diabetestalk.net

Management Of Hyperglycemia In Type 2 Diabetes 2017

Idf Clinical Practice Recommendations For Managing Type 2 Diabetes In Primary Care

Idf Clinical Practice Recommendations For Managing Type 2 Diabetes In Primary Care

IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care - 2017 2 IDF Working Group Chair: Pablo Aschner, MD,MSc, Javeriana University and San Ignacio University Hospital, Bogota, Colombia. Core Contributors: Amanda Adler, MD, PhD, FRCP, Addenbrooke´s Hospital and National Institute for Health and Care Excellence(NICE), Cambridge, UK Cliff Bailey, PhD, FRCP(Edin), FRCPath, Aston University, Birmingham,UK Juliana CN Chan, MB ChB, MD, MRCP (UK), FRCP (Lond), FRCP (Edin), FRCP (Glasgow), FHKAM (Medicine), Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, China. Stephen Colagiuri, MB, BS Honours Class II, FRACP, The Boden Institute, University of Sydney, Sydney, Australia Caroline Day, PhD, FRSB, MedEd UK and Aston University, Birmingham, UK Juan Jose Gagliardino, MD, Cenexa (Unlp-Conicet), La Plata, Argentina Lawrence A. Leiter, MD, FRCPC, FACP, FACE, FAHA, Clinical Nutrition and Risk Factor Modification Centre, Li Ka Shing Knowledge Institute at St. Michael’s Hospital and University of Toronto, Toronto, Canada Shaukat Sadikot, MD, President International Diabetes Federation (2016-2017), Diabetes India and Jaslok Hospital, Mumbai, India Nam Han Cho, MD, PhD, President-Elect International Diabetes Federation (2016-17), Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea Eugene Sobngwi, MD, MPhil, PhD, Central Hospital and University of Yaounde, Yaounde, Cameroon Acknowledgements Milena Garcia, MD, MSc, Javeriana University and San Ignacio University Hospital, Bogota, Colombia. Co-chaired the consensus meeting and contributed to the appraisal of the guidelines Chris Parkin - Medical writing support, CGParkin Communications, USA Martine V Continue reading >>

Clinical Review Of Antidiabetic Drugs: Implications For Type 2 Diabetes Mellitus Management

Clinical Review Of Antidiabetic Drugs: Implications For Type 2 Diabetes Mellitus Management

1GIM Foundation, Little Rock, AR, USA 2University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA 3Christus Trinity Mother Frances Hospital, Tyler, TX, USA 4University of Arkansas for Little Rock (UALR), Little Rock, AR, USA 5Tutwiler Clinic, Tutwiler, MS, USA 6Vanderbilt University, Nashville, TN, USA 7Arkansas Department of Health, Little Rock, AR, USA 8St. Vincent Infirmary, Little Rock, AR, USA 9Baptist Hospital SpringHill, North Little Rock, AR, USA 10The Wright Center for Graduate Medical Education, Scranton, PA, USA Type 2 diabetes mellitus (T2DM) is a global pandemic, as evident from the global cartographic picture of diabetes by the International Diabetes Federation (Diabetes mellitus is a chronic, progressive, incompletely understood metabolic condition chiefly characterized by hyperglycemia. Impaired insulin secretion, resistance to tissue actions of insulin, or a combination of both are thought to be the commonest reasons contributing to the pathophysiology of T2DM, a spectrum of disease originally arising from tissue insulin resistance and gradually progressing to a state characterized by complete loss of secretory activity of the beta cells of the pancreas. T2DM is a major contributor to the very large rise in the rate of non-communicable diseases affecting developed as well as developing nations. In this mini review, we endeavor to outline the current management principles, including the spectrum of medications that are currently used for pharmacologic management, for lowering the elevated blood glucose in T2DM. Introduction Diabetes mellitus (DM) is a complex chronic illness associated with a state of high blood glucose level, or hyperglycemia, occurring from deficiencies in insulin secretion, action, or both. The chronic metabolic imbalanc Continue reading >>

Ada/easd New Hyperglycemia Management Guidelines

Ada/easd New Hyperglycemia Management Guidelines

ADA/EASD New Hyperglycemia Management Guidelines ADA/EASD New Hyperglycemia Management Guidelines Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Inzucchi SE, Bergenstal RM, Buse JB, et al. Glycemic targets and glucose-lowering therapies must be individualized. Diet, exercise, and education remain the foundation of any type 2 diabetes treatment program. Unless there are prevalent contraindications, metformin is the optimal first-line drug. After metformin, there are limited data to guide us. Combination therapy with an additional 12 oral or injectable agents is reasonable, aiming to minimize side effects where possible. Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control. All treatment decisions, where possible, should be made in conjunction with the patient, focusing on his/her preferences, needs, and values. Comprehensive cardiovascular risk reduction must be a major focus of therapy. Antihyperglycemic therapy in type 2 diabetes: general recommendations, based on patient and drug characteristics See right right column to download as PowerPoint The American Diabetes Association and the European Association for the Study of Diabetes have updated guidelines on the management of hyperglycemia in nonpregnant adults with type 2 diabetes. The update is based on new evidence of risks and benefits of glycemic control, evidence on safety and efficacy of new drug classes, the withdrawal and restriction of other drug classes and the increasing need for a more patient-centered approach to care. Individualized treatment is the cornerstone of success. The nov Continue reading >>

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>

New Ada-easd Position Statement On Managing Hyperglycemia In Type 2 Diabetes Favors Individualized Approach

New Ada-easd Position Statement On Managing Hyperglycemia In Type 2 Diabetes Favors Individualized Approach

New ADA-EASD Position Statement on Managing Hyperglycemia in Type 2 Diabetes favors Individualized Approach Patient-centered care is the guiding principle of the management of hyperglycemia in patients with type 2 diabetes, according to a joint position statement released by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Compared with 2008 ADA-EASD treatment algorithm, the new position statement is not as prescriptive and calibrates treatment targets to patient needs while individualizing the treatment options. It also acknowledges the role of lifestyle changes prior to initiating metformin therapy. The features of the new statement were reviewed by Silvio E. Inzucchi, MD, a co-author of the position statement, at the 72nd scientific sessions of the American Diabetes Association. The statement is published in Diabetes Care (2012;35:1364-1379) and Diabetologia (2012;55:1577-1596). The position statement covers the array of antihyperglycemic agents available, the risks and benefits of tight glycemic control in various patient populations, drug safety, and patient-centered care. A patient-centered approach is one that provides care that is respectful of and responsive to individual patient preferences, needs, and valuesensuring that patient values guide all clinical decisions, said Dr. Inzucchi, in quoting from the position statement. First, the patients preferred level of involvement should be gauged. Although decision-making is shared, the final decisions regarding lifestyle choices ultimately lie with the patient, he said. Where possible, therapeutic choices should be explored. He admits that the burden of treatment for some patients with complex chronic comorbidities reduces their capacity to collaborate in their Continue reading >>

Ada/easd Guidelines Hyperglycemia Management In Type 2 Diabetes | Ndei

Ada/easd Guidelines Hyperglycemia Management In Type 2 Diabetes | Ndei

If A1C target is not achieved after 3 months of dual therapy, proceed to Triple Therapy If A1C target is not achieved after 3 months of triple therapy and patient (1) is on oral combination, move to injectable; (2) on GLP-1, add basal insulin; or (3) on optimally titrated basal insulin, add GLP-1 or mealtime insulin. Refractory patients: consider adding TZD or SGLT2. Basal insulin + mealtime insulin or GLP-1 If not controlled after FBG target is reached or if dose >0.5 U/kg/d Add 1 rapid insulin injection before largest meal 4 U, 0.1 U/kg, or 10% basal dose. If A1C <8%, consider decreasing basal dose by same amount Increase dose by 1-2U or 10-15% once to twice weekly until SMBG target is reached Decrease corresponding dose by 2-4U or 10-20% for hypoglycemia Divide current basal dose into 2/3 AM, 1/3 PM, or 1/2 AM, 1/2 PM Increase dose by 1-2U or 10-15% once to twice weekly to reach SMBG target Decrease corresponding dose by 2-4U or 10-20% for hypoglycemia Add 2 rapid insulin injections before meals: basal-bolus 4 U, 0.1 U/kg, or 10% basal dose/meal. If A1C <8%, consider decreasing basal by same amount Increase dose by 1-2U or 10-15% once to twice weekly until SMBG target is reached Decrease corresponding dose by 2-4U or 10-20% for hypoglycemia Continue reading >>

Treating Diabetes Requires A Multifaceted Approach

Treating Diabetes Requires A Multifaceted Approach

Treating Diabetes Requires a Multifaceted Approach Diabetes afflicts more than 30 million Americans.1 There are also an estimated 84 million people in the United States who are pre-diabetic, with elevated blood glucose levels, and at risk for developing the disease.1 This complex, chronic disease requires a multifaceted approach to management that combines education and support, lifestyle modifications, and pharmacological treatment. Diabetes consists of a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.2 Symptoms include blurred vision, extreme fatigue, polydipsia, polyphagia, polyuria, weight loss, and yeast infections.3 Type 1 diabetes (T1D), often called insulin-dependent or immune-mediated diabetes, is usually diagnosed in children or young adults but can develop at any age. About 5% to 10% of those affected by diabetes have T1D, which develops because of the cellular-mediated autoimmune destruction of the beta cells in the pancreas.2,4 Beta-cell destruction can be variable; it is rapid in some individuals and slow in others. Because of the severe insulin deficiency, exogenous insulin is required to control blood glucose and prevent diabetic ketoacidosis. Often, the first symptom of T1D is the presentation of ketoacidosis. In other patients, moderate fasting glucose may quickly change to ketoacidosis in the presence of infection or stress. Yet others can maintain enough residual beta-cell function to prevent ketoacidosis for years. Risk factors for T1D are not very clear, but genetic and environmental components appear to be involved. Type 2 diabetes (T2D), or insulin-resistant diabetes, is the most common type, representing 90% to 95% of patients with diabetes. It is characterized by Continue reading >>

Changes In Treatment Of Hyperglycemia In A Hypertensive Type 2 Diabetes Population As Renal Function Declines

Changes In Treatment Of Hyperglycemia In A Hypertensive Type 2 Diabetes Population As Renal Function Declines

Despite continued efforts to control hemoglobin A1c (HbA1c) and an ever-expanding arsenal of new drugs [1], we may fall short of adequate control in a significant portion of patients with diabetes due to failure to recognize comorbidities [2]. As kidney disease progresses, clearance of oral agents such as glyburide, metformin or sitagliptan may be so diminished as to require discontinuation. The decrease in renal function due to acute kidney injury and chronic kidney disease (CKD) exacerbates fluid/volume overload, congestive heart failure, high blood pressure [3] as well as other comorbidities. Since there is little data focusing on the impact of renal dysfunction on these therapeutic choices, we examined the effect of renal (dys)function on the choice of antidiabetic medications. To understand the medication decisions in patients with both type 2 diabetes and hypertension, we evaluated the records of all patients seen at least twice during a sample 5-year period at Joslin Diabetes Center. This study was approved by the Committee on Human Studies of the Joslin Diabetes Center as a quality assurance study to determine adherence to quality guidelines. All patient records were anonymized and patient data deidentified prior to analysis. During this time 15 481 patients were seen more than twice and 10 540 individuals had diagnosis codes for both hypertension and diabetes. Of these 10 151 patients were identified as meeting these criteria with complete demographic information regarding height, weight, body mass index (BMI), estimated glomerular filtration rate (eGFR) and medication records available. There were 5623 men and 4528 women with a mean BMI of 31 kg/m2 (men 30, women 32), height 67 inches (69, 63), weight 198 lb (212, 182) and mean eGFR of 78 mL/min/1.73 m2 (78, 7 Continue reading >>

Perioperative Hyperglycemia Management: An Update

Perioperative Hyperglycemia Management: An Update

During the fasting state, normal subjects maintain plasma glucose levels between 60 and 100 mg/dl (3.3 to 5.5 mM). The stress of surgery and anesthesia alters the finely regulated balance between hepatic glucose production and glucose utilization in peripheral tissues. An increase in the secretion of counterregulatory hormones (catecholamines, cortisol, glucagon, and growth hormone) occurs, causing excessive release of inflammatory cytokines including tumor necrosis factor-α, interleukin-6, and interleukin-1β (fig. 1). Cortisol increases hepatic glucose production, stimulates protein catabolism, and promotes gluconeogenesis, resulting in elevated BG levels. Surging catecholamines increase glucagon secretion and inhibit insulin release by pancreatic β cells. Additionally, the increase in stress hormones leads to enhanced lipolysis and high FFA concentrations. Increased FFAs have been shown to inhibit insulin-stimulated glucose uptake and limit the intracellular signaling cascade in skeletal muscle responsible for glucose transport activity. Evidence also suggests that tumor necrosis factor-α interferes with the synthesis and/or translocation of the glucose transporter-4 receptor, reducing glucose uptake in peripheral tissues. These processes result in an altered state of insulin action, leading to a relative state of insulin resistance, which is most pronounced on the first postoperative day and may persist for 9 to 21 days after surgery. Continue reading >>

Type 2 Diabetes Mellitus: Outpatient Insulin Management

Type 2 Diabetes Mellitus: Outpatient Insulin Management

In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like peptide 1 receptor agonist when the A1C level is 9% or more, especially if the patient has symptoms of hyperglycemia or catabolism. Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached. A fasting and premeal blood glucose goal of 80 to 130 mg per dL and a two-hour postprandial goal of less than 180 mg per dL are recommended. Insulin use is associated with hypoglycemia and weight gain. Insulin analogues are as effective as human insulin at lowering A1C levels with lower risk of hypoglycemia, but they have significantly higher cost. Patients with one or more episodes of severe hypoglycemia (i.e., requiring assistance from others for treatment) may benefit from a short-term relaxation of glycemic targets. Several new insulin formulations have been approved recently that are associated with less risk of hypoglycemia compared with older formulations. The goals of therapy should be individualized based on many factors, including age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life. Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and progressive beta cell failure.1 Beta cell failure progresses at a rate of approximately 4% per year, requiring the use of multiple medications, oft Continue reading >>

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Abstract Description: The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence. The committee rates the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendations: This synopsis focuses on recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment of type 2 diabetes. The American Diabetes Association (ADA) first released its Standards of Medical Care in Diabetes for health professionals in 1989. These practice guidelines provide an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards cover all aspects of patient care (1); this guideline synopsis focuses on pharmacologic approaches for patients with type 2 diabetes. Pharmacologic Therapy for Type 2 Diabetes: Recommendations Initial Treatment Approach: Metformin Assessing Response and Deciding to Intensify Therapy Recent Evidence From Cardiovascular Outcomes Trials Recent Warnings About Pharmacotherapies Insulin Therapy Continue reading >>

Ada Updates Standards Of Medical Care For Patients With Diabetes Mellitus

Ada Updates Standards Of Medical Care For Patients With Diabetes Mellitus

Key Points for Practice • All adults should be tested for diabetes beginning at 45 years of age. • Overweight or obese patients with one or more risk factors for diabetes should be screened at any age. • Persons who use continuous glucose monitoring and insulin pumps should have continued access after 65 years of age. • Aspirin therapy should be considered for women with diabetes who are 50 years and older. • The addition of ezetimibe to statin therapy should be considered for eligible patients who can tolerate only a moderate-dose statin Ongoing patient self-management education and support are critical to preventing acute complications of diabetes mellitus and reducing the risk of long-term complications. The American Diabetes Association (ADA) recently updated its standards of care to provide the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Key changes in the 2016 update include new screening recommendations, clarification of diagnostic testing, and recommendations on the use of new technology for diabetes prevention, the use of continuous glucose monitoring devices, cardiovascular risk management, and screening for hyperlipidemia in children with type 1 diabetes. General recommendations for treatment of type 2 diabetes are shown in Figure 1. Antihyperglycemic therapy in type 2 diabetes: general recommendations. The order in the chart was determined by historical availability and the route of administration, with injectables to the right; it is not meant to denote any specific preference. Potential sequences of antihyperglycemic therapy for patients with type 2 diabetes are displayed, with the usual transition moving vertically from top to bottom, although horizontal movement within therapy stages is also Continue reading >>

Glucose Management In Hospitalized Patients

Glucose Management In Hospitalized Patients

Glucose management in hospitalized patients poses challenges to physicians, including identifying blood glucose targets, judicious use of oral diabetes mellitus medications, and implementing appropriate insulin regimens. Uncontrolled blood glucose levels can lead to deleterious effects on wound healing, increased risk of infection, and delays in surgical procedures or discharge from the hospital. Previously recommended strict blood glucose targets for hospitalized patients result in more cases of hypoglycemia without improvement in patient outcomes. The current target is 140 to 180 mg per dL. Use of oral diabetes medications, particularly metformin, in hospitalized patients is controversial. Multiple guidelines recommend stopping these medications at admission because of inpatient factors that can increase the risk of renal or hepatic failure. However, oral diabetes medications have important nonglycemic benefits and reduce the risk of widely fluctuating blood glucose levels. There is no proven risk of lactic acidosis from metformin in patients with normal kidney function, and it can be used safely in many hospitalized patients with diabetes. Insulin dosing depends on the patient's previous experience with insulin, baseline diabetes control, and renal function. Other considerations include the patient's current oral intake, comorbidities, and other medications. Many patients can be managed using only a basal insulin dose, whereas others benefit from additional short-acting premeal doses. Historically, sliding scale insulin regimens have been used, but they have no proven benefit, increase the risk of hypoglycemia and large fluctuations in blood glucose levels, and are not recommended. Discharge planning is an important opportunity to address diabetes control, medication Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes: A Consensus Algorithm For The Initiation And Adjustment Of Therapy

Management Of Hyperglycemia In Type 2 Diabetes: A Consensus Algorithm For The Initiation And Adjustment Of Therapy

Injections, three times/day dosing, frequent GI side effects, expensive, little experience *Severe hypoglycemia is relatively infrequent with sulfonylurea therapy. The longer-acting agents (e.g. chlorpropamide, glyburide [glibenclamide], and sustained-release glipizide) are more likely to cause hypoglycemia than glipizide, glimepiride, and gliclazide. Repaglinide is more effective at lowering A1C than nateglinide. GI, gastrointestinal. 1)Begin with low-dose metformin (500 mg) taken once or twice per day with meals (breakfast and/or dinner). 2)After 57 days, if GI side effects have not occurred, advance dose to 850 or 1,000 mg before breakfast and dinner. 3)If GI side effects appear as doses advanced, can decrease to previous lower dose and try to advance dose at a later time. 4)The maximum effective dose is usually 850 mg twice per day, with modestly greater effectiveness with doses up to 3 g per day. GI side effects may limit the dose that can be used. 5)Based on cost considerations, generic metformin is the first choice of therapy. A longer-acting formulation is available in some countries and can be given once per day. Injections, three times/day dosing, frequent GI side effects, expensive, little experience *Severe hypoglycemia is relatively infrequent with sulfonylurea therapy. The longer-acting agents (e.g. chlorpropamide, glyburide [glibenclamide], and sustained-release glipizide) are more likely to cause hypoglycemia than glipizide, glimepiride, and gliclazide. Repaglinide is more effective at lowering A1C than nateglinide. GI, gastrointestinal. David M. Nathan, MD,1 John B. Buse, MD, PHD,2 Mayer B. Davidson, MD,3 Robert J. Heine, MD,4 Rury R. Holman, FRCP,5 Robert Sherwin, MD 6 and Bernard Zinman, MD 7 1 Diabetes Center, Massachusetts General Hospital and Harv Continue reading >>

8. Pharmacologic Approaches To Glycemic Treatment

8. Pharmacologic Approaches To Glycemic Treatment

PHARMACOLOGIC THERAPY FOR TYPE 1 DIABETES Most people with type 1 diabetes should be treated with multiple daily injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion. A Most individuals with type 1 diabetes should use rapid-acting insulin analogs to reduce hypoglycemia risk. A Consider educating individuals with type 1 diabetes on matching prandial insulin doses to carbohydrate intake, premeal blood glucose levels, and anticipated physical activity. E Individuals with type 1 diabetes who have been successfully using continuous subcutaneous insulin infusion should have continued access to this therapy after they turn 65 years of age. E Insulin Therapy Insulin is the mainstay of therapy for individuals with type 1 diabetes. Generally, the starting insulin dose is based on weight, with doses ranging from 0.4 to 1.0 units/kg/day of total insulin with higher amounts required during puberty. The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook notes 0.5 units/kg/day as a typical starting dose in patients who are metabolically stable, with higher weight-based dosing required immediately following presentation with ketoacidosis (1), and provides detailed information on intensification of therapy to meet individualized needs. The American Diabetes Association (ADA) position statement “Type 1 Diabetes Management Through the Life Span” additionally provides a thorough overview of type 1 diabetes treatment and associated recommendations (2). Education regarding matching prandial insulin dosing to carbohydrate intake, premeal glucose levels, and anticipated activity should be considered, and selected individuals who have mastered carbohydrate counting should be educated on fat and protein gram estimation (3–5). Although most Continue reading >>

More in ketosis