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American Diabetes Association Dka Algorithm

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You will be listening to one of our many editorial discussions. This one took place on December 11, 2013 and is led by our Editor, Sherri Boehringer, PharmD, BCPS. You'll hear the voices of Editorial Board members: Steven E. Nissen, MD, MACC, Cleveland Clinic, Ohio; Douglas S. Paauw, MD, University of Washington Medical Center; Joseph E. Scherger, MD, MPH, Eisenhower Medical Center, California; Craig D. Williams, PharmD, FNLA, BCPS, Oregon Health and Science University; and others. You'll also hear the voices of cardiologists and contributing authors to the 2013 ACC/AHA cholesterol and cardiovascular risk assessment guidelines: Neil J. Stone, MD, MACP, FAHA, FACC; Donald M. Lloyd-Jones, MD, ScM, FACC, FAHA, Feinberg School of Medicine, Northwestern University, Illinois.

Detail-document#: 280614: Pharmacist's Letter

Administer sodium bicarbonate to maintain a pH 7.8,9 Project Leader in preparation of this professional resource: Beth Bryant, Pharm.D., BCPS, Assistant Editor Cefalu W, Bakris G, Blonde L, et al. American Diabetes Association standards of medical care in diabetes 2016. Diabetes Care 2016;39:S1-112. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm 2016 executive summary. Endocr Pract 2016;22:84-113 . Canadian Diabetes Association. Pharmacologic management of type 2 diabetes: 2016 interim update. . (Accessed September 2, 2016). Amblee A, Lious D, Fogelfeld L. Combination of saxaglipitin and metformin is effective as initial therapy in new-onset type 2 diabetes mellitus with severe hyperglycemia. J Clin Endocrinol Metab 2016:101:2528-35 . Cahn A, Cefalu WT. Clinical considerations for use of initial combination therapy in type 2 diabetes. Diabetes Care 2016;39:s137-45 . Henske JA, Griffith ML, Fowler MJ. Initiating and titrating insulin in patients with type 2 diabetes. Clin Diabetes 2009;27:72-6. Canadian Diabetes Continue reading >>

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Popular Questions

  1. semidevil

    So I got my blood drawn and I had glucose level of 127. My dr told me to go back for another lab and my hemoglobin ended up at a 5.9, which he said is upper normal. He wants me to be under 6.0. I'm due to go back for another set of labs in 3 months.
    I asked him what this means and all he said was that I need to eat a bit healthier and get in regular exercise, or this can turn to diabetes, and didn't really tell me more.
    I"m 28, about 148lbs, so not overweight ( I don't think).
    So just a couple of questions.
    Is this bad? 5.9 and 127? Do I need to start eating 0 grams sugar going forward? I"m going to start cutting on the refined flour and sugar, but some of my diet still has 2 to 3 grams of natural sugar here and there (greek yogurt, natural peanut butter, raw nuts, etc etc).
    I'm just trying to gauge the severity of 5.9, and how much sugar it takes to get to 6.0.

  2. timneh5

    Your 5.9 number is called an A1C; it's a 3-month average of your blood levels. It matters when your blood was drawn to get a 127 number. Did you eat breakfast or lunch and then go to your appointment?
    Over 125 is considered diabetic. Can it be 127, because you ate poorly for three months and is temporary? I'm not sure about that. You need to get yourself a glucose (blood) monitor to know how you are doing. You have to test your blood when you wake up (before eating), before meals and two hours after eating. Take these numbers to your next appointment and show these to your doctor. Are you on any medications? Metformin?
    Also, many foods turn into sugar after you eat it, so it's not just the obvious sugar you need to be aware of. Here' a link to a site that has a lot of easy to understand information for you: Blood Sugar 101
    Good luck~

  3. semidevil

    well, I wasn't expecting a blood test, so I did have a cup of cappuccino and some pita with hummus probably 30 minutes before the appointment, so I hope that was the reason it went to 127. The Dr. knew that too.
    for the A1C, I also had a cup of oatmeal probably 3 to 4 hours before.

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Diabetes Guidelines Of 2016: Update On Updates

Important updates of the past year sought to recognize the importance of obesity care and the need to better integrate behavioral health into diabetes care. Guidelines that affect diabetes care come from many places: professional societies, advocacy groups, and regulators weigh in on when to use certain drugs and what standards should apply for medical devices. Whether they represent updates to existing standards or cover new ground, guidelines not only affect clinical decisions, but they also drive coverage decisions by payers—and thus, access for patients. The relationship between obesity and diabetes, and the recognition that unmet behavioral health needs affect outcomes drove updates in 2016. Below are some key changes that will affect both diabetes care and payer decisions going into the new year: AACE/ACE issue joint update on type 2 diabetes algorithm. The year began with an update from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) on care of patients with type 2 diabetes (T2D). The statement emphasized the need to improve lifestyle management first, to individualize both targets for glycated hemoglobin (A1C) a Continue reading >>

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Popular Questions

  1. funkydiva77

    What is a 'normal' fasting glucose reading?

    Im new and yet to be diagnosed but I have been trying to find out the 'normal' fasting blood glucose reading. I have been researching on the internet and I have found conflicting information.
    One site says that normal is 70-99 mg/dL (3.8-5.5 mmol/L)
    Impaired test - From 100-125 mg/dL (5.6 to 6.9 mmol/L)
    Another site says that normal is from 70-110 mg/dL (3.8-6.1 mmol/L)
    I used a home meter and it says my fasting blood glucose reading is 100 mg/dL (5.6mmol/L) so that means one site says im normal the other says the reading is impaired???
    Hmmmm Confused!!

  2. trinitarian3n1

    You'll find that there is a broad range of "normal" targets given. The 70-110 was an older standard for normal fasting blood glucose, now, since more research is demonstrating that tighter targets usually translate into fewer complications, the 70-99 is getting adopted as the "normal" standard.
    The Joint Commission, a US organization that accredits hospitals, had us change the standards at our hospital several years ago to the 70-99 range.

  3. Achilles

    A 108 mg/dL would be considered "pre-diabetic". The pre-diabetic range is from 100 - 125 mg/dL for a fasting blood glucose test.
    I would definitely make an appointment with the doctor and get some official blood work done. If you are indeed pre-diabetic, you may have caught this early enough to make some lifestyle changes to minimize the potential of getting full blown diabetes.
    *edit to correct typo*

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My Site - Chapter 15: Hyperglycemic Emergencies In Adults

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) should be suspected in ill patients with diabetes. If either DKA or HHS is diagnosed, precipitating factors must be sought and treated. DKA and HHS are medical emergencies that require treatment and monitoring for multiple metabolic abnormalities and vigilance for complications. A normal blood glucose does not rule out DKA in pregnancy. Ketoacidosis requires insulin administration (0.1 U/kg/h) for resolution; bicarbonate therapy should be considered only for extreme acidosis (pH7.0). Note to readers: Although the diagnosis and treatment of diabetic ketoacidosis (DKA) in adults and in children share general principles, there are significant differences in their application, largely related to the increased risk of life-threatening cerebral edema with DKA in children and adolescents. The specific issues related to treatment of DKA in children and adolescents are addressed in the Type 1 Diabetes in Children and Adolescents chapter, p. S153. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are diabetes emergencies with overlapping features. With insulin deficiency, hyperglycemia causes urinary Continue reading >>

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Popular Questions

  1. augigi

    Don't have enough info to say.

  2. Daytonite

    edema occurs because of trauma to an area, vascular compromise or pump (heart) problems/failure. diabetics are known to develop peripheral vascular problems, heart complications and renal failure. other things where there can be edema in the legs are blood clots in the leg, cellulitis, liver/kidney/heart failure or even some side effect of medications, including insulin. with a 30-year history of diabetes, i wouldn't find it surprising for a diabetic to be developing some sort of complications to their disease. is this person, by any chance, obese? that will also compromise the circulation to the lower extremities and result in some pitting edema. damage to heart, kidney or peripheral vessels is not uncommon in diabetes despite having excellent care and control of their blood sugars.

  3. Wave

    Thanks for your reply, Augigi! What else should I have asked/assessed? (what info is missing? -aside from a complete medical record lol.)
    Wave

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