Diabetes and impaired glucose intolerance (IGT) are increasingly common in the All participants with diabetes who are using insulin or these oral hypoglycemic …
Protocol for Participants with Diabetes
Fasting and Medication Adjustment
Diabetes and impaired glucose intolerance IGT are increasingly common in
the US population, likely related to increasing rates of obesity and
inactivity Diabetes and IGT are also prevalent in persons with HIV
infection who are taking highly active antiretroviral therapy HAART
Once every 6-12 months, study participants are asked to fast for a
prolonged period of time 5 hours or overnight Participants who take
insulin will need to make adjustments to their insulin regimens during a
fast to avoid hypoglycemia, or low blood sugar In addition, there are two
classes of oral diabetes medications which promote hypoglycemia - the
sulfonylureas and the meglitinides All participants with diabetes who are
using insulin or these oral hypoglycemic agents should check with their
physicians or nurse practitioners for the correct adjustments to their
medications during a prolonged fast This Protocol provides some general
recommendations on Medication Adjustments pgs 1 and 2, Diagnostic
Criteria for Diabetes and IGT pg 3 and a list of Oral Diabetes
Medications pg 4 :
Insulin Adjustments
Intermediate Acting Insulin NPH or Lente Alone or With Regular or Fast-
Acting Insulin
For 8:30 AM appt Do not eat or drink anything prior to clinic
visit Do not take any regular or
fast-acting insulin Take your usual morning
intermediate-acting dose If your fasting blood sugar
in the morning tends to run low, you may want to cut
back on your evening intermediate dose the night
before your appt Make sure that you eat after your
appointment and cover with a sliding scale or usual
dose of regular or fast-acting insulin
For 1:00 PM appt Eat usual breakfast, but no food or beverage
after 8 AM Take
morning intermediate-acting insulin dose and usual
regular or fast-acting insulin dose to cover
breakfast
For 5:00 PM Eat usual breakfast and lunch, but no food or
beverage after 12 noon
Decrease morning dose of
intermediate-acting insulin
by Take usual regular or fast-acting insulin after
breakfast, but cut lunch-time regular or fast-acting
insulin in half Test blood sugar at 5:00 PM
appointment If 200, take usual dose of regular or
fast-acting insulin
Long Acting Ultralente Insulin Alone or With Regular or Fast Acting
Insulin
For 8:30 AM appt Do not eat or drink anything prior to clinic
visit Take full dose in the
morning Do not take any regular or fast-acting
insulin
For 1:00 PM appt Eat usual breakfast, but no food or beverage
after 8 AM Take full
dose of long acting insulin in the morning and usual
regular or fast-acting insulin dose to cover
breakfast
For 5:00 PM appt Eat usual breakfast and lunch, but no food or
beverage after 12 noon
Take full dose of long-acting insulin in the morning
and usual fast-acting or regular
insulin to cover
breakfast and lunch
Protocol for Participants with Diabetes, continued
Adjusting Oral Agents That Induce Hypoglycemia:Sulfonylureas and
Meglitinides
For 8:30 AM appt Do not eat or drink anything prior to clinic visit
Omit morning dose of
your sulfonylurea and/or meglitinide medication
Take full dose with first
meal after your clinic appointment
For 1:00 PM appt Eat breakfast, but no food or beverage after 8 AM
With long-acting
sulfonlyureas like Glucotrol XL or Amaryl or
intermediate-acting ones like
Diabeta, Micronase, take morning dose with
breakfast If bid twice a
day take full PM dose before evening meal, as
usual
With short acting sulfonylureas like Orinase, take
full morning dose
with breakfast Take full dose with first meal
after appointment
With meglitinides like Prandin and Starlix, take
full dose with breakfast
Take full dose with first meal after
appointment
For 5:00 PM appt Eat usual breakfast and lunch, but no food or
beverage after 12 noon
With all sulfonylureas, take full morning dose If
bid twice a day, take full
PM dose with evening meal after your clinic visit
With meglitinides, like Prandin and Starlix, take
full dose with breakfast,
lunch and dinner
Give all participants with diabetes juice and crackers immediately after
blood drawing They can resume usual medication regimen for the rest of
the day
It is important to avoid skipping meals For a 1:00 PM appointment,
encourage the participant to eat breakfast before 8:00 AM to allow for the
5-hour fast For a 5:00 PM appointment, encourage participant to eat lunch
before 12 noon This may mean eating these meals earlier than usual If
participant is unable to eat either breakfast or lunch as indicated above,
further adjustments of insulin and/or oral agents may be necessary
For all other oral agents, take as directed See Oral Diabetes
Medications on page 4
Diagnostic Criteria
Normal Blood Glucose
Fasting 110 mg/dl
Results of a 2-hour, 75 gram Oral Glucose Tolerance Test OGTT 140
mg/dl
Diabetes:
Fasting plasma glucose FPG ?126 mg/dl
OR
Random plasma glucose RPG ?200 mg/dl and symptoms of diabetes:
polyuria frequent urination, polydipsia excessive thirst,
ketoacidosis, or unexplained weight loss
OR
Results of a 2-hour, 75 Gram Oral Glucose Tolerance Test OGTT ?200
mg/dl on greater than one occasion
Impaired Glucose Tolerance IGT
People with IGT have blood glucose levels that are higher than normal but
not high enough to say they have diabetes Diagnosis of IGT if:
Fasting plasma glucose is 110-125 mg/dl
OR
Results of a 2-hour OGTT is 140-199 mg/dl
Oral Glucose Tolerance Test OGTT: After a fast of 8-12 hours, a
persons blood glucose is measured before and 2 hours after drinking a
glucose-containing solution The OGTT includes measures of blood glucose
after a fast and after a glucose challenge Although the fasting test may
be easier and less costly, the OGTT is more sensitive in identifying people
with blood glucose problems that may first appear only after a glucose
challenge
Oral Diabetes Medications
Drug
Classifications
All diabetes pills sold today in the United States are members of one of
the following five classes of drugs:
Sulfonylureas, Meglitinides, Biguanides, Thiazolidinediones, and Alpha-
Glucosidase Inhibitors
These five classes of drugs work in different ways to lower blood glucose
levels
Sulfonylureas brand names in parentheses:
Chlorpropamide Diabinese
Glipizide Glucotrol, Glucotrol XL
Glyburide Micronase, Glynase, Diabeta, PresTab
Glimepiride Amaryl
Tolazamide Tolinase
Tolbutamide Orinase
Sulfonylureas stimulate the beta cells of the pancreas to release insulin
For this reason, persons taking sulfonylureas are prone to hypoglycemia
following prolonged periods without food or after exercise These drugs
are generally taken one to three times a day, before meals
Meglitinides brand names in parentheses:
Repaglinide Prandin
Nateglinide Starlix
Meglitinides are drugs that also stimulate the pancreas to release insulin
Persons taking meglitinides are also prone to hypoglycemia following
prolonged periods without food or after exercise They are generally taken
before each of three meals
Biguanides brand names in parentheses:
Metformin Glucophage,
Glucophage XR
Metformin lowers blood glucose levels primarily by decreasing the amount of
glucose produced by the liver It also lowers blood glucose levels by
improving how cells, particularly muscle cells, use insulin Metformin
rarely causes hypoglycemia when used alone This medication is generally
taken 2-3 times a day with meals
Thiazolidinediones brand names in parentheses:
Rosiglitazone Avandia
Pioglitazone Actos
Thiazolidinediones lower blood glucose by reducing glucose production in
the liver and by helping insulin work better in muscle and fat cells They
rarely cause hypoglycemia when used alone These medications are taken
once or twice a day with food Another drug in this class, Troglitazone
brand name Rezulin, was taken off the market due to reports of serious
liver damage
Alpha-glucosidase inhibitors brand names in parentheses:
Acarbose Precose
Meglitol Glyset
Alpha-glucosidase inhibitors help the body lower blood glucose by blocking
the breakdown and absorption of starches from bread, potatoes, pasta,
etc in the intestine Their action slows the rise in blood glucose after
a meal They should be taken with the first bite of a meal These drugs
will not
cause hypoglycemia when used alone but may cause gastrointestinal
side effects such as gas and diarrhea
Source:dars.state.tx.us
