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MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN Enfoque Global De La Diabetes Manual De Endocrinología Y Nutrición MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN Enfoque global de la diabetes Manual de endocrinología y nutrición AUTORES: BOTELLA JI, VALERO MA, SÁNCHEZ AI, CANOVAS B, ES/CA/0113/0030 ROA C, MARTÍNEZ E, ÁLVAREZ F, GARCÍA G, MARTÍN I, LUQUE M, CABANILLAS M, PERALTA M, VADEMÉCUM PINÉS PJ, BEATO P, SANCHÓN R, ANTÓN T. MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN Novo Nordisk Pharma, S.A. Tel. +34 913 349 800 Vía de los Poblados, 3 Fax +34 913 349 820 Parque Empresarial Cristalia Edificio 6 - 3ª Planta 28033 Madrid www.novonordisk.es Agujas Análogos de GLP1 Análogos de insulina Victoza® una vez al día. 32G Basal (insulina detemir) (0,23 mm x 6 mm) Esquema simple de inicio CN: 305966.4 y mantenimiento: InnoLet® CN: 656056.3 30G Comenzar con Mantenimiento con (0,30 mm x 8 mm) FlexPen® CN: 305967.1 0,6 mg una vez al día 1,2 mg CN: 813576.9 al menos durante un semana1 una vez al día1 Rápida (insulina aspart) Antidiabético oral Es posible aumentar la dosis FlexPen® ® a 1,8 mg para lograr NovoNorm 0,5 mg / 1 mg / 2 mg (repaglinida) así una mejora del control CN: 656774.6 glucémico en algunos pacientes Victoza® puede utilizarse en combinación con Mezclas (insulina aspart bifásica) CN: 717702.9 CN: 717769.2 las siguientes terapias: ® ® FlexPen NovoMix 30 (insulina aspart bifásica) 30% insulina aspart Terapia Consideraciones CN: 656773.9 70% insulina aspart CN: 718635.9 protamina Metformina No es necesario el ajuste de dosis de metformina y/o tiazolidindiona1 ® Glucagón Metformina + NovoMix® 50 FlexPen tiazolidindiona (insulina aspart bifásica) 50% insulina aspart CN: 661527.0 GlucaGen® Hypokit 50% insulina aspart protamina CN: 965616.4 Sulfonilurea Puede ser necesaria la reducción de la dosis de sulfonilurea para FlexPen® minimizar el riesgo de ® Metformina + NovoMix 70 (insulina aspart bifásica) hipoglucemia1 Sulfonilurea 70% insulina aspart CN: 661528.7 30% insulina aspart protamina *Algunos pacientes pueden benefeciarse al incrementar la dosis de 1,2 mg a 1,8 mg.1 1Ficha Técnica MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN Enfoque global de la diabetes Manual de endocrinología y nutrición AUTORES: BOTELLA JI, VALERO MA, SÁNCHEZ AI, CANOVAS B, ES/CA/0113/0030 ROA C, MARTÍNEZ E, ÁLVAREZ F, GARCÍA G, MARTÍN I, LUQUE M, CABANILLAS M, PERALTA M, VADEMÉCUM PINÉS PJ, BEATO P, SANCHÓN R, ANTÓN T. MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN Novo Nordisk Pharma, S.A. Tel. +34 913 349 800 Vía de los Poblados, 3 Fax +34 913 349 820 Parque Empresarial Cristalia Edificio 6 - 3ª Planta 28033 Madrid www.novonordisk.es Agujas Análogos de GLP1 Análogos de insulina Victoza® una vez al día. 32G Basal (insulina detemir) (0,23 mm x 6 mm) Esquema simple de inicio CN: 305966.4 y mantenimiento: InnoLet® CN: 656056.3 30G Comenzar con Mantenimiento con (0,30 mm x 8 mm) FlexPen® CN: 305967.1 0,6 mg una vez al día 1,2 mg CN: 813576.9 al menos durante un semana1 una vez al día1 Rápida (insulina aspart) Antidiabético oral Es posible aumentar la dosis FlexPen® ® a 1,8 mg para lograr NovoNorm 0,5 mg / 1 mg / 2 mg (repaglinida) así una mejora del control CN: 656774.6 glucémico en algunos pacientes Victoza® puede utilizarse en combinación con Mezclas (insulina aspart bifásica) CN: 717702.9 CN: 717769.2 las siguientes terapias: ® ® FlexPen NovoMix 30 (insulina aspart bifásica) 30% insulina aspart Terapia Consideraciones CN: 656773.9 70% insulina aspart CN: 718635.9 protamina Metformina No es necesario el ajuste de dosis de metformina y/o tiazolidindiona1 ® Glucagón Metformina + NovoMix® 50 FlexPen tiazolidindiona (insulina aspart bifásica) 50% insulina aspart CN: 661527.0 GlucaGen® Hypokit 50% insulina aspart protamina CN: 965616.4 Sulfonilurea Puede ser necesaria la reducción de la dosis de sulfonilurea para FlexPen® minimizar el riesgo de ® Metformina + NovoMix 70 (insulina aspart bifásica) hipoglucemia1 Sulfonilurea 70% insulina aspart CN: 661528.7 30% insulina aspart protamina *Algunos pacientes pueden benefeciarse al incrementar la dosis de 1,2 mg a 1,8 mg.1 1Ficha Técnica MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN 1 MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN COORDINADOR: Botella Carretero, José Ignacio Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn). Hospital Universitario Ramón y Cajal. Madrid. AUTORES (por orden alfabético): Álvarez Blasco, Francisco Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERdem). Hospital Universitario Ramón y Cajal. Madrid. Antón Bravo, Teresa Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Universitario de Móstoles. Madrid. Beato Víbora, Pilar Isabel Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Badajoz. Botella Carretero, José Ignacio Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. CIBER de fisiopatología de la Obesidad y Nutrición (CIBERobn). Hospital Universitario Ramón y Cajal. Madrid. 2 AUTORES Cabanillas López, María de la O Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital de Llerena -Zafra. Cánovas Gaillemín, Bárbara Médico Adjunto. Servicio de Endocrinología y Nutrición. Hospital Virgen de la Salud. Toledo. García Romero de Tejada, Gema Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Universitario Ramón y Cajal. Madrid. Luque Ramírez, Manuel Facultativo Especialista de Área. Tutor de Residentes de Endocrinología y Nutrición. Servicio de Endocrinología y Nutrición. CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERdem). Hospital Universitario de La Princesa. Madrid. Martín Timón, Icíar Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Cruz Roja San José y Santa Adela. Madrid. Martínez Bermejo, Elena Médico Adjunto. Servicio de Endocrinología y Nutrición. Hospital Virgen de la Salud. Toledo. Peralta Watt, María Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Virgen del Puerto. Plasencia. Cáceres. MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN 3 Pinés Corrales, Pedro José Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Albacete. Roa Llamazares, Carlos Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Santa Bárbara de Puertollano. Ciudad Real. Sánchez Marcos, Ana Isabel Médico Adjunto. Profesora Asociada en CC. Salud de la Universidad de Salamanca. Servicio de Endocrinología y Nutrición. Complejo Asistencial Universitario de Salamanca. Sanchón Rodríguez, Raúl Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Infanta Cristina de Parla. Madrid. Valero González, Miguel Ángel Facultativo Especialista de Área. Servicio de Endocrinología y Nutrición. Hospital Nuestra Señora del Prado. Talavera de la Reina. Toledo. 4 S.V.P. Núm: 122/07/-L-CM 122/07-L-CM Depósito legal: ISBN: 84-695-7223-7-50937-2007 MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN 5 PRÓLOGO En memoria del Dr. César Varela Dacosta. Es un orgullo a la vez que una gran satisfacción poder presentar esta cuarta edición del Manual de Endocrinología y Nutrición, que es resultado de la gran profesionalidad y de la vocación docente de todos los autores, todos compañeros y amigos. Pero esta ocasión es aún más emotiva por el reciente fallecimiento del que fuera nuestro tutor de residentes en el Hospital Universitario Ramón y Cajal cuando arrancó la primera edición de esta obra. Nuestro compañero, tutor y maestro, el Dr. César Varela, hizo posible con su apoyo incondicional, no solo el inicio de este manual, sino el espíritu que se encuentra en el trasfondo del mismo: una herramienta práctica y resolutiva para el manejo del paciente con patología endocrinológica. Ha sido unánime por parte de todos los autores la decisión de que esta cuarta edición del Manual de Endocrinología y Nutrición sea dedicada al Dr. César Varela, quien tanto ha aportado a la Endocrinología española y quien dejó una huella imborrable en todos los que le conocimos, la mayoría residentes suyos, y a los que de una forma u otra supo inculcarnos las vertientes docente e investigadora de nuestra profesión. Gracias César. José Ignacio Botella Carretero 6 PRÓLOGO MANUAL DE ENDOCRINOLOGÍA Y NUTRICIÓN 7 ÍNDICE SECCIÓN I. DIABETOLOGÍA. • Epidemiología, clasificación y diagnóstico de la diabetes mellitus. 13 – Concepto y epidemiología ....................................... 13 – Diagnóstico de diabetes .......................................... 13 – Clasificación ............................................................. 13 • Complicaciones agudas ................................................. 19 – Cetoacidosis diabética ............................................ 19 – Estado hiperglucémico hiperosmolar ...................... 25 – Hiperglucemia aislada ............................................. 26 – Hipoglucemia ........................................................... 27 • Complicaciones crónicas. ............................................. 30 – Generalidades .......................................................... 30 – Nefropatía diabética ................................................ 31 – Retinopatía diabética ............................................... 34 – Neuropatía diabética ............................................... 37 – Complicaciones crónicas macrovasculares ............ 40 – Pie diabético ............................................................ 43 • Tratamiento ....................................................................
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