Dealing with Diabetes2 and remembering Goldi Community Group
A support group for individuals with Type2 diabetes. Encouragement, empathy, advice, and personal experiences from members dealing with the illness. A friendly environment with compassion and support as our main objective.
some guidance given to doctors in the UK about treatment progression
I'm sitll at the Metformin stage and hope I don't need to take too many more pills or injections
iabetes, whereas the update covers only the place of the new drugs. Some key recommendations and
other aspects of the guidelines are listed below;
• targets for control. An HbA1c level of 6.5% or under was set for people with type 2 diabetes
in general, but it was recommended that targets should be tailored to the needs of the
individual, and might be higher than 6.5% (Recommendation 16)
• if HbA1c levels were above target, but pre-meal levels were well-controlled (<7.0 mmol/l),
then consideration should be given to reduction of postprandial glucose levels
(Recommendation 18)
• it was recommended that treatment start with lifestyle measures, but it was accepted that these
would fail in many or most cases.
• first-line therapy (algorithm page 99) should be metformin for people who are overweight or
obese. A sulphonylurea to be considered in those who were not overweight.
• if monotherapy failed a sulphonylurea should be added to metformin, or vice versa. In some
people, a meglitinide analogue might be considered instead of a sulphonylurea. Glitazones
should be considered only if hypoglycaemia was expected to be a problem (though if it was a
problem during a trial of the sulphonylurea, there could be a switch to a glitazone)
• if on dual therapy and HbA1c remained above 7.5%, third line treatment with a glitazone or
insulin should be added. However, at this point treatment with exenatide could be considered.
• once insulin was started, metformin and the sulphonylurea would be continued, but with reconsideration of the sulphonylurea if hypoglycaemia occurred.
• if control deteriorated, the insulin therapy would be intensified (and though not stated, it
would be logical to withdraw the sulphonylurea).
• as regards the type of insulin, Recommendation 52 stated that the first choice should be human
NPH insulin, taken at bedtime or twice daily according to need. Glargine should be considered
in certain situations: those who required a carer to give the injections; those whose lifestyle is
restricted by recurrent symptomatic hypoglycaemia; those who would otherwise need twicedaily basal injections. These situations are the same as those for glargine in Technology
Appraisal 53.
12
(Detemir was excluded from the GDG considerations because it was
expected to be the subject of a technology ap
I'm sitll at the Metformin stage and hope I don't need to take too many more pills or injections
iabetes, whereas the update covers only the place of the new drugs. Some key recommendations and
other aspects of the guidelines are listed below;
• targets for control. An HbA1c level of 6.5% or under was set for people with type 2 diabetes
in general, but it was recommended that targets should be tailored to the needs of the
individual, and might be higher than 6.5% (Recommendation 16)
• if HbA1c levels were above target, but pre-meal levels were well-controlled (<7.0 mmol/l),
then consideration should be given to reduction of postprandial glucose levels
(Recommendation 18)
• it was recommended that treatment start with lifestyle measures, but it was accepted that these
would fail in many or most cases.
• first-line therapy (algorithm page 99) should be metformin for people who are overweight or
obese. A sulphonylurea to be considered in those who were not overweight.
• if monotherapy failed a sulphonylurea should be added to metformin, or vice versa. In some
people, a meglitinide analogue might be considered instead of a sulphonylurea. Glitazones
should be considered only if hypoglycaemia was expected to be a problem (though if it was a
problem during a trial of the sulphonylurea, there could be a switch to a glitazone)
• if on dual therapy and HbA1c remained above 7.5%, third line treatment with a glitazone or
insulin should be added. However, at this point treatment with exenatide could be considered.
• once insulin was started, metformin and the sulphonylurea would be continued, but with reconsideration of the sulphonylurea if hypoglycaemia occurred.
• if control deteriorated, the insulin therapy would be intensified (and though not stated, it
would be logical to withdraw the sulphonylurea).
• as regards the type of insulin, Recommendation 52 stated that the first choice should be human
NPH insulin, taken at bedtime or twice daily according to need. Glargine should be considered
in certain situations: those who required a carer to give the injections; those whose lifestyle is
restricted by recurrent symptomatic hypoglycaemia; those who would otherwise need twicedaily basal injections. These situations are the same as those for glargine in Technology
Appraisal 53.
12
(Detemir was excluded from the GDG considerations because it was
expected to be the subject of a technology ap
But the ordinary patients who researches and uses the internet or sites like D/S probably knows more about their particular problem.
The drug regimes seems to be a bit hit and miss its like lets try this one out for a while
Now it seems there is a type of Cholesterol type 2 have that is worse for clogging up the arteries than the normal cholesterol This seems to be why we are more susceptible to heart problems