Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

Hypoglycemia
There are many drugs including oral diabetes medication and insulin that can decrease blood
sugar levels, resulting in increased risk for hypoglycemic events. The risk of experiencing drug
interactions and negative side effects relative to the expected benefits should be discussed with the
patient when deciding medication regimens to treat and control diabetes.
In particular, beta blockers are known to have adverse interactions with insulin by masking the signs
and symptoms of hypoglycemia. In some cases beta blockers can also increase overall chances of
developing high blood sugar.
Clinical Management of Hypertension 23
The National Heart Lung and Blood Institute (NHLBI), JNC-7 guidelines recommend that
patients with hypertension receive interventional therapies that include a combination of lifestyle
modifications (see Chapter 5, page 79) and pharmacologic therapies to reach target blood pressure
values and decrease long term cardiovascular risk. JNC-7 emphasizes that adoption of healthy
lifestyles by individuals with high blood pressure is critical to preventing and lowering blood
pressure and overall body weight. See JNC-7 Reference Cards, pages 43-44.
Target Blood Pressures and Self Measurement
By treating hypertension to reach target blood pressure values, the risk of developing
cardiovascular complications and mortality is greatly reduced. The NHLBI recommends the
following target blood pressures for individuals with and without related complications:
Table 21: Target Blood Pressure
TAbLe 21 Target blood Pressure
With hypertension, no additional compelling
conditions
For patients with diabetes or chronic kidney
disease
Optimal (Normal)
Less Than 140/90 mm Hg
Less Than 130/80 mm Hg
Less Than 120/80 mm Hg
Patients with high blood pressure should be advised to self monitor at home and work, as a
practical approach to understanding and managing this chronic disease. Self measurements are
also useful in assessing the difference between home and in medical office values commonly
associated with white coat hypertension, also referred to as white coat syndrome. Monitoring
through self measurement will help patients reach target blood pressure values by offering further
insight into the effect of medically supervised management strategies on blood pressure control.
Hypertension Treatment Algorithm, Initial Drug Choices
In addition to lifestyle modifications highlighted in the JNC-7 guidelines, initial hypertensive
therapies may require the use of medications to reach goal. Most patients frequently require a
combination of medications from different antihypertensive drug classes when a single medication
fails to achieve adequate control of blood pressures.
36 CMA FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011