ÎÎIn patients with T2DM who become hypoglycemic and have been
treated with an α-glucosidase inhibitor in addition to insulin or
an insulin secretagogue, oral glucose must be given because
α-glucosidase inhibitors inhibit the breakdown and absorption of
complex carbohydrates and disaccharides (D-4).
Management of Complications
Diabetic Nephropathy
ÎÎPatients with diabetic nephropathy should be counseled regarding the
increased need for optimal glycemic control, blood pressure control,
dyslipidemia control, and smoking cessation (A-1).
ÎÎWhen therapy with angiotensin-converting enzyme (ACE) inhibitors or
angiotensin II receptor blockers (ARBs) is initiated, renal function and
serum potassium levels must be closely monitored (A-1).
ÎÎBeginning 5 years after diagnosis in patients with T1DM and at
diagnosis in patients with T2DM, an annual assessment of serum
creatinine to estimate the glomerular filtration rate (GFR) and urine
albumin excretion should be performed to identify, stage, and monitor
progression of diabetic nephropathy (D-4).
Table 6. Kidney Failure
Stage
Description
Stage 1
Kidney damage with normal or increased GFR > 90 mL/min
Stage 2
Kidney damage with mildly decreased GFR 60-89 mL/min
Stage 3
Moderately decreased GFR 30-59 mL/min
Stage 4
Severely decreased GFR 15-29 mL/min
Stage 5
Kidney failure, GFR < 15 mL/min or dialysis
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