PH <6.9

Stop at PH 7

Treat hypokalemia first*

• Bolus 0.1 units/kg regular insulin       +                                                           o.1 units/kg/hr continuous infusion. 

OR

• 0.14 units/kg/hr

BG <200

+ 2/3

• Bicarb ≥15
• PH >7.3
• Anion gap ≤12

Recomendation for screaning/prevention

A
B
C
D
E
F
G
I

ASA

BP control

Cholesterol management

Dilated retinal exams/Dental

Excretion of proteins (UA/microalbumin)

Foot care

Glycemic control

Immunizations

Fasting Plasma Glucose

≥126 mg/dl

RPG glucose diagnosis

Random Plasma Glucose

≥200 mg/dl + Symptoms (3 Ps)

Pramlintine

• DM1 dose

Symlin

• Initiate 15 mcg sub Q prior to meals

Glipizide

• Class
• Starting dose
• Max dose

Glucotrol

• Sulfonylurea
• 5mg BID
• 20mg BID

(I;ll bid 5$ for 20 of the glue sticks)

Nateglinide

• Class
• Starting dose
• Max dose

(Starlix)

• Glinide
• 120mg TID
• 120mg TID

 (Starlix, the tadpole poke'mon glides across the water at a constant rate of 120 f/s)

Metformin

• Class
• Starting dose
• Max dose

Glucophage

• Biguanide
• 500mg QD -> 500mg BID
• 2550 divided BID or TID)

(50 ÷ 2 = 25.  "2550")

Pioglitazone

• Class
• Starting dose
• Max dose

Actos

• TZD
• 15mg QD
• 45mg QD

(Don't leave yet! it's only the first act, and youve only been here for 15 minutes, and the actress is such a cutie (QD), at least stay another 45 minutes (15+45 = 1 hour).

Acarbose

• Class
• Starting dose
• Max dose

Precose

• α glucosidase inhibitor
• 25mg QD -> TID
• 100mg TID

Carbs are the precursor to a good breakfast, I buy them from the vending machine for 25 ¢ each, every day, sometimes even three times a day. I pay with 100 ¢)

Exenatide

• Class
• Starting dose
• Max dose

Byetta

• GLP-1 Agonist
• 5mcg BID
• 10mcg BID

(The Guilla Monster's venom is very potent (mcg), if one bit you, you would die)

Sitagliptin

• Class
• Starting dose
• Max dose

Januvia

• DPP-IV inhibitor
• 100mg QD
• 100mg QD

(Janna is such a QT, I could look at her 100 times, and she will never change)

Glyburide

• Generic
• Class

• Micronase
• Sulfonylurea

Glimepride

• Generic
• Class

• Amaryl
• Sulfonylurea

Repaglinide

• Generic
• Class

• Prandin
• Glinide

Liraglutide

• Generic
• Class

• Victoza
• GLP-1 Agonist

Saxagliptin

• Generic
• Class

• Onglyza
• DPP-IV Inhibitor

Linagliptin

• Generic
• Class

• Trajenta
• DPP-IV Inhibitor

Rosiglitazone

• Generic
• Class

• Avandia
• TZD

Miglitol

• Generic
• Class

• Glyset
• α-Glucosidase Inhibitor

• FPG ≥92
• 1 hour ≥180
• 2 hours ≥153

GDMGlycemic goals

• PPG
• 1 hour PP
• 2 hours PP

• ≤95
• ≤140
• ≤120

(Total Daily Dose)

• 0.5 units/kg

• 28 days
• Levemir 42 days

• 28 days
• Levemir 42 days

Insulin timing

• Rapid acting

Insulin timing

• Short acting

Insulin timing

• Intermediate acting

2/3 TDD

• 2/3 AM dose = intermediate (NPH)
• 1/3 AM dose = Short (regular)

1/3 TDD

• 2/3 PM dose = intermediate (NPH)
• 1/3 PM dose = Short (regular)

(1:1 acceptable as well)

Basal dose

(Long Acting)

1/2 TDD

Glargine or Detemir

QD

Bolus dose

• Rapid/Short acting

1/2 TDD

Divided evenly TID

or

20% TDD Breakfast, 15% Lunch, 15% Dinner

• NPH

• Glargine (Lantus)
• Detemir (Levemir)

• Lispro (Humalog)
• Aspart (Novolog)
• Glulisine (Apidra)

Insulin carbohydrate ratio

• 500 ÷ TDD=x
• 1:x = For every Xg of carbs, 1 unit of novolog (bolus) needed to neutralize

Insulin sensitivity function

• 1800 ÷ TDD

Insulin sensitivity function

• 1500 ÷ TDD

A₁C cutoffs

• Normoglycemic
• Prediabetic
• Diabetic

• <5.7%
• 5.7-6.4%
• ≥6.5%

FPC cutoffs

• Normoglycemic
• Prediabetic
• Diabetic

• <100 mg/dl
• 100-125 mg/dl
• ≥126 mg/dl

OGTT (Oral Glucose Taste Test)

• Normoglycemic
• Prediabetic
• Diabetic

• <140 mg/dl
• 140-199 mg/dl
• ≥200 mg/dl

RPG cutoffs

• Normoglycemic
• Prediabetic
• Diabetic

• <140 mg/dl
• <200 mg/dl
• ≥200 mg/dl + symptoms

Biguanide risk factors

• P
• H
• A
• R
• M
• D
• S

• Poor renal function
• Hepatic dysfunction
• Alcohol use
• Radiocontrast dye
• Medically managed CHF
• Dehydration
• Surgery

• Scr ≥1.5 in males
• Scr ≥1.4 in females
• CrCl ≤ 60ml/min

1. Biguanides (Metformin)
2. Sulfonylureas (Glipizide)
3. Glinides (Nateglinide)
4. GLP-1 agonist (Exenatide)
5. DPP-IV inhibitor (Sitagliptin)
6. TZD (Pioglitazone)
7. α glycosidase inhibior (Acarbose)