By G. Sancho. State University of New York College at Cortland.

For most adults Although 24-hour collections are not needed for routine screen- with diabetes duphaston 10 mg online, a target A1C of <7 order duphaston 10mg on-line. It should be noted that these als should be counseled to discard the rst morning urine on the studies examined people with early renal disease and diabetes. Evi- day of collection, and then collect all subsequent urine for a 24-hour dence supporting intensive glycemic control is lacking in people with period, including the rst morning urine of the next day. Consideration should be given to providing people with a sick-day medication list, instruct- 1. Screening should commence at diagnosis of diabetes in indi- viduals with type 2 diabetes and 5 years after diagnosis in adults with type 1 diabetes and repeated yearly thereafter [Grade D, Consensus]. People with diabetes should be referred to a specialist with expertise in urinary potassium excretion. Unable to remain on renal-protective therapies due to adverse effects, advice should be sought from a renal specialist. S88 microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study. Markers of and risk factors for the develop- ment and progression of diabetic kidney disease. The course of kidney function in type 2 Relevant Appendices (non-insulin-dependent) diabetic patients with diabetic nephropathy. Therapeutic Considerations for Renal Impairment normotensive type 1 diabetic patients. Clinical versus histological diagno- Related Websites sis of diabetic nephropathyis renal biopsy required in type 2 diabetic patients with renal disease? Development and progression of renal insuf- resources/kidneywisetoolkit/) ciency with and without albuminuria in adults with type 1 diabetes in the Ontario Renal Network: KidneyWise Clinical Toolkit (available at diabetes control and complications trial and the epidemiology of diabetes inter- ventions and complications study. The nephropathy of non-insulin- dependent diabetes: Predictors of outcome relative to diverse patterns of renal injury.

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Earlier onset and/or more frequent fetal health surveillance is surveillance during pregnancy as determined by the vision care special- recommended in those considered at highest risk [Grade D generic duphaston 10mg online, Consensus] cheap 10mg duphaston with visa. Induction prior to 38 weeks of gestation should Grade D, Consensus for type 2 diabetes]. Womenshouldbecloselymonitoredduringlabouranddelivery,andmater- an interprofessional diabetes health-care team, including diabetes edu- nalbloodglucoselevelsshouldbekeptbetween4. Once pregnant, women with type 2 diabetes should be switched to insulin on the pump during labour and delivery [Grade C, Level 3 (172) for type 1 for glycemic control [Grade D, Consensus]. Receive an individualized insulin regimen and glycemic targets typi- prepregnant doses and titrated as needed to achieve good glycemic control cally using intensive insulin therapy by basal-bolus injection therapy [Grade D, Consensus]. Women with pre-existing diabetes should have frequent blood glucose for type 1 diabetes] monitoring in the rst days postpartum, as they have a high risk of hypo- b. Health-care providers should discuss appropriate weight gain at the initial visit and regularly throughout pregnancy [Grade D, Consensus]. Metforminand/orglyburidemaybeusedduringbreastfeeding[GradeC, mendations for weight gain during pregnancy should be individualized Level 3 (203) for metformin; Grade D, Level 4(204) for glyburide]. Metformin may be used as an alternative to insulin [Grade A, Level 1A (362) for metformin]; however, women should be informed 26. Women identied as being at high risk for type 2 diabetes should be that metformin crosses the placenta, longer-term studies are not yet offered earlier screening with an A1C test at the rst antenatal visit to available, and the addition of insulin is necessary in approximately identify diabetes which may be pre-existing [Grade D, Consensus]. If the initial screening is performed before 24 weeks of gestation and is negative, the woman should be rescreened as outlined in recom- 35. Preconception counseling in women with diabetes: A population-based study in the north of England. Rate of preconception care in women with type 2 diabetes still lags behind that of women with type 1 dia- betes. Effect of pregnancy on progression of diabetic reti- Organization of Diabetes Care, p. Diabetes Control and Complications Trial Research Group, The Diabetes Control Type 2 Diabetes and Indigenous Peoples, p.