Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

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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 <strong>CMA</strong> FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011
separate prescriptions or in fixed-dose combinations. (See figure 1.) The initiation of drug therapy with more than one agent may increase the likelihood of achieving the BP goal in a more timely fashion, but particular caution is advised in those at risk for orthostatic hypotension, such as patients with diabetes, autonomic dysfunction, and some older persons. Use of generic drugs or combination drugs should be considered to reduce prescription costs. FIGuRe 3 Algorithm for Treatment of Hypertension Figure 1. Algorithm for treatment of hypertension Stage 1 Hypertension (SBP 140–159 or DBP 90–99 mmHg) Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Lifestyle Modifications Not at Goal Blood Pressure (
Page 1 and 2: 3 Comprehensive Management of Type
Page 3 and 4: TAbLe 13 Diabetes Care Guidelines/F
Page 5 and 6: TAbLe 15 Recommended blood Glucose
Page 7 and 8: Proper Disposal of Syringes and Nee
Page 9 and 10: TAbLe 17 Oral Medications Drug clas
Page 11 and 12: TABLe 18 Non-Insulin Injectables Dr
Page 13 and 14: Diabetes Coalition of California Ty
Page 15 and 16: CMA FoundAtion . diAbetes And CArdi
Page 17: TABLe 20 Insulin Injectables Drug c
Page 21 and 22: TABLe 22 Oral Blood Pressure Loweri
Page 23 and 24: TABLe 22 Oral Blood Pressure Loweri
Page 25 and 26: Reference Card From the Seventh Rep
Page 27 and 28: Clinical Management of Dyslipidemia
Page 29 and 30: Pharmacotherapy for Dyslipidemia 23
Page 31 and 32: TABLe 24 Lipid combinations Fibric
Page 33 and 34: 4 Step 4 5 Step 5 6 Step 6 If 2+ ri
Page 35 and 36: 8 Step 8 Identify metabolic syndrom
Page 37 and 38: Hard Coronary Heart Disease (10-Yea
Page 39 and 40: Weight Loss/Maintenance Even a mode

Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

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