Spellman CW. Management of Diabetes in the Real World: Tight Control of Glucose Metabolism. J Am Osteopath Assoc 2003;103(8_suppl_5):S8–S13. doi: .
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This clinical review looks at tight control of blood glucose with oral agents and insulin in adults and children with type 2 diabetes mellitus. It includes recommendations based on the treatment algorithms from the Texas Diabetes Council. The focus is on specific indications for selecting initial monotherapy, early dual therapy, or combination oral therapy. Discussion includes glycemic targets and times to goal along with recommendations for insulin management that depend on patient stratification as “treatment naïve” or “combination oral agent failures” (defined as A1c value ⩽9.5% or >9.5%). This presentation also includes protocols for once-daily injections, multidose insulin injections, and intensive insulin therapy (physiologic insulin delivery) as well as discussion of starting doses, titration schedules, optimum basal bolus insulin regimen, and calculation of insulin augmentation.
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