Figures and Tables Fig.1. Simplified flowchart for American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology
(ACE) 2009 glycemic control algorithm. Pathways are provided for patients with hemoglobin Ale (A1C) in 3 ranges: 6.5% to 7.5%, >7.6% to 9.0%, and >9.0%. There is a progression from rnonotherapy, to dual therapy, to triple therapy, to insulin therapy with or without additional agents. The order of presentation of regimens indicates general priorities that should be customized to the individual patient, with consideration of contraindications and precautions, allergies, comorbid conditions, drug-drug interactions, and drug-laboratory interactions. Physicians must be thoroughly familiar with complete prescribing information before selection of therapy. In each case, response to therapy should be monitored closely (determination of A1C every 2 to 3 months), and titration of dosages or changes of regimen should be implemented in a timely manner. Rx = treatment. Note accompanying Table of Annotated Abbreviations for Figure 1. Table of Annotated Abbreviations for Figure 1(a) Abbreviation Generic name Trade name
Glipizide (generic), Glucotrol, Glucotrol
Abbreviation Definition
a The following single-tablet combinations of agents are available: sitagliptin + metformin (Janumet), pioglitazone + metformin (ActoPlus Met), rosiglitazone + metformin (Avandamet), repaglinide + metformin (PrandiMet), glipizide + metformin (Metaglip and generic), and glyburide + metfonnin (Glucovance and generic). Table Al. Outline of Various Types of Insulin Type of insulin Trade name Rapid-acting insulin analogues
with reduced risk of hypoglycemia 2-5 hours after a meal or overnight
Premixed insulin/protamine
breakfast and dinner; provides postprandial coverage with 2 injections per day; less flexible than use of basal-bolus therapy with a combination of rapid-acting and long-acting analogues
Long-acting insulin analogues
patients with type 2 diabetes; excellent reproducibility of absorption profile within individuals; possibly less weight gain than with other insulins
Not recommended
persistence of effect is too long to mimic a normal prandial physiologic profile; the result is impaired efficacy and increased risk of delayed hypoglycemia
"peakless" basal insulin; highly variable absorption even within individuals; increased risk of hypoglycemia compared with the long-acting insulin analogues glargine or detemir
TableA2 Summary of Insulin Regimens Insulin regimen Components and frequency of administration Injections per day
Glargine or detemir (daily or twice a day)
NovoLog Mix or Humalog Mix (usually twice a day;
occasionally used daily or 3 times a day)
NovoLog, Humalog, or Apidra (usually 3 times a day)
NovoLog, Humalog, or Apidra (usually 3 times a day) in 4
combination with glargine or detemir (daily)
Duration Biguanides
Start 500 mg po bid with meals Half-life: 6.2 h
500 mg #60: 70850 mg #60 $1141000 mg #60: $142
Dipeptidyl- Peptidase-4 Inhibitors (DDP-4)
25 mg #90 $64650 mg #30 $221100 mg #30 $216
Glucose-Like Peptide-1 (GLP-1)
Start 5 mcg sc <1h before meals Half-life: 2.4 h
Start 0.6 mg sc qd x1wk then 1.2 Half-life: 13 h
Long-acting Insulins
0.1-0.2 u/kg sc hs; then adjust as Onset 5-7h; no peak; 100 u/ml (1 vial, 10
Short-acting analog insulins
Onset < 0.25 h, Peak 100 u/ml (1 vial, 10
30% total according to 12 hour after-meal glucose reading
Abbreviations: / means a ratio such as numerator divided by denominator, u/ml means units per mililiter; # means number
as in dispensing;< means less than; bid means twice a day; CHO means carbohydrateER means extended release; h means hour; hs means hour of sleep, or bedtime; kg means kilograms; Max means maximummin means minute; ml means mililiter; po means orallyqd menas dailyqwk means once a weeksc means subcutaneous;tabs means tablets u means units; XR means extended release.
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DEPRESSION DURING THE TRANSITION TO MENOPAUSE: A Guide for Patients and Families David A. Kahn, MD, Margaret L. Moline, PhD, Ruth W. Ross, MA, Lori L. Altshuler, MD, and Lee S. Cohen, MD www.womensmentalhealth.org It is a common myth that as women enter the menopausal years, it is “normal” to feel depressed. Serious depression, however, should never be viewed as a “normal