2 diabetes in children and adolescents were added for glycemic targets, metabolic surgery, nephropathy, neuropathy, retinopathy, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovary syndrome, cardiovascular disease, dyslipidemia, cardiac function testing, and psychosocial factors. SECTION 14. MANAGEMENT OF DIABETES IN PREGNANCY Women with preexisting diabetes are now recommended to have their care managed in a multidisciplinary clinic to improve diabetes and pregnancy outcomes. Greater emphasis has been placed on the use of insulin as the preferred medication for treating hyperglycemia in gestational diabetes mellitus as it does not cross the placenta to a measurable extent and how metformin and glyburide should not be used as first-line agents as both cross the placenta to the fetus. SECTION 15. DIABETES CARE IN THE HOSPITAL Because of their ability to improve hospital readmission rates and cost of care, a new recommendation was added calling for providers to consider consulting with a specialized diabetes or glucose management team where possible when caring for hospitalized patients with diabetes. SECTION 16. DIABETES ADVOCACY The “Insulin Access and Affordability Working Group: Conclusions and Recommendations” ADA statement was added to this section. Published in 2018, this statement compiled public information and convened a series of meetings with stakeholders throughout the insulin supply chain to learn how each entity affects the cost of insulin for the consumer, an important topic for the ADA and people living with diabetes.Dr. Peerzada Ovais Ahmad6 Likes7 Answers
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GDM is significantly and independently associated with childhood IGT. Abstract OBJECTIVE Whether hyperglycemia in utero less than overt diabetes is associated with altered childhood glucose metabolism is unknown. We examined associations of gestational diabetes mellitus (GDM) not confounded by treatment with childhood glycemia in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort. RESEARCH DESIGN AND METHODS HAPO Follow-up Study (FUS) included 4,160 children ages 10–14 years who completed all or part of an oral glucose tolerance test (OGTT) and whose mothers had a 75-g OGTT at ∼28 weeks of gestation with blinded glucose values. The primary predictor was GDM by World Health Organization criteria. Child outcomes were impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes. Additional measures included insulin sensitivity and secretion and oral disposition index. RESULTS For mothers with GDM, 10.6% of children had IGT compared with 5.0% of children of mothers without GDM; IFG frequencies were 9.2% and 7.4%, respectively. Type 2 diabetes cases were too few for analysis. Odds ratios (95% CI) adjusted for family history of diabetes, maternal BMI, and child BMI z score were 1.09 (0.78–1.52) for IFG and 1.96 (1.41–2.73) for IGT. GDM was positively associated with child’s 30-min, 1-h, and 2-h but not fasting glucose and inversely associated with insulin sensitivity and oral disposition index (adjusted mean difference −76.3 [95% CI −130.3 to −22.4] and −0.12 [−0.17 to −0.064]), respectively, but not insulinogenic index. CONCLUSIONS Offspring exposed to untreated GDM in utero are insulin resistant with limited β-cell compensation compared with offspring of mothers without GDM. GDM is significantly and independently associated with childhood IGT. © 2019 by the American Diabetes AssociationDr. Anudeep Puvvula1 Like3 Answers
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Good morning dear friends and colleagues, Today let's have a look at Gestational diabetes mellitus. With regards, Dr Sepuri Tirumala Devi.Dr. Sepuri Tirumala Devi16 Likes33 Answers
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20yrs female c/o intractable hiccups since 1month CBC uric acid .BL urea Srcret tsh normal what other investigations needed to diagnosisDr. Gopal B Patil0 Like16 Answers
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Mr.X. 30 years ,taking Biphasic insulin two times day.He was brought to me in a semi conscious state .History not effectively able to elicit due to patients condition,and relatives illiterates .capillary blood glucose reveled HI ,it means his blood sugar was more than 600 mg per DL.. fast acting aspart ,insulin was started 10 units SC hourly basis .Pt is not willing for iv fluids management, in spite there is indication of dehydration which is warranted in this case. On third hour his CBG showed 540 mg of blood glucose by the blood glucose monitor.. 3 hours later he gained consciousness ,advised to go home. FAIS,Fast acting Insulin Aspart ,was advised for bolus insulin regime of 16 units for all meals .Plus NPH for BiD of 30/units for basal control. A week back reported to me.The photo was shot and published here.His Weight was 38 kg. He has altered bowel habits ,polys, ,fatigability, aggressive behaviour,poor sleep, mild cough,,Patient feel better. I remodified the insulin regime ,of Aspart of bolus regime ,and and multiple dose of basal regime . Advised rich proteins. Learned personnel can contribute ,and discuss widely..Dr. Elumalai Subbarayan2 Likes11 Answers