Diabetes mellitus type 2

Definition

A disease of glucose processing caused by a combination of insulin resistance and decreased insulin production that is characterized by elevated serum glucose, decreased glucose tolerance, and elevated glycosylated products, and that greatly increases the risk of cardiovascular disease

If asymptomatic, need to repeat the same test on a different day, and also needs another of below; if symptomatic, only need one criteria
Fasting plasma glucose ≥7.0 (normal ≤6.0)
Hemoglobin A1c ≥6.5% (normal <6%)
Random plasma glucose ≥11.1
2h 75g oral glucose tolerance test ≥11.1 (normal ≤7.7)

ABCDEs: A1c, BP, Cholesterol, Drugs (ACEi/Statin/ASA), Exercise/Eating, Stop smoking
Smoking cessation
Targets
- Hemoglobin A1c ≤7% for most people, ≤6.5% for some, and ≤8.5% for elderly or significant comorbidities that complicate management
- BP ≤130/80
- LDL-C ≤2.0
Monitoring
- A1c
- Urine microalbumin
- Lipid panel
- Eye exam
Driving if on a hypoglycemic agent
- CBG ≥5 before driving (snack or dex tabs if lower, then recheck)
Exercise 150 minutes per week of moderate exercise
Statins
- ≥40 yrs, or age >30 yrs with diabetes >15 years
- Macro or microvascular disease
ACEi/ARBs
- ≥55 years
- Micro or macrovascular disease
- Agents:
  - perindopril 8mg (EUROPA)
  - ramipril 10mg (HOPE)
  - telmisartan 80mg daily (ONTARGET)
ASA: insufficient evidence
CKD: ACR≥2.0 or eGFR < 60
Retinopathy: screen probably q2y if no or mild retinopathy, and q6mo. in severe
Neuropathy: screen with monofilament or tuning fork
Treat pain with
- Anticonsulsants gabapentin, valproate
- Antidepressents: amitriptyline, duloxetine, venlafaxin
- Opioids
Sick day management (what to do if unable to eat and drink)
- Counsel patient on which medications to hold