1. Type 1 DM:
-7.5-10% adults with presumed DMII will have +Antibodies
-Antibodies: GAD65, IA2, ZnT8
2. Things that cause
3. Pre-Diabetes
-A1C 5.7-6.4
-Fasting glucose 100-125
-10% progression to DM2 every year
4. Diabetes Prevention Program trial (NEJM)
-3 arms:
-Standard lifestyle recommendations + placebo twice daily
-Standard lifestyle recommendations + metformin titrated to 850 mg twice daily
-Intensive lifestyle modification (low-calorie/low-fat diet, moderate physical activity 150 min/wk)
-Mean of 2.8 years of follow up.
-Intensive supervised lifestyle decreased risk of developing DM by 58%, metformin by 31%
5. Meformin
-drops hepatic gluconeogenesis
-typically lowers A1C 1-2% @ max dose.
-Titrate to 1000 BID to lower GI symptoms.
-CI if there is a risk of renal problems-- if Cr >1.4 (F) >1.5 (M), or if they have acute heart failure, or if they need a dye study/cath - hold for 48 hours.
6. Sulfonyurea,
-drops A1C 1-2% @ max dose.
-Glipizide (10 mg qD XL, 10 mg BID if not XL release).
-Causes weight gain, hypoglycemia.
-Avoid in people with insulin, NPO.
-Cheap.
7. DPP4-I
-Enhances GLP-1 by stopping degredation
-Sitaglipitn (Januvia)
-Lowers A1C ~1 point
8. GLP agonists: 
-GLP-1 secreted from the gut after food: slows gastric emptying, stimulates insulin secretion, inhbits glucagon.
-byetta and victoza (injectibles),
-lowers A1C about 1%,
-slows gastric emptying,
-typically causes weight loss.
-But also causes pancreatitis, AKI
9. Thiazolidinediones
-Avandia
-PPARy inhibitors, Increases glucose uptake in skeletal muscles
-FDA black box
10. Insulin 
-Short acting: humolog, novolog used for SSI and mealtimes
-Long acting: Lantus for basal control (starts at 2, lasts 24, no peak)
-If their insurance won't cover lantus, do NPH, but that has to be dosed BID
-Can use combined long/short (70/30), dosed 2x a day.