U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Saturday, December 20, 2014

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives


Quick Guide Cards

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Diabetes Treatment

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NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

Treatment Algorithm for Type 2 Diabetes

If any of the following occur skip Steps 1 through 3 and go directly to Step 4: FPG >250, glucose >300, A1C >10%, active liver disease, ETOH abuse, ketonuria, or weight loss. If acidotic, patient should be hospitalized.

Step 1: Start with metformin and lifestyle interventions.
Step 2: If target levels are not reached with Step 1, add a sulfonylurea.
Step 3: If target levels are not reached with Step 2, add either basal insulin or a thiazolidinedione (TZD). To start basal insulin, consider 10 units of NPH at bedtime or 10 units of a long-acting insulin.
Step 4: If targets are not reached with Step 3, start/intensify insulin therapy.

Immunizations

Pneumococcal vaccine – at diabetes dx; revaccinate once after age 65 if more than 5 years since the first shot
Td /Tdap – per protocol or routine
PPD – once after diagnosis of diabetes; a positive reaction in patient with diabetes is ≥10 mm

Don't forget the following:

Glucose toxicity – insulin production is decreased with prolonged hyperglycemia; treating with insulin short-term helps reverse this condition.

Pancreatic exhaustion – almost all individuals with type 2 diabetes will eventually require insulin.

References:

ADA. Standards of Medical Care in Diabetes – 2014. Exit Disclaimer: You Are Leaving www.ihs.gov Diabetes Care 2014; 37(Sup 1): S1–80.

Inzucchi SE. et. al. 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). Exit Disclaimer: You Are Leaving www.ihs.gov Diabetes Care 2012; 35:1364-1379.

 

Overview How To Other Resources

Division of Diabetes Treatment and Prevention | Phone: (505) 248-4182 | Fax: (505) 248-4188 | diabetesprogram@ihs.gov