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Managemnt

Diet

Life style changes

Oral drugs

Insulins

Incretin based therapies

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First line of therapy

Medical nutrition therapy Exercise Weight loss

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Total calories

Carbohydrates 50%

Fat 30%

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Which drug is the preferred initial therapy in type 2 DM?

Metformin If blood sugar is not controlled

Metformin + insulin secretogogues If blood sugar is still not controlled

Reassess Hb A 1c Finally, insulin with or without combination

oral drugs

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Oral glucose-lowering agents

If the target blood sugar level is not achieved after 4 weeks

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Insulin

Most doctors Only if blood sugar control cannot be obtained

with oral hypoglycemic drugs

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Exercise

Lowers plasma glucose during and following exercise

Increase insulin sensitivity in both type 1 and type 2 DM

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Exercise has multiple benefits

Cardiovascular benefits Reduced BP Maintenance of muscle mass Reduction in body fat Weight loss

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Normal HbA1c

< 6%

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HbA1c% with treatment

< 7. 0

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Plasma glucose

10 – 15 % > whole blood

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