ÎIn 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
ÎPatients with diabetic nephropathy should be counseled regarding the increased need for optimal glycemic control, blood pressure control, dyslipidemia control, and smoking cessation (A-1).
ÎWhen 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).
ÎBeginning 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 Stage 2
Kidney damage with normal or increased GFR > 90 mL/min Kidney damage with mildly decreased GFR 60-89 mL/min
Stage 3 Moderately decreased GFR 30-59 mL/min Stage 4 Stage 5
Severely decreased GFR 15-29 mL/min Kidney failure, GFR < 15 mL/min or dialysis
11
