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afya
Type2NICE2009Mx
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''Diet'' high fibre, low glycaemic index CHO low-fat dairy, oily fish - good limit saturated fats and trans fatty acids limit sucrose substitute (avoid xs energy intake) discourage specific diabetic foods weight loss - initial target if overweight 5-10% ''HbA1c'' overall target 48 (6.5%) (not less) but needs to be individualised check 2-6/12ly till stable, then 6/12thly ''BP'' target < 140/80 (or < 130/80 if end-organ damage present) ACE inhibitors first-line treatment algorithm - complex ... lifestyle first 1st line - metformin (?start on diagnosis) then sulfonylurea if HbA1c still > 48 avoid sulphonylurea and consider other if .... worries over hypo risk - DPP-4 inhibitor or thiazolidinedione erratic lifestyle - meglitinides (insulin secretagogues) if ''HbA1c > 58'' (7.5%) consider insulin continue metformin with insulin use exenatide if needs insulin but obesity (BMI >35) so high dose insulin will be needed Continue only if beneficial response occurs and is maintained (> 1.0% HbA1c loss and >3% wt loss at 6/12) ''Starting insulin'' if HbA1c >58 start with NPH (isophane, intermediate acting) at bed-time or bd ''Other'' aspirin to all > 50y and to younger if other risk factors (still in NICE, no longer in SIGN - latest evidence not support aspirin in primary prevent) lipids - >40y without risk factors (smoking, obese, HT) and CVS 10yr risk <20% - don't need ... use Simva 40 - if target not reached inc to Simva 80 then atorva, then ezetimibe target total cholesterol < 4.0 fenofibrate if TG >4.5
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Type2Mx