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diabetes

Diabetes

Let’s ๐Ÿ‘๐Ÿป talk ๐Ÿ‘๐Ÿป diabetes๐Ÿ‘๐Ÿป!โ 
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๐ŸŒŸAmerican 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. ๐Ÿค“โ 
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๐ŸŒŸThere has been lots of debates regarding whether metformin should still be first-line for all patients with type 2 diabetes. โ 
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๐ŸŒŸ 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. โ 
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๐Ÿ’—๐Ÿซ˜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. โ 
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๐ŸŒŸ 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. โ 
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๐Ÿ‘‰๐ŸปGLP-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.โ 
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๐Ÿ‘‰๐ŸปSLGT-2 inhibitors are linked to genital yeast infections, and volume depletion. Cost is about $600/month but they do come in oral formulations.โ 
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Reference: Diabetes Care. 2023 Jan 1;46 (suppl 1):S140-S157โ 

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Insulin

1๏ธโƒฃ In Type 1 Diabetes, the pancreas is unable to produce insulinโ 

2๏ธโƒฃ In type 2 diabetes, the body does not respond normally to insulin, and over time, the pancreas starts to produce less and less insulinโ 
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โญ๏ธ What is insulin?โ 
IN-sulin is a hormone that helps glucose get IN-side cells to be used as energyโ 
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โญ๏ธ Counseling Tips:โ 
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๐Ÿ‘‰๐Ÿป Educate patients on the symptoms of hypoglycemia (fatigue, hunger, increased anxiety dizziness, palpitations)โ 
๐Ÿ‘‰๐Ÿป Inject the exact dose of insulin subcutaneously into the abdomen (preferred), upper arms, thighs, or buttocksโ 
๐Ÿ‘‰๐Ÿป Rotate injection sites every 1-2 weeksโ 
๐Ÿ‘‰๐Ÿป Monitor blood glucose in frequent intervals (2- 4 times a day) as directed by the doctorโ .

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