ABC of Diabetes, Sixth Edition by Tim Holt, Sudhesh Kumar

By Tim Holt, Sudhesh Kumar

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Administration of bicarbonate is rarely indicated and must only be considered after taking specialist advice. 1 Protocol for the hospital management of diabetic ketoacidosis used at the University Hospital, Coventry. Emergencies and Management in Hospitals The acidosis usually corrects itself with fluid replacement and insulin. 9) to buy time. 26% bicarbonate should be given in 500 ml. Insulin infusion should be continued until the patient is ready to eat. At this point the patient should be given subcutaneous insulin and after the meal, IV insulin is discontinued.

Other drug therapies Other treatment options include the metiglinides (repaglinide or nateglinide), which are taken before a meal to promote insulin secretion and reduce post-prandial hyperglycaemia. Repaglinide is not recommended for use in patients over 75 years old. The alpha-glucosidase inhibitor acarbose acts by delaying carbohydrate absorption and can be taken with other agents but is not well tolerated due to its gastrointestinal effects. 1 Major classes of hypo-glycaemic agents and their current role in therapy.

Patients starting insulin can continue their oral medication, but an intensive insulin therapy regimen may be simpler if the sulphonylurea is withdrawn, as the insulin is providing a similar effect exogenously. Patients starting insulin who continue a glitazone are at higher risk of fluid retention and this may precipitate heart failure in susceptible individuals. However, the combination may be beneficial as insulin sensitivity is increased. Glitazones take 8–12 weeks to be effective, and may be added in to improve control in a patient already taking insulin.

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