Diabetes, insulin deficiency or insulin organism due to the impact of defects carbohydrates (KH), can not avail itself of fat and protein, which requires constant medical care, it is a chronic metabolic disease. Disease, the risk of acute complications
The treatment is expensive and reduce the long-term and chronic (retinal, renal, neural, cardiac and vascular) continuing education of health professionals and patients to avoid the sequelae It is essential.
The recommendations presented in this guide, evidence-based information and the current international consensus on
light, it aims to reduce health problems in patients with diabetes.
see more about diabetes information
https://en.wikipedia.org/wiki/Diabetes_mellitus
First-line treatment
New diagnosis of type 2 diabetes and A1C is not very high (<8.5%, <69 mmol /
mol) simultaneously in patients with lifestyle modifications (any
or contraindication has long been used, the effect is proven and cost effective
a drug) should be initiated metformin. Also, each treatment lifestyle modifications
It should be applied in stages.
Metformin is that metformin is contraindicated or not tolerated, weak
diabetes, especially in quick response to treatment desired state or GLN group water It can be initiated with a drug. relatively long-term effects of sulfonylureas such as glibenclamide choiceIt should be considered.
FPG should be measured 3 days per week initially, then as required by the selected drug SMBG form should be used. When the changes in treatment, and initiation of insülin The frequency of SMBG during dose titration should be increased.
Overweight or obese patients, diet and physical activity to ensure weight loss
proposals should be implemented, but these initiatives are inadequate in the long term.
KV problems often accompany diabetes, hypertension and dyslipidemia for positive effects (at least 4 Kg or up to 5% by weight) is necessary to provide weight loss.
The first drug as 2x500 mg of metformin, or in patients with gastrointestinal sensitivity 1x500 mg should be initiated by increasing the effective dose of 500 mg every 1-2 weeks and within 1-2 months
usually 2x1000 mg, rarely a maximum of 3000 mg / day) should be assumed.
Diabetes A1C beginning of 8.5-10% (69-75 mmol / mol) for treatment of patients
initiated with metformin, a second combination of OAD or basal insulin
conceivable. Especially combinations with secretagogues or insulin, metformin
WATER / GLN) is the condition of patients should be closely monitored and glycemia levels fall the dose should be reduced. Thus exposure to patient hypoglycemia and overweight receiving can be prevented.
Initial A1C ≥ 10% (86 mmol / mol), FPG> 250 mg / dl or random PG> 300 mg /
dL or clinical symptoms of hyperglycemia with or catastrophic (DKA,
HHS) patients should start treatment with insulin. Some patients with this condition in fact previously unrecognized type 1 diabetes is likely to be the facts.
Some In patients with
type 2 diabetes are serious lack of insulin. insulin therapy in these patients preferably a basal-bolus (or mixture) should be done with insulin and with the possible metformin should be given. However, it does not comply with TBT, asymptomatic obese patients
The patient to determine the insulin therapy and physician’s experience is the schema properties.
Second-line treatment
target glycemic goals are not reached or could not be maintained in a short time (3 months) drug the dose should be increased or switch to the new regimen. Lifestyle changes for 2000 mg / day metformin with 7-7.5% after 3 months A1C (53-58 mmol / mol) lifestyle should be revised again, A1C> 7.5% (> 58 mmol / mol), or if the individual glycemic targets a second drug should be added to the treatment can not be reached.
The second drug selection should be based on the patient’s individual characteristics, efficacy and safety In addition, the cost should be considered. with the selected drug in the second step together, it must be maintained at any contraindications or metformin.
Insulin in the second stage is the most effective way. Especially A1C ≥ 8.5% (≥69 mmol / mol) is preferably a basal insulin (long-acting analog or NPH insulin) should be initiated. ready mix in appropriate cases (biphasic) insulin can be given. The risk of hypoglycemia for insulin therapy to be selected and the patient’s weight gain application skills must be considered.
A1C 7.1-8.5% (54-69 mmol / mol) of the treatment according to the patient’s condition WATER, GLN, DPP4-inhibitor, AGI, GLP-1, in selected cases, PDSs or SGLT2-inhibitor may be added.
Sulfonylurea is the cheapest option and antidiabetic activity than many groups
It is high. The risk of hypoglycemia and weight gain should be considered. long effects such as glibenclamide term risk of hypoglycemia is higher than sulfonylureas.
Postprandial glycemic control, especially if aimed at GLN, DPP4-inhibitor drugs, AG or GLP-1 can be selected. However, the cost and AGI, or GLP-1 in the gastrointestinal side effects should be taken into account in the choice. weight increase of DPP4-inhibitor and AG group has no effect.
Incretin-based drugs (GLP-1 and DPP4-inhibitor), but the risk of hypoglycemia than insulin and sulfonylureas low, activity is slightly lower. DPP4-inhibitor group of drugs, they are neutral in terms of weight and have significant side effects that may be useful to have.
It would be particularly useful in weight loss patient suspected of GLP-1 can be used.Due to the limited experience, the group of GLP-1 drugs, under the age of 18 obese type 2 It should not be used in people with diabetes. sufficient to 6 months treatment with exenatide (at least 3%) weight
This treatment should not be continued if the loss was not available. In addition, patients risk of pancreatitis The direction to be followed.
pion risk of hypoglycemia is the only example of the use of TZDs in our country,
lower than sulfonylureas and higher long-term efficacy. However, TZDs group
drug edema, congestive heart failure and anxiety in the direction to increase the fracture risk taking into account, if the patient is to be added to metformin as second-line drugs, the duration of treatment, the dose of the drug and be carefully monitored for side effects are needed.
Third-line treatment.
Metformin to a second AD (or GLP-1) was added after 3 months following A1C> 8.5% (69 mmol /mol) without loss of insulin, or if the individual glycemic targets are not met,treatment should be started. basal insulin therapy in patients using insulin in the previous stage (alternative as premixed insulin) should be added.
WATER Metfo with controlled release of my patients who use or GLN
The most convenient way of treatment is the addition of basal insulin. using metformin with DPP4-inhibitor or GLP-1 basal treatment of obese patients The addition of insulin may be appropriate, but in our country the present group of GLP-1 drugs use in combination with insulin is not covered by the refund. biphasic insulin insulin therapy in patients in the previous step must be concentrated.
with pioglitazone, insulin when used in patients, edema and congestive heart failure It should be monitored closely in terms of risk.
patients using insulin, metformin should be continued to be provided.
After adding the second drug Metformin A1C 7.1-8.5% (54-69 mmol / mol)
OAD can be added to a third treatment.
But in this case the cost of treatment increases,
The efficacy of treatment is reduced compared to insulin. After a short period of time may be inadequate. with metformin water / GLN, or in patients using basal insulin therapy,DPP4-inhibitor or GLP-1 can be added, but caution should be exercised in terms of the risk of hypoglycemia. Treatment of insulin resistance in patients with PSDs can be added. Overall insulin or insulin, together with two triple anti-hyperglycemic drug
Despite the combination treatment after 3 months A1C> 8.5% (69 mmol / mol) or individual
or if glycemic targets are not reached unsustainable intensive insulin therapy
It must be passed. Intensive insulin therapy MDI (stepped or multiple doses) insulin therapy
the form must be issued.
Some obese patients basal insulin + metformin + a GLP-1
It may benefit from the combination. Basal-bolus insulin and glycemic control can not be achieved with flexible lifestyle,
high intellectual level and willingness type 2 diabetic patients insulin pump (CSII)
therapy can be applied.
Know Diabetes is a disease that should be considered. There are two ways to treat diabetes three digits.
I tried to tell them in writing of the above. together with them must be in the diabetes diet doctor kontr health can continue with daily life.
walk together with them must leave the dance should abstain from cigarettes and alcohol. More information on the official site of diabetes
You can visit
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