Intensive management of diabetes mellitus depends on cooperative, well-motivated patients. For type I diabetes, several schedules of multiple daily insulin injections are available; consider an insulin pump if it is affordable and suits a patient's lifestyle. Teach patients how to adjust insulin doses according to glycemic changes. Make sure that they (and persons close to them) recognize early signs of hypoglycemic and know how to inject glucagon if necessary. For patients with type II diabetes, weight reduction remains a prime target. Appetite suppressants may prove useful but are untested in diabetes. Consider recommending gastric reduction surgery for the morbidly obese. Metformin, alone or added to a sulfonylurea, can decrease hemoglobin A1c by nearly 2%. Acarbose, alone or in combination with another oral hypoglycemic, also reduces hemoglobin A1c, but less so than metformin. If these agents fail, add bedtime NPH insulin. If all else fails, institute 2 daily injections of insulin.
|Original language||English (US)|
|Number of pages||10|
|State||Published - Nov 1 1996|