Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

474 Diabetes Mellitus, Type 1

■Established disease: assess degree of control, presence of complica-

tions/associated conditions

General Measures

■Self-monitoring of glucose

■Attention to meal planning (diet)

■Regular exercise

■Continuing education

Treatment Goals.....................................

■Glucose:

➣Preprandial: 80–120 mg/dL

➣Bedtime: 100–140 mg/dL

➣HgbA1c: <7%

➣Individualized based on ability to understand/carry out treat-

ment regimen, risk of hypoglycemia, advanced age, renal disease,

CVD

➣BP: <130/80

➣Lipids: LDL cholesterol <100 mg/dL

specific therapy

■Diabetic ketoacidosis:

➣Hydration with normal saline or half-normal saline (3–5 L deficit

in adults)

➣IV regular insulin

➣Start replacement if serum potassium normal or low; if serum

potassium high, delay replacement until serum potassium nor-

mal

➣Consider 1–2 amps bicarbonate in half normal saline if pH <7.0–

7.1

■Established disease:

➣Insulin, 3 or more injections/day or insulin pump

■Side Effects & Contraindications

■Insulin:

➣Side effects: hypoglycemia, lipohypertrophy, lipoatrophy, insulin

allergy, insulin antibodies

➣Contraindications: none

follow-up

■See well-controlled, stable patients q 3 mo

■See poorly controlled patients more frequently, PRN

■Review records of home glucose monitoring (HGM), adherence,

symptoms of hyper/hypoglycemia, chronic complications, other ill-

nesses, medications, lifestyle changes, psychosocial issues