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Let’s 👏🏻 talk 👏🏻 diabetes👏🏻!⁠

🌟American Diabetes Association (ADA) and the European Society of Cardiology (ESC) released new 2023 guidelines recently and I just had to do a doodle note on it. 🤓⁠

🌟There has been lots of debates regarding whether metformin should still be first-line for all patients with type 2 diabetes. ⁠

🌟 It still is a great first-line option for most patients due to it’s proven efficacy, safety, and low cost. There are also some speculation that it m-a-y have cardiovascular benefits as well considering many patients in the clinical trials were also on metformin. ⁠

💗🫘However, in patients with ASCVD or high ASCVD risks, heart failure, and chronic kidney disease, the ADA/ESC guidelines recommend starting a SGLT-2 inhibitor or GLP-1 agonists with cardiovascular and renal benefits regardless if they have type 2 diabetes. ⁠

🌟 It is still important to look at patient specific factors (cost, comorbidities, side effects) when deciding which agent to start first or to add on. ⁠

👉🏻GLP-1 agonists commonly have GI side effects and carry warnings for rare pancreatitis and gallbladder disease. It can cost patients $1000/month. Most of the agents are injectables and supply is not consistent.⁠

👉🏻SLGT-2 inhibitors are linked to genital yeast infections, and volume depletion. Cost is about $600/month but they do come in oral formulations.⁠

Reference: Diabetes Care. 2023 Jan 1;46 (suppl 1):S140-S157⁠


1️⃣ In Type 1 Diabetes, the pancreas is unable to produce insulin⁠

2️⃣ In type 2 diabetes, the body does not respond normally to insulin, and over time, the pancreas starts to produce less and less insulin⁠
⭐️ What is insulin?⁠
IN-sulin is a hormone that helps glucose get IN-side cells to be used as energy⁠
⭐️ Counseling Tips:⁠
👉🏻 Educate patients on the symptoms of hypoglycemia (fatigue, hunger, increased anxiety dizziness, palpitations)⁠
👉🏻 Inject the exact dose of insulin subcutaneously into the abdomen (preferred), upper arms, thighs, or buttocks⁠
👉🏻 Rotate injection sites every 1-2 weeks⁠
👉🏻 Monitor blood glucose in frequent intervals (2- 4 times a day) as directed by the doctor⁠.

Hypoglycemia, Symptoms of

Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL.⁠

⭐ It is important to note that beta-blockers can mask common signs and symptoms that diabetics use to recognize hypoglycemic episodes (tremors and palpitations).⁠