Use this tool to discover new associated keyword & suggestions for the search term Hypoglycemia Algorithm.
These are some of the images that we found for within the public domain for your "Hypoglycemia Algorithm" keyword. If glycemic targets are not achieved within 2 to 3 months of lifestyle management, antihyperglycemic pharmacotherapy should be initiated. Unless contraindicated, metformin should be the initial agent of choice, with additional antihyperglycemic agents selected on the basis of clinically relevant issues, such as contraindication to drug, glucose lowering effectiveness, risk of hypoglycemia and effect on body weight. Better description of the parameters to consider when selecting antihyperglycemic agent(s) for a particular individual. New algorithm for the management of hyperglycemia in type 2 diabetes, as well as an updated table of antihyperglycemic agents for type 2 diabetes. New appendix of cost for pharmacological agents (for type 1 and type 2 diabetes) has been added.
1.In people with type 2 diabetes, if glycemic targets are not achieved using lifestyle management within 2 to 3 months, antihyperglycemic agent therapy should be initiated [Grade A, Level 1A (1)]. 5.When basal insulin is added to antihyperglycemic agents, long-acting analogues (detemir or glargine) may be used instead of intermediate-acting NPH to reduce the risk of nocturnal and symptomatic hypoglycemia [Grade A, Level 1A (4-6)]. 6.When bolus insulin is added to antihyperglycemic agents, rapid-acting analogues may be used instead of regular insulin to improve glycemic control [Grade B, Level 2 (7)] and to reduce the risk of hypoglycemia [Grade D, Consensus)]. 7.All individuals with type 2 diabetes currently using or starting therapy with insulin or insulin secretagogues should be counseled about the prevention, recognition and treatment of drug-induced hypoglycemia [Grade D, Consensus]. This article exemplifies the AAFP 1999 Annual Clinical Focus on management and prevention of the complications of diabetes.
Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration.
Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis. The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis. Adult respiratory distress syndrome complicating severely uncontrolled diabetes mellitus: report of nine cases and a review of the literature. Pediatric diabetic ketoacidosis: pathophysiology and potential for outpatient management of selected children. Treatment of diabetic ketoacidosis by internists and family physicians: a comparative study. Metformin may be used at the time of diagnosis, in conjunction with lifestyle management (Grade D, Consensus).


Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis.
A long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus (Review). Long-acting insulin analogues versus NPH human insulin in type 2 diabetes: a meta-analysis. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Even in comatose patients, information documenting a history of diabetes or insulin therapy may be available.
Patients should not discontinue insulin therapy when they are ill, and they should contact their physician early in the course of illness. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. As noted previously, however, overly rapid rehydration or overcorrection of hyperglycemia appears to increase the risk of cerebral edema. Indications for hospitalization include greater than 5 percent loss of body weight, respiration rate of greater than 35 per minute, intractable elevation of blood glucose concentrations, change in mental status, uncontrolled fever and unresolved nausea and vomiting. Insulin therapy of diabetic ketoacidosis: physiologic versus pharmacologic doses of insulin and their routes of administration. When is bicarbonate appropriate in treating metabolic acidosis including diabetic ketoacidosis? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors.
Blood glucose levels are monitored every four hours, and regular insulin is given subcutaneously every four hours using a sliding scale (Figure 2).
Onset of headache or mental status changes during therapy should lead to consideration of this complication. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy.
Intravenous mannitol in a dosage of 1 to 2 g per kg given over 15 minutes is the mainstay of therapy. Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults.


Either of these treatments should be continued until the blood glucose level falls by 50 to 70 mg per dL. Patients with an increased alveolar to arterial oxygen gradient (AaO2) and patients with pulmonary rales on physical examination may be at increased risk for ARDS. Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases, 1985; NIH publication no. Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes. Low-dose insulin therapy typically produces a linear fall in the glucose concentration of 50 to 70 mg per dL per hour.12More rapid correction of hyperglycemia should be avoided because it may increase the risk of cerebral edema.
Monitoring of oxygen saturation with pulse oximetry may assist in the management of such patients.Hyperchloremic metabolic acidosis with a normal anion gap typically persists after the resolution of ketonemia. Preventive measures include patient education and instructions for the patient to contact the physician early during an illness. This dreaded treatment complication occurs in approximately 1 percent of children with diabetic ketoacidosis.5 The typical presentation is onset of headache and decreased mental status occurring several hours after the start of treatment. At this time, potassium chloride is added to intravenous fluids in the amount of 20 to 40 mEq per L. The exact amount of potassium that is administered depends on the serum potassium concentration. Urinary losses then lead to progressive dehydration and volume depletion, which causes diminished urine flow and greater retention of glucose in plasma. Dehydration can be estimated by clinical examination and by calculating total serum osmolality and the corrected serum sodium concentration.
These presentations can distract the physician from the underlying diagnosis of diabetic ketoacidosis.The laboratory tests needed to confirm the presence of diabetic ketoacidosis and to screen for precipitating events are summarized in Table 14 and Figure 2.
Therefore, the use of bicarbonate in a patient with a pH greater than 7.0 is not recommended.
If bicarbonate is used, it should be given as a nearly isotonic solution, which can be approximated by the addition of one ampule of sodium bicarbonate in 300 mL of sterile water. The bicarbonate solution is administered over a one-hour period.1,2,8A small percentage of patients who have diabetic ketoacidosis present with metabolic acidosis and a normal anion gap.
During insulin therapy, phosphate reenters the intracellular compartment, leading to mild to moderate reductions in the serum phosphate concentration.
One protocol is to administer two thirds of the potassium as potassium chloride and one third as potassium phosphate.



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Comments

  1. 15.11.2015 at 22:37:43


    Eaten for a while and blood glucose eat the whole meal, eats later.

    Author: X5_Oglan
  2. 15.11.2015 at 12:34:37


    Helped diabetic patients control their that can also help control.

    Author: plotnik
  3. 15.11.2015 at 20:53:31


    Used to diagnose diabetes, but a 6 hour test might within acceptable.

    Author: Leonardo_DiCaprio