Diabetes mellitus medical therapy

# Medical Therapy
Diabetes mellitus is currently a chronic disease, without a cure, and medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems. There is an exceptionally important role for patient education, dietetic support, sensible exercise, self glucose monitoring, with the goal of keeping both short-term blood glucose levels, and long term levels as well,  within acceptable bounds. Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2 not responding to oral medications). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure and cholesterol by exercising more, smoking cessation, consuming an appropriate diet, wearing diabetic socks, and if necessary, taking any of several drugs to reduce pressure. Many Type 1 treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog,  Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with the some of most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod.
In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists, podiatrists/chiropodists, dietitians, physiotherapists, clinical nurse specialists (eg, Certified Diabetes Educators and DSNs (Diabetic Specialist Nurse)), or nurse practitioners may jointly provide multidisciplinary expertise. In countries where patients must provide their own health care, the impact of out-of-pocket costs of diabetic care can be high. In addition to the medications and supplies needed, patients are often advised to receive regular consultation from a physician (e.g., at least every three to six months).
In hospitalized patients, Clinical practice guidelines are available by the American College of Physicians (ACP) recommends "Best Practice Advice 1: Clinicians should target a blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) if insulin therapy is used in SICU/MICU patients. Best Practice Advice 2: Clinicians should avoid targets less than 7.8 mmol/L (<140mg/dL)"

### Contraindicated medications
Diabetes (when coadministrated with ARBs or ACEIs) is considered an absolute contraindication to the use of the following medications:
- Aliskiren
- Amlodipine and Benazepril
Diabetes mellitus with vascular disease is considered an absolute contraindication to the use of the following medications:
- Drospirenone and Ethinyl estradiol
- Norethindrone acetate and Ethinyl estradiol
- Norgestimate and Ethinyl estradiol

# 2013 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)

## Insulin Therapy for Type 1 Diabetes

## Pharmacological Therapy for Hyperglycemia in Type 2 Diabetes

## Antiplatelet Agents

## CHD Treatment

# Management
Diabetes management | Diabetic diet | Anti-diabetic drug | Conventional insulinotherapy | Intensive insulinotherapy