DIABETES

Norma Técnica Minsa / ADA

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HISS
05 Tratamiento
 Diabetes
TIPOS: (Según norma técnica)
 DM 1
 DM2
 D GESTACIONAL
 OTROS TIPOS ESPECÍFICOS DE DB:
Defectos genéticos en la función de la célula beta, defectos genéticos de la acción de
la insulinaenfermedades del páncreas exocrino, endocrinopatías (acromegalia,
síndrome de Cushing), cromosomopatías (síndrome de Down, síndrome de Turner) o
relacionado al uso de medicamentos (glucocorticoides, pentamidina, diazóxido) entre
otros
DB 1 – DB2
 Factores de riesgo asociados:
Medio ambiente: Urbanización- Riesgo ocupacional

Estilos de vida:
 Sedentarismo: activ. Física ≤ a 150 min. Por
semana
 Malos hábitos alimentarios
 Tabaquismo
 Alcohol
 Factores de riesgo asociados:
Factores Hereditarios:
 Antecedentes familiar de diabetes mellitus

Relacionadas a la persona
 Hiperglucemia intermedia
 Sindrome metabólico
 Sobrepeso y obesidad
 Obesidad abdominal
 Edad
 Dislipidemia
 historia de enfermedad cardiovascular
 Hipertensión arterial (HTA)
 Antecedentes obstétricos de diabetes mellitus gestacional
 Antecedente de hijos macrosómicos
 Antecedente de bajo peso al nacimiento
 Acantosis nigricans32 y acrocordones
 Síndrome de ovario poliquístico (SOPQ)
 Condiciones clínicas como: esteatosis hepática, síndrome de apnea-sueño, hiperuricemia.
 CUADRO CLÍNICO
Asintomáticos:
Sintomáticos: 4p + adicionalmente presentar visión borrosa, , debilidad,
prurito.
Varían adormecimientos, calambres, hormigueos (parestesias),
dolor tipo quemazón o electricidad en miembros inferiores
neuropatía diabética.

Comorbilidades asociada: ITUS

crisis hiperglucémica: deshidratación M-S, ↓sensorio, polipnea,
nauseas, vómitos, dolor abdominal, respiración acidótica, kussmaul.
 DIAGNÓSTICO
1.DX TEMPRANO: RETO complicaciones micro y
macrovasculares.
 Sobrepeso y obesidad abdominal  insulinoresistencia y DB-2.

CRIBADO:
2.VALORACION INTEGRAL DEL PACIENTE CON DB

EXAMENES AUXILIARES:
 DIAGNÓSTICO:
PRE- DB:
DB:
 GLU AYU. : 100- 125 ---- GLU ALTERA.
 GLU AYU. ≥ 126 1RO A UTILIZAR
EN AYUNAS
 TEST SOG ≥ 200
 TEST SOG : 140 – 199 ----
 GLU AZAR ≥ 200 + 4P CLINICA DB
INTOLERANCIA A LA GLUCOSA
 HB A1C ≥ 6.5 MENOS UTILIZADO +
 GLU AZAR : XXXX
PARA MONITORIZACION
 HB A1C : 5.7 – 6.4

ALGORITMO:
1. CLINICA CLASICA 4P / O CRISIS HIPERGLICEMICA (CETOACIDO.)  SI UTILIZO EL
EXAMEN GLUCOSA AL AZAR ( EN CUALQUIER MOMENTO) SI ≥ 200 O MAS  SI
DIABETES

CASO: SI PACIENTE TIENE OBESIDAD, ACANTOSIS, ACROCORDONES, DICE Q PRESENTA

4P, Y EN SU FAMILIA HAY ANTECEDENTES DE DB, Y SI GLUCOSA SALE U VALOR DE 350
SI CATALOGAMOS COMO DIABETICO
CRITERIOS DIAGNOSTICOS
 TRATAMIENTO:
1. COMPONENTE NO FARMACOLOGICO: ESTILOS DE VIDA SALUDABLE
2. FARMACOLOGICO:
DB-1: INSULINA --- VIA SUBCUTÁNEA: INSULINA BASAL + INSULINA PRANDIAL (ANTES
DE COMER) / CON BOMBA DE INFUSION CONTINUA.
DB-2: ESTILO DE VIDA SALUDABLE + ANTIDIABETICOS ORALES
1 LINEA: METFORMINA
OTROS: INSULINA
METAS:
GLU AYUNAS: 80 – 130 MG/DL
HB A1C: (CADA 3 MESES): <7%
GLUCOSA POST PRANDIAL:
(2HRS DESPUES DE COMIDA): <
180 MG/DL
METAS DE CONTROL METABOLICO
MANEJO DE DIABETES MELLITUS
 GUIA DE ASOC DE ENDOCRINOLOGOS CLINICOS:
PRIMERO PRIORIZAR EL ESTILO DE VIDA
SI EL PACIENTE CON DB TIENE UN ALTO RIESGO
CARDIOVASCULAR, O TIENE ENFERMEDAD
CARDIOVASCULAR ESTABLECIDA LLAMESE, ENFERMEDAD
CORONOARIA PREVIA O U INFARTO CEREBRAL, SE
RECOMIENDA USAR ESTE TIPO DE DROGAS QUE SE
CONOCE COMO SGLT2.
O TBN LOS INYECTABLES QUE SON AGONISTAS DE GLP1.
YA QUE TIENE UN EFECTO PROTECTOR.

SI NO TUVIERA ESTA ENFERMEDAD CARDIOVASCULAR

ESTABLECIDA, Y EN BASE A LA HEMOGLOBINA
GLICOSILADA NOS PUEDE DAR UNA IDEA DE DONDE
EMPEZAMOS:

SI MI HB GLICOSILADA ESTA MENOS DE 7.5 LA GUIA ME

DICE QUE PUEDO USAR MONOTERAPIA, Y PUEDE SER:
METFORMINA, TBN NOS PONE COMO ALTERNATIVA EL
MISMO GLP1, LOS INHIBIDORES SGLT2, ENTRE OTRAS
CON MENORES POTENCIA.

PERO SI LA HEMOGLOBINA GLICOSILADA ESTA ENTRE 7.5

A 9. NOS DICE QUE MEJOR ES IR CON DOBLE TERAPIA,
PODEMOS IR CON METFORMINA COMBINADA CON UN
GLP1, O CON INHIBIDOR DE DPP4, O SULFONILUREAS.
TBN VAMOS A DOBLE TERAPIA CUANDO CON LA
MONOTERAPIA NO CONSEGUIMOS LAS METAS.

Y USAMOS ALGUN INYECTABLE, SI LA HEMOGLOBINA

GLICOSILADA ES MAS DE 9, Y HAY SINTOMAS: 4P, SE
RECOMIENDA USAR INSULINA . SI NO HUBIERA SINTOMAS
PUDIESE UTILIZARSE DOS DROGAS ORALES O TRIPLE
INCLUSO PUDIERA SER.

INSULINOTERAPIA
En este cuadro se evalua como el
medicamento puede tener efectos
adversos, por ejemplo en cuanto a
la hipoglicemia, a la cabeza esta las
sulfonilureas, glibenclamida.
Y lo otro en la metformina, si ya la
función renal es menos de 30,aquí
ya no estaría indicado el uso de
metformina.
Y en cuanto al peso si queremos
manejar el peso, las sulfonilureas,
tiene un incremento moderado del
peso, en cambio metformina esta
asociado a una disminución
moderada de peso.
COMPLICACIONES AGUDAS
MANEJO DE DIABETES MELLITUS
 Registro HISS
REGISTRO DE CRISIS HIPOGLUCEMICA/ HIPERGLICEMICA:

E 162
E 119

E 739

E 109

hipoglucemia : GLICEMIA< 70 mg/dl, CON O SIN SINT

crisis hiperglucémicas: GLUCEMIA mayor de 250 mg/dl --- >estado hiperosmolar hiperglucémico (EHH) y la cetoacidosis diabética (CAD).  VA TENER Q SER REFERIDO
En el ítem: Diagnóstico motivo de consulta: VAN LOS DOS DX: registre Hipoglicemia no especificada Y VA CON D : DEFINITIVO,Y CUAL ES SU TIPO DE DB QUE YA TENIA (Y
SERA R) QUE ES EX REPETIDO. Y RF” si el paciente es referido a otro establecimiento.
 Registro HISS
DIABETES MELLITUS, NO COMPLICADA, CONTROLADA:

E 119
82947
99199.22

controlada porque las: glicemia en ayunas 70 a 130 mg/dl en dos mediciones, o hemoglobina glucosilada menor de 7%. Y Presión arterial menor de 140/80 mmHg
nO COMPLICADO: sin retinopatía, sin nefropatía > a 60 ml/min, si pie diabetico.
En Diagnóstico motivo de consulta: registrar el dx: diabetes mellitus tipo 2 sincomplicaciones y es R por q es dx repetido, tbn registrar el dosaje de glucosa en sangre
aquí con d de definitivo, y tbn el Examen de presión arterial con d de definitivo.
Y marcar “N” cuando el resultado de examen de glucosa es < 130 mg/dl y “A” cuando el resultado de la glucosa es ≥ 130 mg/dl.
 Registro HISS
REGISTRO DE CONSULTA DE CONTROL A LOS 3 MESES:

E 119
82947
99199.22

Em el ítem Diagnóstico motivo de consulta: registrar diabetes mellitus tipo 2 sin complicaciones y marcar “R” de diagnóstico repetido, tbn registrar el dosaje de glucosa
en sangre y el Examen de presión arterial, aquí ambos marcar “D” de diagnóstico definitivo.
Y en el En el ítem Laboratorial, y marcar “PC” si se alcanzó las metas de control de laglucosa o hemoglobina glucosilada y presión arterial.
“N” cuando la presión arterial es normal (< 120/80) y “A” cuando la presión arterial es anormal (≥ 120/80).
 Registro HISS
PACIENTES DIABETICOS CON TRATAMIENTO ESPECIALIZADO: con
complicaciones

UPS Nefrología

E 112
N 18.3

Em el ítem Diagnóstico motivo de consulta: registrar la complicación que presenta,

En el 2º casillero registre el estadio , en este caso el estadio de la tasa de filtración glomerular por ser paciente renal.
Estadio 3 cuando la tasa de Filtración Glomerular (TFG) está entre 30-59 mL/min.
Para el primer dx de diabetes ES R DE REPETIDO, Y PARA EL 2DO DX ES D DE DEFINITIVO
 Registro HISS
PACIENTES DIABETICOS CON TRATAMIENTO ESPECIALIZADO: con
complicaciones

UPS Oftalmología

H 360

Em el ítem Diagnóstico motivo de consulta: registrar la complicación que presenta, EN ESTE CASO OFATLMOLOGICA: diabética (H360), Glaucoma (H420).
Y Marcar “R” de diagnóstico repetido.
SULFONUREAS
TIAZOLI
INHIBIDORES DE DPP4
INHIBIDORES DE SGLT2
AGONISTAS DE GLT1
 FISIOPATOLOGÍA

No se produce Resistencia a la
Insulina Insulina

DM1 DM2

INSULINA HIPOGLICEMIANTES
ORALES
 Que es la Diabetes
Trastorno de la utilización de la glucosa por células y tejidos, lo
que lleva a la hiperglicemia.

FISIOPATOLOGÍA

Resistencia a la
No se produce
Insulina
Insulina

DM1 DM2
TRATAMIENTO

INSULINA HIPOGLICEMIANTES
ORALES
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add a unique zing and appeal to your Presentations. You
can simply impress your audience and add a unique zing
and appeal to your Presentations. I hope and I believe
that this Template will your Time, Money and Reputation.
You can simply impress your audience and add a unique
zing and appeal to your Presentations. You can simply
impress your audience and add a unique zing and
appeal to your Presentations.
You can simply impress your audience and add a unique
zing and appeal to your Presentations.
02 PowerPoint Presentation
You can simply impress your audience and add a unique
zing and appeal to your Presentations. I hope and I
believe that this Template will your Time, Money and
Reputation. You can simply impress your audience and
add a unique zing and appeal to your Presentations. You
can simply impress your audience and add a unique zing
and appeal to your Presentations. I hope and I believe
that this Template will your Time, Money and Reputation.
You can simply impress your audience and add a unique
zing and appeal to your Presentations. You can simply
impress your audience and add a unique zing and
appeal to your Presentations.
You can simply impress your audience and add a unique
zing and appeal to your Presentations.
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