Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

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Patient Logs and Worksheets Patient blood glucose daily logs, diabetes health records and healthy goal worksheets are helpful tools that promote better self-management and increase medication adherence by reminding patients to check their blood glucose levels and track daily activities. Many logs and worksheets also contain simple tools and tips to help patients adhere to recommended therapies and promote making lifestyle changes necessary to manage their type 2 diabetes. Such logs and worksheets can help guide health care providers by patient discussions, support adjustments to prescribed therapies and educate patients about type 2 diabetes and the importance of effective selfmanagement. See the Patient Resources section Chapter 6, page 95 of this reference guide for a selection of sample logs, goal worksheets and more. Pharmacotherapy for Diabetes 28,29 The clinical approach to managing diabetes starts with lifestyle/behavior modification, weight loss, physical activity promotion, and dietary control (see page 56). However, most patients with type 2 diabetes will also need oral or insulin medications to help achieve glycemic control. Healthcare providers should take into consideration any individual patient cardiovascular risk factors and the potential impact of side effects including fluid retention and weight gain when prescribing oral and injectable diabetes medications. Of note, diabetes progresses over time, requiring adjustments to the medication regimen. Often using multiple drugs is necessary to achieve adequate glycemic control and reduce the risk of co-morbid cardiovascular disease and complications. In some cases, the use of combination drugs can help to simplify patient drug regimens and hopefully lead to better compliance or fewer copays. The following tables highlight common oral and injectable medications used to treat and manage diabetes. 26 CMA FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011
TAbLe 17 Oral Medications Drug class Generic name brand name(s) Mechanism of action biguanides Metformin Fortamet Glucophage Glucophage XR Glumetza Riomet Inhibits liver glucose production, q muscle glucose uptake Sulfonylureas Glimepiride Amaryl q pancreatic insulin production Glipizide Glipezide ER Glipezide XL Glucotrol Glucotrol XL Glyburide Diabeta Glynase Micronase Glycron Meglitinides Repaglinide Prandin q insulin released from pancreas Thiazolidinediones (TZDs) Alpha-glucosidase inhibitors bile acid sequestrant Nateglinide Starlix Pioglitazone Actos q skeletal muscles Avandia glucose uptake Rosiglitazone** **Restricted use by FDA due to possible increased CV risk (only use if unable to use other options.) Acarbose Precose Inhibits carbohydrate absorption by the small intestine Colesevelam hydocloride Welchol Lipid t polymer that binds bile acids in the intestine, t reabsorption. The exact A1c t action is currently unknown. Potential side effects Cramping, nausea, diarrhea, vomiting, gas, loss of appetite, metallic taste Hypoglycemia, GI upset, weight gain (note: avoid glyburide in elderly and those with renal insufficiency due to increased risk of hypoglycemia in this population.) Hypoglycemia, weight gain, joint pain Hypoglycemia, edema, headache, mild anemia, weight gain, muscle pain, URI, sinusitis Cramping, diarrhea, gas, GI upset/pain, weight loss. Need to treat hypoglycemia with glucose Constipation, nasopharyngitis, dyspepsia, hypoglycemia, nausea, hypertension CMA FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011 27 Comprehensive management of type 2 diabetes
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: Proper Disposal of Syringes and Nee
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 and 18: TABLe 20 Insulin Injectables Drug c
Page 19 and 20: separate prescriptions or in fixed-
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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