Diabetes

Diabetes Mellitus

Therapy:

1. Education of patient.
2. Diet (reduce rapidly absorbed carbohydrates, animal and dairy fat; increase polyunsaturated fats and fibre).
3. Exercise and weight reduction program.
4. Type 2 only - Oral hypoglycaemics singly or combined, e.g. sulfonylureas if thin (chlorpropamide, glipizide, tolbutamide, glibenclamide), metformin if obese.
5. Type 2 only - ADD acarbose or rosiglitazone or pioglitazone.
6. Insulin in one to three daily injections of one or more of the different types, e.g. soluble (peak 4h, duration 8h), isophane (peak 10h, duration 24h), protamine zinc* (peak 16h, duration 36h), lente zinc suspension (peak 8h, duration 24h), semilente zinc suspension (peak 4h, duration 12h), biphasic (peak 2h, duration 24h).
7. Clofibrate.

Precautions:

*Protamine zinc insulin cannot be mixed with other insulins.
Only soluble insulin can be given IVI.
Clofibrate increases half-life of tolbutamide and chlorpropamide.

Prognosis:

Good with adequate control

Hypoglycaemia

Therapy:

1. Oral glucose drink or tablets.
2. Glucose 10% 20 mL IVI stat.
3. Glucagon IMI stat.
4. Treat precipitating factor.

Prognosis:

Recovery within minute usual. Brain damage with prolonged hypoglycaemia. 

Hyperinsulinism Therapy: Glucose enriched diet AND/OR diazoxide AND/OR pancreatectomy ADD glucose IVI when acute. Prognosis: Good with adequate therapy. Brain damage may occur in infants before diagnosis.