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    Diabetes for Primary Care: A Step By Step Approach
    Diabetes for Primary Care: A Step By Step Approach
    Diabetes for Primary Care: A Step By Step Approach
    Ebook125 pages53 minutes

    Diabetes for Primary Care: A Step By Step Approach

    By Nachida Hamidi-Sitouah, MD

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    About this ebook

    As a primary care provider, you might find it challenging to care for patients with diabetes. Diabetes for Primary Care: A Step-by-Step Approach, describes how experts manage diabetes with a simplified approach that focuses on the practical aspects.
    This book presents the author’s knowledge and expertise acquired after a full year of a diabetes fellowship, and it is inspired by the author’s own experiences managing diabetes before and after the fellowship, containing the discoveries that allowed her to improve diabetes control.
    Diabetes for Primary Care: A Step-by-Step Approach, highlights the most common mistakes made by primary care providers and the potential causes of treatment failure in diabetes. And finally, it provides you with a template for a patient’s pre-visit checklist that will hold all necessary information during office visits. This will not only help guide you in your decision making process but will also save a tremendous amount of your valuable time.
    LanguageEnglish
    PublisherLulu Publishing Services
    Release dateNov 20, 2014
    ISBN9781483419060
    Diabetes for Primary Care: A Step By Step Approach

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      Book preview

      Diabetes for Primary Care - Nachida Hamidi-Sitouah, MD

      NACHIDA HAMIDI-SITOUAH, MD

      DIABETES for

      PRIMARY

      CARE

      A Step-by-Step Approach

      Copyright © 2014 Nachida Sitouah.

      All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

      ISBN: 978-1-4834-1905-3 (sc)

      ISBN: 978-1-4834-1906-0 (e)

      Permission for text used in this book granted by AMERICAN DIABETES ASSOCIATION

      Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

      Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

      Certain stock imagery © Thinkstock.

      Lulu Publishing Services rev. date: 10/27/2014

      Contents

      Acknowledgments

      Introduction

      Part 1    Overview of Most Commonly Used Antidiabetic Agents

      1.    Metformin

      2.    Sulfonylureas

      3.    The Meglitinides

      4.    Thiazolidinediones (TZDs)

      5.    Drugs Focused on the Incretin System: GLP-1 Receptor Agonists and DPP4 Inhibitors

      GLP-1 Receptor Agonists

      DPP4 Inhibitors

      6. Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors

      7. Insulins

      A. Insulin Types

      -   Pharmacokinetics of SQ insulin in patients with normal kidney function

      -   Premixed insulin

      -   Glargine (Lantus) versus Detemir (Levemir)

      -   Rapid- versus short-acting insulin (Novolog, Humalog, or Apidra vs. Regular insulin)

      -   U-500 regular insulin (500 units/ml)

      B. Insulin Regimens

      -   Conventional therapy using premixed insulin

      (70/30, 75/25, 50/50 insulin)

      -   Modified fixed-dose insulin regimen

      -   Flexible regimen/intensive insulin therapy (basal-bolus regimen)

      Part 2    Implementation Strategies of Antihyperglycemic Therapy

      Part 3    Practical Approach (Office Visit)

      1. Diabetes Pre-Visit Checklist

      2. Topics to Discuss

      Diet

      Metformin

      Blood-Sugar Monitoring

      Targets

      Noncompliance

      Ruling out Inadequate Insulin Use

      Injection Techniques

      Insulin Storage

      3. Calculating the Insulin Total Daily Dose (TDD)

      4. A1c and Blood-Sugar Log Review with Insulin Adjustment

      Hypoglycemia

      Hypoglycemia Definition

      Hypoglycemia causes

      –Lows Due to Excessive Prandial Insulin Dose

      –Lows Due to Inappropriate Insulin Use

      –Lows Due to Increase in Physical Activity

      Hypoglycemia Treatment

      Hyperglycemia

      Fasting Hyperglycemia

      –Elevated Fasting BGs with Elevated Bedtime BGs

      –Elevated Fasting BGs with Normal Bedtime BGs

      Non-Fasting Hyperglycemia (Preprandial and/or Bedtime Hyperglycemia)

      5.    Supplemental (Correctional) Insulin

      6.    Insulin Dose Adjustment at Home

      7.    Potential Causes of Treatment Failure in Diabetes

      Part 4    Most Common Errors Made by Health-Care Providers When Managing Diabetes

      Part 5    Special Situations

      1.    Extreme Insulin Resistance

      2.    Insulin Pump Therapy

      3.    Gastroparesis

      4.    Obstructive Sleep Apnea

      5.    Double Diabetes

      6.    Pancreoprivic Diabetes

      7.    LADA

      Part 6    Case Studies

      Case 1

      Case 2

      Case 3

      Case 4

      Case 5

      Case 6

      Case 7

      Case 8

      Case 9

      Case 10

      Case 11

      References

      Diabetes Pre-visit Check List

      Acknowledgments

      This book couldn’t have been completed without the help of some very important and special people, including:

      Fiona Cook, MD, Clinical Associate Professor, who deserves special recognition because of her great contribution in finalizing this book (editing, positive criticism, and ideas).

      Robert Tanenberg, MD, Professor of Medicine, Director of Diabetes Fellowship, for being my mentor and principal teacher during my fellowship.

      My family, for all their support during this process.

      Introduction

      I worked for three years as a primary care physician in a community clinic. Throughout my time there, diabetes quickly became the most prevalent disease in my caseload. I was faced with the daily challenge of managing patients with uncontrolled diabetes. The length of routine follow-up visits (fifteen minutes) and the need to address other problems as well made it even more challenging. The emergence of numerous antidiabetic drugs like DPP4 inhibitors and GLP-1 receptor agonists and the complexity of some of my patients held an interest for me in pursuing a diabetes fellowship. I had no experience with the aforementioned drugs and did not feel comfortable prescribing them. Patients with brittle diabetes presented with significantly variable blood-sugar levels due to a strong sensitivity to food and insulin. Finding the right insulin dose for them seemed nearly impossible, so I had to refer them to a subspecialist. I also had many patients who were

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