Aace medical guidelines for the management of diabetes mellitus,type 2 diabetes food list pdf zetten,nvidia gl driver error 13,supplements to help with type 2 diabetes - Review


Today only, save on used books and help us reach 15,000 books sold to double the donations. Every patient with documented type 2 diabetes mellitus (T2DM) should have a comprehensive care plan (CCP), which takes into account the patient’s unique medical history, behaviors and risk factors, ethnocultural background, and environment. The multidisciplinary team typically oversees the medical management of T2DM, including the prescription of antihyperglycemic therapy and the delivery of diabetes self-management education (DSME). Either the physician or a registered dietitian (RD) should discuss healthful eating recommendations in plain language at diagnosis of T2DM and then periodically during follow-up office visits (Table 1). MNT involves a more detailed discussion of calories, grams, and other metrics, as well as intensive implementation of dietary recommendations aimed at optimizing glycemic control and reducing the risk for complications. Patients should be advised that any physical activity is better than none, and that they should make every effort to increase their activity level. An exercise prescription should be developed for each patient according to both goals and limitations.
Antidiabetic treatment should be promptly intensified to maintain blood glucose at individual targets. Selection of agents should be based on individual patient medical history, behaviors, and risk factors, ethnocultural background, and environment. Self-monitoring of blood glucose (SMBG) is a vital tool for day-to-day management of blood sugar in all patients using insulin and many patients not using insulin. Most patients with an initial A1C level greater than 7.5% will require combination therapy using agents with complementary mechanisms of action.
Antihyperglycemic agents may be broadly categorized by whether they predominantly target FPG or PPG levels (see Table 3). The choice of whether to target FPG or PPG should be based primarily on the individual patient’s glycemic profile obtained by self-monitoring of blood glucose (SMBG).
Intensification of pharmacotherapy requires glucose monitoring and medication adjustment at appropriate intervals when treatment goals are not achieved or maintained. Long-acting basal insulin is generally the initial insulin choice, and the insulin analogues glargine and detemir are strongly preferred over human NPH insulin because they have relatively peakless time-action curves and a more consistent effect from day to day, resulting in a lower risk of hypoglycemia. Basal insulin is usually added to existing noninsulin therapy, and many antihyperglycemic agents are approved for use with insulin: DPP-4 inhibitors, glinides, GLP-1 receptor agonists (but not exenatide XR), metformin, pramlintide, sulfonylureas, and TZDs. The risk of hypoglycemia is increased when combining insulin with sulfonylureas, glinides, DPP-4 inhibitors, and GLP-1 receptor analogues.
GLP-1 receptor analogues and DPP-4 inhibitors have not been studied with prandial insulin. Using insulin with TZDs may increase the risk of weight gain, edema, and congestive heart failure.
Rapid-acting insulin analogues are preferred over regular human insulin because they have a more rapid onset and offset of action and are associated with less hypoglycemia. Premixed insulin analogue therapy may be considered for patients in whom drug regimen adherence is an issue; however, these preparations lack component dosage flexibility and may increase the risk for hypoglycemia compared with basal insulin or basal-bolus insulin.
This approach (ie, transitioning to insulin after noninsulin agents fail to maintain glycemic targets) is supported by the recently published results of the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial. Several new classes of agents are under investigation for the treatment of T2DM, and some new agents within existing classes may represent improvements over currently available options.17 The listing in Table 4 should be considered representative and not necessarily all-inclusive. For complete descriptions of the devices and accompanying technology themselves, click on the links above.
CSII is recommended mainly for patients with type 1 diabetes mellitus (T1DM), but patients with advanced T2DM who are absolutely insulin-deficient, take 4 or more insulin injections a day, and assess their blood glucose levels 4 or more times daily are candidates for CSII.
Safety—particularly the risk of hypoglycemia—should be the primary concern when choosing an antidiabetic therapy.
Table 3 lists the major safety risks associated with currently available antidiabetic agents.
Severe hypoglycemia stimulates sympathetic adrenergic discharge, causing arrhythmias or autonomic dysfunction (or both) and has long been recognized to have potential for causing mortality. In addition to increased mortality, hypoglycemia negatively affects adherence to therapy and quality of life and also contributes to morbidity.
Management of hypoglycemia involves appropriate choice of antihyperglycemic therapy, tailoring of insulin treatment to minimize risks, and patient education in the recognition and treatment of acute hypoglycemia (Table 5).40 It is important to remember that the features listed in Table 5 occur along a continuum, and glycemic thresholds and symptom manifestations may vary widely among individuals. For T2DM patients, most of whom are overweight or obese, the risk of additional weight gain must be balanced against the benefits of the agent itself. Once T1DM and monogenic diabetes have been ruled out and a T2DM diagnosis has been definitively established for a child or adolescent, diet and lifestyle modification are always the first treatment choices.
Children born to women with any form of diabetes are at greater risk of developing T2DM themselves. Older adults are more likely to have an increased number of comorbid conditions (eg, frailty, dementia, depression, urinary incontinence) that can complicate their diabetes management.


Fasting is a common religious practice that can pose a challenge to diabetes management, particularly if the fast occurs over an extended time, such as Ramadan, a holy month of Islam in which all healthy adults consume no food or fluids between sunrise and sunset.
The risk of these outcomes depends on the severity and complications of T2DM according to the categories in Table 7.
For the management of glycemia during extended fasts, general principles and recommendations are listed below.
DIABETES MELLITUS Dr Marino Fernandez Dr Eduardo Bonnin Erales Dra Pamela Vazquez RIMI MIP Mirelle Kramis Hollands. Introduccion La Diabetes Mellitus es una epidemia nivel mundial que a creado una crisis para el sector salud y para la sociedad.
Periodo postabsortivo: 50% cerebro, insulino-independiente 25% higado y al tejido gastrointestinal, insulino- independiente 25% musculo y tejido adiposo, insulino dependientes. Despues de la ingesta de glucosa: Se estimula la liberacion del insulina Hiperinsulinemia + hiperglucemia Absorba perifericamente la glucosa por el musculo (80-85%) y adipocitos. INSULINA Es sintetizada en las celulas ? del pancreas Es codificada en el cromosoma 11 Su estimulo tanto para su sintesis como secrecion es gracias a la glucosa Su marcador para la secrecion es el peptido C (urinario) ya que el 60% de la insulina se va al higado Boron W F, Boulpaep E. La insulina plasmatica responde a la ingesta oral de glucosa el doble que a la glucosa intravenosa Esto se relaciona con: GLP-1 (peptido relacionado al glucagon tipo I) y GIP (polipeptido insulinotropico dependiente de glucosa) de las celulas del intestino = INCRETINAS Tienden a aumentar la secrecion de insulina postprandial. GLUCAGON GLUCAGON: La mitad de la produccion de la glucosa hepatica depende de niveles basales normales de glucagon.
Definicion Segun la OMS: es un desorden metabolico de multiples etiologias caracterizado por hiperglucemia cronica, con alteraciones en el metabolismo de carbohidratos, lipidos y proteinas, resultado de un defecto en la secrecion de la insulina, en su accion o ambas. Adultos entre 65-74 anos tienen la mayor prevalencia de desarrollar DM tipo 2, 12 veces mas que en menores de 45 anos. Diabetes Mellitus Tipo 1 Es una condicion en donde la destruccion de las celulas ? pancreaticas nos llevan a una deficiencia absoluta de insulina. La larga etapa prodromica que precede el inicio de DM I, nos hace pensar en una potencial prediccion de la enfermedad y en metodos para su prevencion.
QUE ES LO QUE SUCEDE EN DM I La insulina circulante esta ausente, el glucagon en plasma esta elevado, y las celulas ? del pancreas no responden a los estimulos insulogenicos. Etapa de luna de miel Toma lugar despues del diagnostico clinico y el inicio de la terapia con insulina. Diabetes Mellitus Tipo 2 90-95 % de los casos de DM Causado por una combinacion de desordenes metabolicos complejos que resultan de defectos coexistentes en multiples organos. Herencia: El estilo de vida y la sobrealimentacion son los factores patogenicos principales. This practical quick-reference tool contains oral and insulin drug therapy and dosing information. The ultimate goal of the CCP is to reduce the risk of diabetes complications without jeopardizing patient safety.
DSME is used to educate the patient on the components of therapeutic lifestyle changes, namely medical nutritional therapy (MNT) and physical activity.
These recommendations are suitable for the general population, including people without diabetes, and focus on foods that can promote health vs foods that may promote disease or complications from disease.
Recommendations should be personalized, and in general, evaluation and teaching should be conducted by an RD or knowledgeable physician. Overweight individuals with type 2 diabetes should strive for a 5% to 10% reduction in weight and should avoid weight gain.
Unstructured activities include walking up or down stairs instead of using elevators, using parking spaces farther from building entrances, and the like.
Degludec, a new ultra-long–acting basal insulin, is currently undergoing review by the U.S.
This 6-year study, which included over 12,000 patients, compared the use of insulin glargine with standard care in patients with cardiovascular risk factors plus either prediabetes or recent-onset T2DM (mean T2DM duration at baseline: 5 years). These patients must also be motivated to achieve tighter plasma glucose control and be intellectually and physically able to undergo the rigors of insulin pump therapy initiation and maintenance. While individual agents may have contraindications or carry increased risks for specific populations, in general, hypoglycemia and weight gain are the primary limiting factors in diabetes treatment. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan.
Effects of aerobic and resistance training on hemoglobin A1C levels in patients with type 2 diabetes: a randomized controlled trial. Exercise training improves glycemic control in long-standing insulin-treated type 2 diabetic patients.
Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients. Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes.


Lower baseline glycemia reduces apparent oral agent glucose-lowering efficacy: a meta-regression analysis. Ultra-long-acting insulin degludec has a flat and stable glucose-lowering effect in type 2 diabetes.
Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. A new-generation ultra-long-acting basal insulin with a bolus boost compared with insulin glargine in insulin-naive people with type 2 diabetes: a randomized, controlled trial. Renal sodium-glucose transport: role in diabetes mellitus and potential clinical implications. The effects of salsalate on glycemic control in patients with type 2 diabetes: a randomized trial. Statement by the American Association of Clinical Endocrinologists Consensus Panel on insulin pump management. Statement by the American Association of Clinical Endocrinologists Consensus Panel on continuous glucose monitoring.
Benefits of self-monitoring blood glucose in the management of new-onset type 2 diabetes mellitus: the St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. ROSES: role of self-monitoring of blood glucose and intensive education in patients with Type 2 diabetes not receiving insulin. Restoration of normal glucose tolerance in severely obese patients after bilio-pancreatic diversion: role of insulin sensitivity and beta cell function.
The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study.
Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Despues de una comida la hiperinsulinemia inhibe la concentracion de glucagon y mantienen la glucosa postprandial en niveles normales.
El riesgo de muerte en pacientes con DM es casi el doble que en pacientes sanos de la misma edad.
Por su asociacion con incidencia de la diabetes y con riesgo de desarrollo de enfermedad cardiovascular.
Aumenta el riesgo si hay familiares con diabetes, 6% si el papa esta afectado y 3% si la mama esta afectada. Gracias a la deteccion de autoanticuerpos en familiares de pacientes con DM I 90% Tambien sirven como predictores en poblaciones. Los tres tejidos blanco para la accion de la insulina fallan en la absorcion de nutrientes pero continuan liberando glucosa, amino acidos, y acidos grasos hacia la circulacion.
Declinacion progresiva en la secrecion pancreatica de insulina y produccion hepatica libre de glucosa. Historia familiar incrementa 2.4 el riesgo, 15-25% de familiares de primer grado desarrollan intolerancia a la glucosa o diabetes. Recommendations should be personalized on the basis of a patient’s specific medical conditions, lifestyle, and behavior. To date, metformin remains the only oral medication approved by the FDA for use in children with T2DM. En pacientes diagnosticados antes de los 40 anos la disminucion en la expectativa de vida es 12 anos para hombres y 19 anos para las mujeres. El riesgo segun a la edad de 80 anos es de 38% si se tiene un familiar con DM II Si los dos papas estas afectados: el riesgo es de 60% a los 60 anos. The FLASHcard is endorsed by the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE). Patients unable to maintain a healthy weight on their own should be referred to an RD or weight-loss program that has a proven success rate.
Insulin use in the prediabetic patients did reduce the incidence of T2DM (see detailed discussion in Prediabetes), but there was no difference in cardiovascular outcomes between treatment groups after 6 years. Median FPG and A1C levels were lower in the glargine group, but the incidence of hypoglycemia and weight gain were modestly increased.



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Comments

  1. ALOV

    Not consume any white foods.

    01.04.2014

  2. ZaraZa

    Your goal weight already, including too many and.

    01.04.2014