SUMÁRIO

04 O Processo de Comunicação com o cliente Diabético

05 Papel do Farmacêutico no Controle Glicêmico do Paciente Diabético

07 Farmácia Clínica e o Consultório Farmacêutico

09 Diabetes: conceitos básicos

12 Diabetes Gestacional

13 Entendendo os sinais e sintomas do diabetes

15 Porque tratar o Diabetes?

16 Complicações Agudas

18 Cetoacidose diabética

20 Hiperglicemia do alvorecer

21 Efeito Somogyi

21 Complicações Crônicas

23 Complicações Macrovasculares

24 Doença Arterial Periférica (DAP)

25 Complicações Microvasculares

26 Retinopatia diabética

27 Neuropatia Diabética

29 Critérios para diagnóstico do diabetes

30 Diagnóstico de Diabetes Gestacional

2 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
 SUMÁRIO

32 Situações em que a HbA1c NÃO É ADEQUADA para o DIAGNÓSTICO de diabetes

34 Pilares do tratamento do diabetes

34 Educação em Diabetes

35 Atividade física e o controle da glicemia

36 Hipoglicemia e Atividade física

37 Dieta e controle glicêmico

39 Os grupos Alimentares

40 Contagem de Carboidratos

41 Impacto dos macronutrientes na glicemia

42 Monitorando os níveis de glicose

43 CGMS

44 Hemoglobina glicada

45 Glicemia laboratorial

45 Automonitoração

50 Tratamento farmacológico do Diabetes

57 Insulinoterapia

63 Considerações Finais

64 Referências

3 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
O Processo de
Comunicação com o
Cliente Diabético

Atender as necessidades das pessoas com diabetes e seus cuidadores requer a compreensão dos
*ů)1&-),0#1,/"0.2"&+1"/$"*-/&+Ɲ2"+ &/!"0é,!,- &"+1",1/1*"+1,-/"0 /&1,"
adaptação à doença. Quando você consegue fazer com que seu cliente entenda sua condição e
como ele pode melhorar sua qualidade de vida, você consegue garantir esta adesão. E posso te
$/+1&/Ǿ.2"+é,"5&01"+!*&0$/1&Ɯ +1"-/.2"*0"!"!&  2&!/!0ů!"!")$2ć*Ǿ
do que receber o retorno da satisfação de seu cliente.

Durante todos os anos que estive na gestão da Farmácia Doce Vida – Especializada em Diabetes, que
fundei, uma das coisas mais importantes que aprendi, foi a me comunicar de forma clara e objetiva
com meus clientes diabéticos e seus cuidadores. Este tipo de comunicação eu uso ainda hoje, em
todo o conteúdo que crio no meu Blog de Educação em Diabetes – Diabetes&Você.

Veja abaixo alguns dos retornos que tenho de meus seguidores nas redes sociais:

Depoimento Facebook

Depoimento Blog

4 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
A comunicação vai muito além da orientação, avaliação e acompanhamento do tratamento do
cliente diabético. Na farmácia, podemos incluir aí vários fatores, como os abaixo:

ͻ/ĚĞŶƟĮĐĂƌĂƐŶĞĐĞƐƐŝĚĂĚĞƐĚĞŝŶƐƵŵŽƐ͕ƚĂŝƐĐŽŵŽƟƌĂƐ͕ƐĞƌŝŶŐĂƐ͕ĂŐƵůŚĂƐ͖
ͻ/ĚĞŶƟĮĐĂƌĂŶĞĐĞƐƐŝĚĂĚĞĚĞĐƌĞŵĞƐƉĂƌĂŚŝĚƌĂƚĂĕĆŽĚĂƉĞůĞ͖
ͻ  /ĚĞŶƟĮĐĂƌ ƋƵĂů ŵĞĚŝĚŽƌ ĚĞ ŐůŝĐŽƐĞ Ġ Ž ŝĚĞĂů ƉĂƌĂ ĐĂĚĂ ĐůŝĞŶƚĞ͕ ĚĞ ĂĐŽƌĚŽ ĐŽŵ ƋƵĞŵ ǀĂŝ ƵƐĂƌ͕
ƋƵĂŶƚŽƐƚĞƐƚĞƐĞƌĆŽƌĞĂůŝnjĂĚŽƐƉŽƌŵġƐ͘
ͻ/ĚĞŶƟĮĐĂƌƉŽƐƐşǀĞŝƐĞƌƌŽƐƋƵĞŽĐůŝĞŶƚĞƉŽƐƐĂĞƐƚĂƌĐŽŵĞƚĞŶĚŽŶĂĂƉůŝĐĂĕĆŽĞĂƌŵĂnjĞŶĂŐĞŵĚĂ
ŝŶƐƵůŝŶĂ͕ƋƵĞǀĂŝĐŽŵƉƌŽŵĞƚĞƌƐƵĂĂĕĆŽ͘

PEQUENOS DETALHES INFLUENCIAM DIRETAMENTE NO CONTROLE GLICÊMICO DO SEU

CLIENTE. LEMBRA-SE:

“O diabo mora nos detalhes”.

KƚƌĂƚĂŵĞŶƚŽĚŽĚŝĂďĞƚĞƐĠƌŝĐŽĞŵĚĞƚĂůŚĞƐ͕ƋƵĞŵƵŝƚĂƐǀĞnjĞƐƉĂƐƐĂŵďĂƟĚŽƐ͕ƋƵĞůĞǀĂŵƋƵĞĂ
ƉĞƐƐŽĂŶĆŽĐŽŶƐŝŐĂĐŽŶƚƌŽůĂƌƐĞƵƐŶşǀĞŝƐŐůŝĐġŵŝĐŽƐ͘ŽŵƵŵĂĐŽŶǀĞƌƐĂĐůĂƌĂĞŽďũĞƟǀĂ͕ŶŽďĂůĐĆŽ
ŽƵĂƚĠŵĞƐŵŽŶŽĐŽŶƐƵůƚſƌŝŽĨĂƌŵĂĐġƵƟĐŽ͕ǀŽĐġĐŽŶƐĞŐƵĞĚĞƐŵĂƐĐĂƌĂƌĚĞƚĂůŚĞƐƋƵĞŵƵŝƚĂƐǀĞnjĞƐ
ƉĂƐƐĂŵĚĞƐƉĞƌĐĞďŝĚŽƐŶĂĐŽŶƐƵůƚĂŵĠĚŝĐĂ͘

WĂƌĂƵŵĂďŽĂĐŽŵƵŶŝĐĂĕĆŽĚĞǀĞŵŽƐĮĐĂƌĂƚĞŶƚŽƐĂŽƐƉƌŝŶĐşƉŝŽƐĂďĂŝdžŽ͗
• Transparência;
• Parceria na tomada de decisão;
ͻKďũĞƟǀŽƐĚŽƚƌĂƚĂŵĞŶƚŽ͖
• Informações corretas;
• Respeito mútuo;
ͻƉƌĞŶĚŝnjĂĚŽĐŽŶơŶƵŽ͖
• Ambiente de apoio;

ŽŵŽĚŝnjĞŵŽƐĞƐĐŽƚĞŝƌŽƐ͕ĚĞǀĞŵŽƐĮĐĂƌƐĞŵƉƌĞĂůĞƌƚĂƐƋƵĂŶĚŽĞƐƚĂŵŽƐĂƚĞŶĚĞŶĚŽŶŽƐƐŽƐĐůŝĞŶƚĞƐ͘

Papel do Farmacêutico
no Controle Glicêmico
do Paciente Diabético:

5 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
džŝƐƚĞŵ ĐĞƌĐĂ ĚĞ ϭϰ ŵŝůŚƁĞƐ ĚĞ ďƌĂƐŝůĞŝƌŽƐ ĚŝĂďĠƟĐŽƐ͕ ƐĞŐƵŶĚŽ Ž /& ʹ /ŶƚĞƌŶĂƟŽŶĂů ŝĂďĞƚĞƐ
&ĞĚĞƌĂƟŽŶ͕ĞŽƌĂƐŝůƐĞĞŶĐŽŶƚƌĂŶĂƋƵĂƌƚĂĐŽůŽĐĂĕĆŽĞŵŶƷŵĞƌŽĚĞĚŝĂďĠƟĐŽƐŶŽŵƵŶĚŽ͕ƉĞƌĚĞŶĚŽ
ƐŽŵĞŶƚĞƉĂƌĂĂŚŝŶĂ͕1ŶĚŝĂĞh͘ϭKĚŝĂďĞƚĞƐĠƵŵƐĠƌŝŽƉƌŽďůĞŵĂĚĞƐĂƷĚĞƉƷďůŝĐĂĞŵƚŽĚŽŽ
ƉůĂŶĞƚĂĞŵĞƐŵŽĐŽŵŽƐƵƌŐŝŵĞŶƚŽĚĞŶŽǀĂƐƚĞĐŶŽůŽŐŝĂƐ͕ĐŽŵŽŽƉąŶĐƌĞĂƐĂƌƟĮĐŝĂů͕ŵĞĚŝĚŽƌĞƐĚĞ
ŐůŝĐŽƐĞƋƵĞŶĆŽƉƌĞĐŝƐĂŵĚĞƉŝĐĂĚĂƐ͕ŝŶƐƵůŝŶĂŝŶĂůĂĚĂ͕ƋƵĞĚŝƐƉĞŶƐĂŽƵƐŽĚĞĂŐƵůŚĂ͕ƐĞŵĚƵĐĂĕĆŽ
;ĐŽŶŚĞĐŝŵĞŶƚŽͿ͕ŽƚƌĂƚĂŵĞŶƚŽĮĐĂĐŽŵƉƌŽŵĞƟĚŽ͕ƉŽĚĞŶĚŽůĞǀĂƌĂŽƐƵƌŐŝŵĞŶƚŽĚĂƐĐŽŵŽƌďŝĚĂĚĞƐ
ŝŶĞƌĞŶƚĞƐĚŽĚĞƐĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽƚĂŝƐĐŽŵŽ͗

ͻ ZĞƟŶŽƉĂƟĂ
ͻ EĞƵƌŽƉĂƟĂ
ͻ EĞĨƌŽƉĂƟĂ
ͻ ŽĞŶĕĂƐĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ
• Amputações
ͻ ŝƐĨƵŶĕĆŽĞƌĠƟů

KŐƌĂŶĚĞŶƷŵĞƌŽĚĞĨĂƌŵĄĐŝĂƐĞĚƌŽŐĂƌŝĂƐĞdžŝƐƚĞŶƚĞƐŶŽƌĂƐŝů;ĐĞƌĐĂĚĞϴϬ͘ϬϬϬĞƐƚĂďĞůĞĐŝŵĞŶƚŽƐͿ͕
ĂĨƌĞƋƵġŶĐŝĂĐŽŵƋƵĞŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽǀĂŝĂƚĠĂĨĂƌŵĄĐŝĂĞĂĨĂĐŝůŝĚĂĚĞĞŵƐĞƌĂƚĞŶĚŝĚŽƉŽƌƵŵ
ƉƌŽĮƐƐŝŽŶĂů ĚĂ ĄƌĞĂ ĚĞ ƐĂƷĚĞ͕ ĐŽůŽĐĂ ƚŽĚŽƐ ŽƐ ĨĂƌŵĂĐġƵƟĐŽƐ ŶĂ ůŝŶŚĂ ĚĞ ĨƌĞŶƚĞ Ğ ĐŽŵ Ƶŵ ƉĂƉĞů
ĨƵŶĚĂŵĞŶƚĂůŶŽƚƌĂƚĂŵĞŶƚŽĚŽĚŝĂďĞƚĞƐ͘KƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽŽƵƐĞƵĐƵŝĚĂĚŽƌĨƌĞƋƵĞŶƚĂĂĨĂƌŵĄĐŝĂ
ŶŽŵşŶŝŵŽϭǀĞnjĂŽŵġƐĞŵďƵƐĐĂĚĞƐĞƵƐŵĞĚŝĐĂŵĞŶƚŽƐĚĞƵƐŽĐŽŶơŶƵŽĞŝŶƐƵŵŽƐƉĂƌĂĐŽŶƚƌŽůĞ
ĚĂĚŽĞŶĕĂ͘KƵƐĞũĂ͕ŽĚŝĂďĠƟĐŽƚĞŵŵĂŝƐĐŽŶƚĂƚŽĐŽŵŽĨĂƌŵĂĐġƵƟĐŽĚŽƋƵĞĐŽŵŽŵĠĚŝĐŽ͕ƋƵĞĞůĞ
ǀġĐŽŵŵĞŶŽƐĨƌĞƋƵġŶĐŝĂ;ĞŵŵĠĚŝĂĚĞϮǀĞnjĞƐĂŽĂŶŽͿ͘

KĨĂƌŵĂĐġƵƟĐŽƉŽĚĞĨĂnjĞƌĂĚŝĨĞƌĞŶĕĂ͕ƉŽŝƐƐĞĞŶĐŽŶƚƌĂďĞŵƉŽƐŝĐŝŽŶĂĚŽƉĂƌĂĂĐŽŶƐĞůŚĂƌĞĞĚƵĐĂƌŽƐ
ĚŝĂďĠƟĐŽƐƉĂƌĂŽĐŽŶƚƌŽůĞĚŽƐŶşǀĞŝƐŐůŝĐġŵŝĐŽƐ͘ůĞĠŽƉƌŝŵĞŝƌŽƉƌŽĮƐƐŝŽŶĂůĚĞƐĂƷĚĞĂƚĞƌĐŽŶƚĂƚŽ
ĐŽŵƵŵĂƉĞƐƐŽĂĐŽŵ͕ŽƵĞŵƌŝƐĐŽĚĞĚĞƐĞŶǀŽůǀĞƌĚŝĂďĞƚĞƐ͕ƉŽĚĞŶĚŽŝĚĞŶƟĮĐĂƌŽƐƉĂĐŝĞŶƚĞƐĚĞĂůƚŽ
ƌŝƐĐŽ;ŚŝƐƚſƌŝĐŽĨĂŵŝůŝĂƌ͕ŽďĞƐŝĚĂĚĞ͕ƐĞĚĞŶƚĂƌŝƐŵŽ͕ƚĂďĂŐŝƐŵŽ͕ŚŝƉĞƌƚĞŶƐĆŽͿĞŽƌŝĞŶƚĄͲůŽƐĂďƵƐĐĂƌŽ
ŵĠĚŝĐŽƉĂƌĂƵŵĚŝĂŐŶſƐƟĐŽƉƌĞĐŽĐĞ͘Ϯ

ǀĂůŝĂŶĚŽŽĞƐƚĂĚŽĚĞƐĂƷĚĞĚŽƉĂĐŝĞŶƚĞƚĞŵĐŽŵŽŝŶĐĞŶƟǀĄͲůŽĂĂĚĞƌŝƌĂŽƚƌĂƚĂŵĞŶƚŽƉƌĞƐĐƌŝƚŽƉĞůŽ
ŵĠĚŝĐŽ͕ĂůĠŵĚĞĚĞƚĞĐƚĂƌƉŽƐƐşǀĞŝƐŝŶƚĞƌĂĕƁĞƐŵĞĚŝĐĂŵĞŶƚŽƐĂƐ͘džĞƌĐĞŶĚŽŽƉĂƉĞůĚĞĚƵĐĂĚŽƌĞŵ
ŝĂďĞƚĞƐ͕ŽĨĂƌŵĂĐġƵƟĐŽƉŽĚĞĐĂƉĂĐŝƚĂƌŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽĂŐĞƌŝƌŵĞůŚŽƌŽƐĞƵĐŽŶƚƌŽůĞ͕ĂƚƌĂǀĠƐ
ĚŽ ĂƵƚŽĐƵŝĚĂĚŽ ƚĂŝƐ ĐŽŵŽ ŽƌŝĞŶƚĂŶĚŽͲŽ ŶĂƐ ŵĞůŚŽƌĞƐ ƉƌĄƟĐĂƐ ĚĞ ƵƐŽ ĐŽƌƌĞƚŽ ĚĂƐ ŵĞĚŝĐĂĕƁĞƐ Ğ
ĞƋƵŝƉĂŵĞŶƚŽƐĐŽŵŽŐůŝĐŽƐşŵĞƚƌŽƐĞĚŝƐƉŽƐŝƟǀŽƐƉĂƌĂĂƉůŝĐĂĕĆŽĚĞŝŶƐƵůŝŶĂĐŽŵŽĐĂŶĞƚĂƐĞƐĞƌŝŶŐĂƐ͘

ƉƌĞƐƚĂĕĆŽĚĞƐĞƌǀŝĕŽƐĚĞŐĞƌĞŶĐŝĂŵĞŶƚŽĚĞĚŝĂďĞƚĞƐƌĞƋƵĞƌĐŽŶŚĞĐŝŵĞŶƚŽĚŽŵĞƌĐĂĚŽ͕ŚĂďŝůŝĚĂĚĞƐ
ĚĞ ĐŽŵƵŶŝĐĂĕĆŽ Ğ Ƶŵ ĐŽŵƉƌŽŵŝƐƐŽ ĚĞ ƚĞŵƉŽ͕ ĞƐĨŽƌĕŽ Ğ ƌĞĐƵƌƐŽƐ͘ &ĂƌŵĂĐġƵƟĐŽƐ ƋƵĞ Žďƚġŵ
ƚƌĞŝŶĂŵĞŶƚŽĞŵŐĞƐƚĆŽĚĞĚŝĂďĞƚĞƐĐŽůŚĞŵƌĞĐŽŵƉĞŶƐĂƐĞŵƐĂƟƐĨĂĕĆŽƉƌŽĮƐƐŝŽŶĂů ĞƌĞĞŵďŽůƐŽ
ĮŶĂŶĐĞŝƌŽ͘Ϯ

6 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Farmácia Clínica
e o Consultório
Farmacêutico
&ĂƌŵĂĐġƵƟĐŽƐĚĞƐĞŵƉĞŶŚĂŵƵŵƉĂƉĞůĐƌşƟĐŽŶŽƐŝƐƚĞŵĂĚĞƐĂƷĚĞ͘ƉƌĄƟĐĂĚĂĨĂƌŵĄĐŝĂƚĂŵďĠŵ
ĞƐƚĄ ĞǀŽůƵŝŶĚŽ Ğ ƐĞ ĞdžƉĂŶĚŝŶĚŽ Ğ ŽƐ ĨĂƌŵĂĐġƵƟĐŽƐ ĞƐƚĆŽ ĂƐƐƵŵŝŶĚŽ ŵĂŝƐ ƌĞƐƉŽŶƐĂďŝůŝĚĂĚĞƐ Ğ
ĂƟǀŝĚĂĚĞƐĚŽƋƵĞŶƵŶĐĂ͘ŽŵĂĨĂůġŶĐŝĂĚŽƐŝƐƚĞŵĂƉƷďůŝĐŽĚĞƐĂƷĚĞ͕ĂƐĨĂƌŵĄĐŝĂƐĐŽŵƵŶŝƚĄƌŝĂƐ
ĞƐƚĆŽĂďƐŽƌǀĞŶĚŽƐĞƌǀŝĕŽƐƋƵĞĂƚĠƉŽƵĐŽƚĞŵƉŽĂƚƌĄƐĞƌĂŵĚĞƌĞƐƉŽŶƐĂďŝůŝĚĂĚĞĚŽƐƉŽƐƚŽƐĚĞƐĂƷĚĞ͘
ƐƚĂƐĂƚƌŝďƵŝĕƁĞƐĞƐƚĆŽƐſŶŽŝŶşĐŝŽ͕ǀŝƐƚŽƋƵĞĂĐĂƉŝůĂƌŝĚĂĚĞĚĞůŽŐşƐƟĐĂĚĂƐĨĂƌŵĄĐŝĂƐĐŽŵƵŶŝƚĄƌŝĂƐ
ĠďĞŵŵĂŝƐĂďƌĂŶŐĞŶƚĞĚŽƋƵĞĂĚŽŶŽƐƐŽƐĞƌǀŝĕŽƉƷďůŝĐŽĚĞƐĂƷĚĞĂƚƵĂů͘

ŽŵĂůĞŝĨĞĚĞƌĂůϭϯ͘ϬϮϭϯ͕ƋƵĞƚƌĂŶƐĨŽƌŵĂŵĂĨĂƌŵĄĐŝĂĞŵĞƐƚĂďĞůĞĐŝŵĞŶƚŽĚĞƐĂƷĚĞ͕ĞĂƐƌĞƐŽůƵĕƁĞƐ
ϱϴϱϰĞϱϴϲϱĚŽ&&ʹŽŶƐĞůŚŽĨĞĚĞƌĂůĚĞĨĂƌŵĄĐŝĂ͕ƋƵĞƌĞŐƵůĂŵĞŶƚĂŵĂƐĂƚƌŝďƵŝĕƁĞƐĐůşŶŝĐĂƐĚŽ
ĨĂƌŵĂĐġƵƟĐŽĞĂƉƌĞƐĐƌŝĕĆŽĨĂƌŵĂĐġƵƟĐĂ͕ƌĞƐƉĞĐƟǀĂŵĞŶƚĞ͘ůĂƐǀŝĞƌĂŵƉĂƌĂƌĞƐŐĂƚĂƌĞŶŽƌŵĂƟnjĂƌ
ŽƋƵĞũĄĂĐŽŶƚĞĐŝĂ͕ĚĞĨŽƌŵĂŝŶĨŽƌŵĂů͕ŶŽƐďĂůĐƁĞƐĚĂƐĨĂƌŵĄĐŝĂƐĞŵƚŽĚŽŽƌĂƐŝů͘

&ĂƌŵĄĐŝĂ ůşŶŝĐĂ Ġ Ă ĄƌĞĂ ĚĂ ĨĂƌŵĄĐŝĂ ƉƌĞŽĐƵƉĂĚĂ ĐŽŵ Ă ĐŝġŶĐŝĂ Ğ ƉƌĄƟĐĂ ĚĞ ƵƐŽ ĚĞ ŵĞĚŝĐĂĕĆŽ
ƌĂĐŝŽŶĂůϲ͘ƐƚĞŵŽǀŝŵĞŶƚŽƚĞǀĞŝŶşĐŝŽŶŽƐϲϬ͕ŶĂƵŶŝǀĞƌƐŝĚĂĚĞĚĞDŝĐŚŝŐĂŶ͕ŶŽƐƐƚĂĚŽƐhŶŝĚŽƐϳ͘

K ĨĂƌŵĂĐġƵƟĐŽ ĐůşŶŝĐŽ ĚĞǀĞ ŐĂƌĂŶƟƌ Ž ƵƐŽ ƌĂĐŝŽŶĂů ĚŽƐ ŵĞĚŝĐĂŵĞŶƚŽƐ Ğ ĐƵŝĚĂƌ ĚŽƐ ƉĂĐŝĞŶƚĞƐ
ƉƌŽŵŽǀĞŶĚŽƐĂƷĚĞĞƋƵĂůŝĚĂĚĞĚĞǀŝĚĂ͘

ƐƚĂŵŽƐƉĂƐƐĂŶĚŽƉŽƌƵŵƉƌŽĐĞƐƐŽĚĞƚƌĂŶƐĨŽƌŵĂĕĆŽŶĂƉƌŽĮƐƐĆŽĨĂƌŵĂĐġƵƟĐĂ͕ŽŶĚĞŽĨĂƌŵĂĐġƵƟĐŽ
ĚĞǀĞ ǀŽůƚĂƌ Ă ƐĞ ĮƌŵĂƌ ĐŽŵŽ ƉƌŽĮƐƐŝŽŶĂů ĚĞ ƐĂƷĚĞ Ğ ŵƵĚĂƌ Ž ƉĂƌĂĚŝŐŵĂ ĚĞ ƋƵĞ Ġ ƐŽŵĞŶƚĞ Ƶŵ
ĞŶƚƌĞŐĂĚŽƌĚĞĐĂŝdžĂƐĚĞŵĞĚŝĐĂŵĞŶƚŽƐŶŽƐďĂůĐƁĞƐĚĂƐĨĂƌŵĄĐŝĂƐĞĚƌŽŐĂƌŝĂƐ͘

ƉŽƐƐŝďŝůŝĚĂĚĞĚĞƐƚĞƌĞƐŐĂƚĞĞƐƚĄŶŽƐĐŽŶƐƵůƚſƌŝŽƐĨĂƌŵĂĐġƵƟĐŽƐƋƵĞƐĞŵƵůƟƉůŝĐĂŵĂĐĂĚĂĚŝĂĞŵ
ŶŽƐƐŽƉĂşƐ͘

KĐŽŶƐƵůƚſƌŝŽ&ĂƌŵĂĐġƵƟĐŽĠŽůŽĐĂůĂƉƌŽƉƌŝĂĚŽƉĂƌĂƌĞĂůŝnjĂƌƚŽĚŽĞƐƚĞĂƚĞŶĚŝŵĞŶƚŽĚĞƉƌŽĐĞƐƐŽ
ĚĞƚƌĂŶƐĨŽƌŵĂĕĆŽŶĂǀŝĚĂĚŽƐƉĂĐŝĞŶƚĞƐ͘ůŝŽĨĂƌŵĂĐġƵƟĐŽĠŽŵĂĞƐƚƌŽƋƵĞƌĞŐĞĞƐƚĂĨĂŶƚĄƐƟĐĂ
ĞdžƉĞƌŝġŶĐŝĂ͕ƵƐĂŶĚŽƚŽĚŽŽƐĞƵĐŽŶŚĞĐŝŵĞŶƚŽĨĂƌŵĂĐŽƚĞƌĂƉġƵƟĐŽƉĂƌĂĞĚƵĐĂƌĞŽƌŝĞŶƚĂƌŽƉĂĐŝĞŶƚĞ͕
ĂƐƐŝŵĐŽŵŽ͕ƌĞĐŽŵĞŶĚĂƌĂŽŵĠĚŝĐŽŽƐĂũƵƐƚĞƐŶĞĐĞƐƐĄƌŝŽƐĂŽƚƌĂƚĂŵĞŶƚŽ͘

KƐĐŽŶƐƵůƚſƌŝŽƐĨĂƌŵĂĐġƵƟĐŽƐƉŽĚĞŵĞƐƚĂƌƉƌĞƐĞŶƚĞƐĚĞŶƚƌŽĚĂƐĨĂƌŵĄĐŝĂƐϴďƌĂƐŝůĞŝƌĂƐ͕ĐŽŵŽũĄǀĞŵ

7 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŽĐŽƌƌĞŶĚŽĚĞƐĚĞŵĞĂĚŽƐĚĞϮϬϭϲ͕ĂƐƐŝŵĐŽŵŽĞŵĐůşŶŝĐĂƐƉĂƌƟĐƵůĂƌĞƐ͘hŵĞƐƚƵĚŽƌĞĂůŝnjĂĚŽƉŽƌƵŵĂ
ĐůşŶŝĐĂĂŵĞƌŝĐĂŶĂĚĞĞŶĚŽĐƌŝŶŽůŽŐŝĂϵ͕ĚĞŵŽŶƐƚƌŽƵƋƵĞŽĂƚĞŶĚŝŵĞŶƚŽĐŽůĂďŽƌĂƟǀŽĞŶĚŽĐƌŝŶŽůŽŐŝƐƚĂͲ
ĨĂƌŵĂĐġƵƟĐŽ͕ƉĂƌĂƉĂĐŝĞŶƚĞƐĚŝĂďĠƟĐŽƐŵĂŝƐĐŽŵƉůĞdžŽƐ͕ŽŶĚĞŽĨĂƌŵĂĐġƵƟĐŽĚŝƐƉĞŶƐĂŵĂŝƐƚĞŵƉŽ
ŶŽĂƚĞŶĚŝŵĞŶƚŽƉĞƌƐŽŶĂůŝnjĂĚŽĂŽƉĂĐŝĞŶƚĞ͕ĞdžŝƐƚĞďĞŶĞİĐŝŽƐĐůşŶŝĐŽƐĞĞĐŽŶƀŵŝĐŽƐĐŽŵƉƌŽǀĂĚŽƐ͘

hŵĂĚĂƐŵĂŝŽƌĞƐĚƷǀŝĚĂƐƋƵĞĂĐŽŵĞƚĞŽĨĂƌŵĂĐġƵƟĐŽĐůşŶŝĐŽĂƚƵĂůŵĞŶƚĞĠ͗͞ŽďƌĂƌŽƵŶĆŽĐŽďƌĂƌ
ƉĞůĂĐŽŶƐƵůƚĂ͍ĂƉĞƌŐƵŶƚĂƋƵĞĚĞǀĞŵŽƐĨĂnjĞƌĠ͗͞ƉŽƌƋƵĞŶĆŽĐŽďƌĂƌ͍͟YƵĂŶĚŽǀĂŵŽƐĂŽŵĠĚŝĐŽ͕
ƉĂŐĂŵŽƐ ƉĞůĂ ĐŽŶƐƵůƚĂ ĚŝƌĞƚĂ ŽƵ ŝŶĚŝƌĞƚĂŵĞŶƚĞ ;ƉĞůŽ ^h^͕ ƉĞůŽ ƉůĂŶŽ ĚĞ ƐĂƷĚĞ ŽƵ Ğŵ ĐŽŶƐƵůƚĂƐ
ƉĂƌƟĐƵůĂƌĞƐͿ͕ŵĂƐƉĂŐĂŵŽƐŽƋƵĞ͍KƋƵĞ͞ĐŽŵƉƌĂŵŽƐ͟ĚŽŵĠĚŝĐŽ͍ŽŵƉƌĂŵŽƐƐĞƵĐŽŶŚĞĐŝŵĞŶƚŽ
ĠĞƐƚĞŽƉƌŽĚƵƚŽƋƵĞŽŵĠĚŝĐŽŶŽƐĞŶƚƌĞŐĂ͘ĞƐƚĂŵĂŶĞŝƌĂ͕ŽƐĨĂƌŵĂĐġƵƟĐŽƐƚĂŵďĠŵĚĞǀĞŵĐŽďƌĂƌ͕
ƉŽƌ ƐƵĂƐ ŽƌŝĞŶƚĂĕƁĞƐ͕ ƉŽŝƐ ĂŶƚĞƐ ĚĞ ĂĚƋƵŝƌŝƌ ĞƐƚĞ ĐŽŶŚĞĐŝŵĞŶƚŽ͕ ĨŽŝ ĨĞŝƚŽ Ƶŵ ŝŶǀĞƐƟŵĞŶƚŽ ƉĂƌĂ
ĂĚƋƵŝƌŝƌĞƐƚĞĐŽŶŚĞĐŝŵĞŶƚŽ͘

KƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽĠŽŵĂŝŽƌƟĐŬĞƚŵĠĚŝŽĚŽǀĂƌĞũŽĨĂƌŵĂĐġƵƟĐŽ͕ĞůĞŐĂƐƚĂĞŵŵĠĚŝĂZΨϯϱϬ͕ϬϬƉŽƌ
ŵġƐŶĂĨĂƌŵĄĐŝĂ͕ŝƐƐŽĂĐŽŶƚĞĐĞ͕ƉŽƌƋƵĞĞůĞĠƵŵƉĂĐŝĞŶƚĞƋƵĞŶŽƌŵĂůŵĞŶƚĞĠƉŽůŝŵĞĚŝĐĂŵĞŶƚĂĚŽ͕
ĚĞǀŝĚŽĂƐĐŽŵŽƌďŝĚĂĚĞƐƋƵĞƐĞŝŶƐƚĂůĂŵĂŽůŽŐŽĚĞĂŶŽƐĚŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞĂůƚĞƌĂĚŽ͘

hŵƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽƟƉŽϮƉŽĚĞůĞǀĂƌĚĞϰĂϳĂŶŽƐƉĂƌĂƐĞƌĚŝĂŐŶŽƐƟĐĂĚŽ͕ƉŽŝƐĞƐƚĂŵŽƐĨĂůĂŶĚŽ
ĂƋƵŝĚĞƵŵĂĚŽĞŶĕĂŽŶĚĞŽƐƐŝŶƚŽŵĂƐŶĆŽƐĆŽƉƌŽŶƵŶĐŝĂĚŽƐ͘ĞƌĐĂĚĞϰϳйĚŽƐŝŶĚŝǀşĚƵŽƐĚŝĂďĠƟĐŽƐ
ƟƉŽϮ͕ĂŝŶĚĂŶĆŽĨŽƌĂŵĚŝĂŐŶſƐƟĐĂĚŽƐϭ͘YƵĂŶĚŽƐĆŽĚŝĂŐŶŽƐƟĐĂĚŽƐ͕ĐĞƌĐĂĚĞϱϬйĚŽƐŝŶĚŝǀşĚƵŽƐũĄ
ĂƉƌĞƐĞŶƚĂŵĂůŐƵŵĂĐŽŵƉůŝĐĂĕĆŽĚĞǀŝĚŽĂŽůŽŶŐŽƉĞƌşŽĚŽĚĞĚĞƐĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽƐĞŵƚƌĂƚĂŵĞŶƚŽ
ĂĚĞƋƵĂĚŽ͘

ƐƚĞƉĂĐŝĞŶƚĞƚĞŵŶĞĐĞƐƐŝĚĂĚĞĚĞƐĞĂƵƚŽĐŽŶŚĞĐĞƌĞĚĞĐŽŶŚĞĐĞƌƐƵĂƉĂƚŽůŽŐŝĂ͘ƐŽƌŝĞŶƚĂĕƁĞƐ
ĚĂĚĂƐƉĞůŽĨĂƌŵĂĐġƵƟĐŽĠĂŵĞůŚŽƌĞŵĂŝƐƉƌſdžŝŵĂƉŽƐƐŝďŝůŝĚĂĚĞĚĞƋƵĞŝƐƐŽŽĐŽƌƌĂĚĞŵĂŶĞŝƌĂ

8 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ƉƌĞĐŝƐĂĞƐĞŐƵƌĂ͘KĨĂƌŵĂĐġƵƟĐŽĠŽƉƌŽĮƐƐŝŽŶĂůĚĞƐĂƷĚĞŵĂŝƐƉƌſdžŝŵŽĞĂĐĞƐƐşǀĞůĚĂƉŽƉƵůĂĕĆŽĞŵ
ŐĞƌĂů͕ƉŽĚĞŶĚŽĚĞƐĞŵƉĞŶŚĂƌƵŵƉĂƉĞůĨƵŶĚĂŵĞŶƚĂůĚĞĞĚƵĐĂĕĆŽĞŵƐĂƷĚĞ͕ŵŝŶŝŵŝnjĂŶĚŽŽƐƌŝƐĐŽƐ
ĚŽĚĞƐĞŶǀŽůǀŝŵĞŶƚŽĚĞĐŽŵŽƌďŝĚĂĚĞƐƉŽƌƉĂƌƚĞĚŽƐƉĂĐŝĞŶƚĞƐĚŝĂďĠƟĐŽƐĚŝĂŐŶŽƐƟĐĂĚŽƐŽƵŶĆŽ͘

Diabetes:
conceitos básicos
O que é diabetes?

ŝĂďĞƚĞƐĠƵŵĂƉĂƚŽůŽŐŝĂƋƵĞĂĐŽŶƚĞĐĞƋƵĂŶĚŽŽŽƌŐĂŶŝƐŵŽĚŽŝŶĚŝǀşĚƵŽŶĆŽĐŽŶƐĞŐƵĞƉƌŽĐĞƐƐĂƌ
ĂĚĞƋƵĂĚĂŵĞŶƚĞĂŐůŝĐŽƐĞ͕ƉƌŽĚƵnjŝĚĂƉĞůĂĚŝŐĞƐƚĆŽĚŽƐĂůŝŵĞŶƚŽƐŝŶŐĞƌŝĚŽƐ͕ĞŵĞŶĞƌŐŝĂ͘ƐƚĞƉƌŽĐĞƐƐŽ
ĚĞƉĞŶĚĞĚĂŝŶƐƵůŝŶĂ͕ŚŽƌŵƀŶŝŽŶĞĐĞƐƐĄƌŝŽƉĂƌĂƚƌĂŶƐƉŽƌƚĂƌĂŐůŝĐŽƐĞ͕ĚĂĐŽƌƌĞŶƚĞƐĂŶŐƵşŶĞĂ͕ƉĂƌĂ
ĚĞŶƚƌŽĚĂƐĐĠůƵůĂƐĞĂƐƐŝŵƚƌĂŶƐĨŽƌŵĄͲůĂĞŵĞŶĞƌŐŝĂ͘

ĨĂůƚĂƚŽƚĂůŽƵƉĂƌĐŝĂůĚĞŝŶƐƵůŝŶĂ͕ĂƐƐŝŵĐŽŵŽƋƵĂŶĚŽĞůĂŶĆŽĚĞƐĞŵƉĞŶŚĂƐĞƵƉĂƉĞůĐŽƌƌĞƚĂŵĞŶƚĞ
;ƌĞƐŝƐƚġŶĐŝĂ ŝŶƐƵůşŶŝĐĂͿ͕ ůĞǀĂŵ Ă ƵŵĂ ĞůĞǀĂĕĆŽ ĚĂ ŐůŝĐĞŵŝĂ ĚŽ ŝŶĚŝǀşĚƵŽ͕ ƋƵĞ ƋƵĂŶĚŽ Ġ х ƋƵĞ ϭϮϲ
ŵŐͬĚ>ĚĞƐĂŶŐƵĞĞŵũĞũƵŵŽƵхϮϬϬŵŐͬĚůĚĞƐĂŶŐƵĞϮŚŽƌĂƐĂƉſƐƵŵĂƌĞĨĞŝĕĆŽ͕ĚŝnjĞŵŽƐƋƵĞĞƐƚĞ
ŝŶĚŝǀşĚƵŽƚĞŵŝĂďĞƚĞƐ͘

sĂůŽƌĞƐĞŶĐŽŶƚƌĂĚŽƐĞŶƚƌĞŽŝŶƚĞƌǀĂůŽхϵϵŵŐͬĚ>ĞфϭϮϲŵŐͬĚ>͕ĞŵũĞũƵŵĞхϭϰϬŵŐͬĚ>ĞфϮϬϬŵŐͬ
Ě>͕ƚĞŵŽƐŽƐŝŶĚŝǀşĚƵŽƐĐŚĂŵĂĚŽƐĚĞƉƌĠͲĚŝĂďĠƟĐŽƐ͘ƐƚĞƐĚĞǀĞŵƐĞĐƵŝĚĂƌ͕ĂƚƌĂǀĠƐĚĂŵƵĚĂŶĕĂĚĞ

9 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŚĄďŝƚŽƐĚĞǀŝĚĂ͕ĂĚŽĕĆŽĚĞĂůŝŵĞŶƚĂĕĆŽďĂůĂŶĐĞĂĚĂĞĂƟǀŝĚĂĚĞİƐŝĐĂƌĞŐƵůĂƌ͕ƉĂƌĂƋƵĞĞƐƚĞĞƐƚĄŐŝŽ
ŶĆŽƐĞƚƌĂŶƐĨŽƌŵĞĞŵĚŝĂďĞƚĞƐ͘

Quem pode ter diabetes?

ŝĂďĞƚĞƐ Ġ ƵŵĂ ƉĂƚŽůŽŐŝĂ ŵƵŝƚŽ ĚĞŵŽĐƌĄƟĐĂ͕ ƋƵĂůƋƵĞƌ ŝŶĚŝǀşĚƵŽ ƉŽĚĞ ĚĞƐĞŶǀŽůǀĞƌ͕
ŝŶĚĞƉĞŶĚĞŶƚĞŵĞŶƚĞĚĂŝĚĂĚĞ͕ƐĞdžŽ͕ƌĂĕĂ͕ƌĞůŝŐŝĆŽĞĐŽŶĚŝĕĆŽƐŽĐŝŽĞĐŽŶƀŵŝĐĂ͘

ƟŽůŽŐŝĂĚŽŝĂďĞƚĞƐ
KƐƉƌŝŶĐŝƉĂŝƐƟƉŽƐĚĞĚŝĂďĞƚĞƐƐĆŽ͗ŽdŝƉŽϭĞŽdŝƉŽϮ͘

DƵŝƚĂƐ ƉĞƐƐŽĂƐ ĐŽŶĨƵŶĚĞŵ ŽƐ ƟƉŽƐ ĚĞ ĚŝĂďĞƚĞƐ ƉĞůĂ ŶĞĐĞƐƐŝĚĂĚĞ ĚŽ ƵƐŽ ĚĞ ŝŶƐƵůŝŶĂ͕ ŵĂƐ ƚŽĚŽƐ
ŽƐƟƉŽƐĚĞĚŝĂďĞƚĞƐƉŽĚĞŵƵŵĚŝĂŶĞĐĞƐƐŝƚĂƌĚĞĂƉůŝĐĂĕƁĞƐĚĞŝŶƐƵůŝŶĂ͕ĚĞƐƚĂŵĂŶĞŝƌĂ͕ĚĞǀĞŵŽƐ
ůĞŵďƌĂƌƋƵĞŽƵƐŽĚĞŝŶƐƵůŝŶĂŶĆŽĚĞƚĞƌŵŝŶĂŽƟƉŽĚĞĚŝĂďĞƚĞƐ͘

Diabetes Tipo 1 (DM1)

KdŝƉŽϭŽƵDϭĂĐŽŵĞƚĞĐĞƌĐĂĚĞϭϬйĚĂƐƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐĞŵƚŽĚŽŽŵƵŶĚŽ͘ƐƚĂĠƵŵĂ
ĚŽĞŶĕĂĂƵƚŽŝŵƵŶĞ͕ŽƵƐĞũĂ͕ŽƐŝƐƚĞŵĂŝŵƵŶŽůſŐŝĐŽĚĂƉĞƐƐŽĂŶĆŽƌĞĐŽŶŚĞĐĞŵĂŝƐĂƐĐĠůƵůĂƐďĞƚĂ
ƉĂŶĐƌĞĄƟĐĂƐĞĂƐĚĞƐƚƌſŝ͘

'ĞƌĂůŵĞŶƚĞĚŝĂŐŶŽƐƟĐĂĚŽĞŵĐƌŝĂŶĕĂƐĞũŽǀĞŶƐĂĚƵůƚŽƐ͕ĂŶƚĞƌŝŽƌŵĞŶƚĞĞƌĂĐŽŶŚĞĐŝĚĂĐŽŵŽĚŝĂďĞƚĞƐ
ũƵǀĞŶŝů͘EŽDϭŽŽƌŐĂŶŝƐŵŽŶĆŽƉƌŽĚƵnjŝŶƐƵůŝŶĂ͘

ŽŵŽ Ă ŝŶƐƵůŝŶĂ Ġ ĞƐƐĞŶĐŝĂů ƉĂƌĂ ǀŝĚĂ ŚƵŵĂŶĂ͕ ƋƵĞŵ ƚĞŵ Dϭ ƉƌĞĐŝƐĂ ĨĂnjĞƌ   ĂƉůŝĐĂĕƁĞƐ ĚŝĄƌŝĂƐ
ĚĞƐƚĞŚŽƌŵƀŶŝŽ͕ĚŝĞƚĂďĂůĂŶĐĞĂĚĂĞĂƟǀŝĚĂĚĞİƐŝĐĂ͘^ĂďĞƌƐĞĐƵŝĚĂƌƉĂƌĂĐŽŶƚƌŽůĂƌƐƵĂĐŽŶĚŝĕĆŽĠ
ĨƵŶĚĂŵĞŶƚĂůƉĂƌĂƵŵĂǀŝĚĂůŽŶŐĂ͕ƐĂƵĚĄǀĞůĞĨĞůŝnj͘YƵĞŵĐŽŶǀŝǀĞĐŽŵŽĚŝĂďĞƚĞƐĚĞǀĞŝŶĐŽƌƉŽƌĂƌ
ĞƐƚĂĂƟƚƵĚĞĞĂƚĠŵĞƐŵŽĐƌŝĂŶĕĂƐƉĞƋƵĞŶĂƐĐŽŵDϭƚġŵĞƐƚĞƉŽĚĞƌ͊

Diabetes Tipo 2 (DM2)

KdŝƉŽϮŽƵDϮĂĐŽŶƚĞĐĞĞŵϵϬйĚŽƐĐĂƐŽƐĚĞĚŝĂďĞƚĞƐĞĠĐŽŶƐŝĚĞƌĂĚĂƐŝůĞŶĐŝŽƐĂ͕ƉŽŝƐƋƵĞŵƚĞŵ
ĞƐƚĂĚŝƐĨƵŶĕĆŽŐĞƌĂůŵĞŶƚĞŶĆŽĂƉƌĞƐĞŶƚĂƐŝŶƚŽŵĂƐ͘džŝƐƚĞƵŵĂŐƌĂŶĚĞƌĞůĂĕĆŽĞŶƚƌĞobesidade e
sedentarismo͘ƐƟŵĂͲƐĞƋƵĞϲϬйĂϵϬйĚŽƐƉŽƌƚĂĚŽƌĞƐĚĂĚŽĞŶĕĂƐĞũĂŵŽďĞƐŽƐ͘EŽĚŝĂďĞƚĞƐƟƉŽ
Ϯ͕ŽŽƌŐĂŶŝƐŵŽNÃOƉƌŽĚƵnjŝŶƐƵůŝŶĂƐƵĮĐŝĞŶƚĞŽƵĂŝŶƐƵůŝŶĂƉƌŽĚƵnjŝĚĂNÃOĚĞƐĞŵƉĞŶŚĂƐĞƵƉĂƉĞů
ĐŽƌƌĞƚĂŵĞŶƚĞ͘

10 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŝŶĐŝĚġŶĐŝĂĚŽDϮĠŵĂŝŽƌĂƉſƐŽƐϰϬĂŶŽƐ͘sŽĐġƉŽĚĞƉƌĞǀĞŶŝƌŽƵƌĞƚĂƌĚĂƌƐĞƵĂƉĂƌĞĐŝŵĞŶƚŽ
ĂƚƌĂǀĠƐĚĞƵŵĞƐƟůŽĚĞǀŝĚĂƐĂƵĚĄǀĞů͘&ĂĕĂƵŵĂĂůŝŵĞŶƚĂĕĆŽĞƋƵŝůŝďƌĂĚĂ͕ĂƵŵĞŶƚĞŽƐĞƵŶşǀĞůĚĞ
ĂƟǀŝĚĂĚĞİƐŝĐĂ͕ŵĂŶƚĞŶŚĂƵŵƉĞƐŽƐĂƵĚĄǀĞů͊ŽŵĞƐƚĂƐŵĞĚŝĚĂƐƉŽƐŝƟǀĂƐ͕ǀŽĐġƉŽĚĞĮĐĂƌŵĂŝƐ
ƐĂƵĚĄǀĞůĞƌĞĚƵnjŝƌŽƌŝƐĐŽĚĞĚĞƐĞŶǀŽůǀĞƌĚŝĂďĞƚĞƐ͘

11 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Diabetes
Gestacional
ƵƌĂŶƚĞ Ă ŐƌĂǀŝĚĞnj͕ ŵƵůŚĞƌĞƐ ƋƵĞ ĂƉƌĞƐĞŶƚĂŵ ŶşǀĞŝƐ ĞůĞǀĂĚŽƐ ĚĞ ŐůŝĐŽƐĞ ŶŽ ƐĂŶŐƵĞ ƉŽĚĞŵ ƐĞƌ
ĚŝĂŐŶŽƐƟĐĂĚĂƐĐŽŵĚŝĂďĞƚĞƐŐĞƐƚĂĐŝŽŶĂů͘ƐƚĞƟƉŽĂĨĞƚĂĐĞƌĐĂĚĞϰйĚĞƚŽĚĂƐĂƐŵƵůŚĞƌĞƐŐƌĄǀŝĚĂƐ
ĞĞůĂƐŐĞƌĂůŵĞŶƚĞƐĆŽĚŝĂŐŶŽƐƟĐĂĚĂƐĞŵƚŽƌŶŽĚĂϮϴǐƐĞŵĂŶĂ͘

KŝĂďĞƚĞƐŐĞƐƚĂĐŝŽŶĂůŶĆŽƚƌĂƚĂĚŽŽƵŵĂůĐŽŶƚƌŽůĂĚŽƉŽĚĞĂĨĞƚĂƌŽďĞďġ͘KƋƵĞĂĐŽŶƚĞĐĞĠƋƵĞ
ŽƉąŶĐƌĞĂƐƚƌĂďĂůŚĂƉĂƌĂƉƌŽĚƵnjŝƌŝŶƐƵůŝŶĂ͕ƉŽƌĠŵĞůĂŶĆŽĐŽŶƐĞŐƵĞďĂŝdžĂƌŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽ
ƐĂŶŐƵĞ͘

ŝŶƐƵůŝŶĂŶĆŽĂƚƌĂǀĞƐƐĂĂƉůĂĐĞŶƚĂ͕ŵĂƐĂŐůŝĐŽƐĞĞŽƵƚƌŽƐŶƵƚƌŝĞŶƚĞƐ͕Ɛŝŵ͘ŐůŝĐŽƐĞƋƵĞĞƐƚĄĞŵ
ĞdžĐĞƐƐŽ ŶŽ ƐĂŶŐƵĞ ĚĂ ŵĆĞ ĞůĞǀĂ ŽƐ ŶşǀĞŝƐ ĚĞ ŐůŝĐŽƐĞ ŶŽ ƐĂŶŐƵĞ ĚŽ ďĞďġ͕ ŽŵŽ ĞůĞ ŐĂŶŚĂ ŵĂŝƐ
ĐĂůŽƌŝĂƐĚŽƋƵĞŶĞĐĞƐƐŝƚĂƉĂƌĂĐƌĞƐĐĞƌĞƐĞĚĞƐĞŶǀŽůǀĞƌ͕ĞůĞĂƌŵĂnjĞŶĂĞƐƚĂĞŶĞƌŐŝĂĞdžƚƌĂŶĂĨŽƌŵĂĚĞ
ŐŽƌĚƵƌĂ͘/ƐƐŽƉŽĚĞůĞǀĂƌăŵĂĐƌŽƐƐŽŵŝĂ͕ŽƵƵŵďĞďġŐŽƌĚŽ͕ŶŽƌŵĂůŵĞŶƚĞĐŽŵƉĞƐŽĂĐŝŵĂĚĞϰŬŐ͘
ƋƵĞĐŽŶƐĞƋƵġŶĐŝĂŝƐƐŽƉŽĚĞƚĞƌ͍ZŝƐĐŽĚĞĐŽŵƉůŝĐĂĕƁĞƐŶŽƉĂƌƚŽ͕ĚĞŶƚƌĞŽƵƚƌĂƐƐŝƚƵĂĕƁĞƐ͘

WŽƌĐĂƵƐĂĚŽĂƵŵĞŶƚŽĚĂŐůŝĐĞŵŝĂĚŽďĞďġ;ĂŝŶĚĂĚƵƌĂŶƚĞĂŐƌĂǀŝĚĞnjͿ͕ƐĞƵƉąŶĐƌĞĂƐƉĂƐƐĂĂĨĂďƌŝĐĂƌ
ŝŶƐƵůŝŶĂĞŵĞdžĐĞƐƐŽ͕ŽƋƵĞƉŽĚĞůĞǀĂƌĂŽƌŝƐĐŽĚĞŚŝƉŽŐůŝĐĞŵŝĂ;ŐůŝĐĞŵŝĂŵƵŝƚŽďĂŝdžĂͿŶŽƐƌĞĐĠŵͲ
ŶĂƐĐŝĚŽƐĞƚĂŵďĠŵŚĄƵŵŵĂŝŽƌƌŝƐĐŽĚĞƉƌŽďůĞŵĂƐƌĞƐƉŝƌĂƚſƌŝŽƐ͘
^ĂďĞͲƐĞƋƵĞďĞďġƐƋƵĞƉĂƐƐĂŵƉŽƌĞƐƚĂƐƐŝƚƵĂĕƁĞƐƐĞƚŽƌŶĂŵĐƌŝĂŶĕĂƐĞĂĚƵůƚŽƐĐŽŵŵĂŝŽƌƌŝƐĐŽĚĞ
ĚĞƐĞŶǀŽůǀĞƌŽďĞƐŝĚĂĚĞĞĚŝĂďĞƚĞƐƟƉŽϮ͘

dŽĚŽƐĞƐƚĞƐƉƌŽďůĞŵĂƐƉŽĚĞŵƐĞƌĞǀŝƚĂĚŽƐŽƵƌĞĚƵnjŝĚŽƐƋƵĂŶĚŽĂƐŵĂŵĆĞƐŐƌĄǀŝĚĂƐĐŽŶƐĞŐƵĞŵ
ĐŽŶƚƌŽůĂƌ ďĞŵ ƐƵĂƐ ŐůŝĐĞŵŝĂƐ͘ WĂƌĂ ŝƐƐŽ͕ ƚƌĂƚĂŵĞŶƚŽ͕ ĞdžĂŵĞƐ Ğ ĂĐŽŵƉĂŶŚĂŵĞŶƚŽ ŵĠĚŝĐŽ ƐĆŽ
ĨƵŶĚĂŵĞŶƚĂŝƐ͊

Quais são os sinais e sintomas do diabetes?

DƵŝƚŽƐ ĚŽƐ ƐŝŶĂŝƐ Ğ ƐŝŶƚŽŵĂƐ ĚŽ ĚŝĂďĞƚĞƐ ƉĂƌĞĐĞŵ ŝŶŽĨĞŶƐŝǀŽƐ͕ ůĞǀĂŶĚŽ Ă ƵŵĂ ĚŝĮĐƵůĚĂĚĞ ŶŽ
ĚŝĂŐŶſƐƟĐŽŝŶŝĐŝĂů͘ƐƚƵĚŽƐŝŶĚŝĐĂŵƋƵĞƋƵĂŶƚŽŵĂŝƐƉƌĞĐŽĐĞĨŽƌŽĚŝĂŐŶſƐƟĐŽĞŽŝŶşĐŝŽĚŽƚƌĂƚĂŵĞŶƚŽ͕
ŵĞŶŽƌĞƐƐĆŽĂƐĐŚĂŶĐĞƐĚĞĚĞƐĞŶǀŽůǀĞƌĂƐƐĠƌŝĂƐĐŽŵƉůŝĐĂĕƁĞƐĚŽĚŝĂďĞƚĞƐ͘

12 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Diabetes Tipo 1
ͻ WŽůŝƷƌŝĂ͖
ͻ WŽůŝĚŝƉƐŝĂ͖
ͻ WŽůŝĨĂŐŝĂ͖
ͻ WĞƌĚĂĚĞƉĞƐŽ͖
ͻ džƚƌĞŵĂĨĂĚŝŐĂĞŝƌƌŝƚĂďŝůŝĚĂĚĞ͘

Diabetes Tipo 2
EŽƌŵĂůŵĞŶƚĞŽƐƐŝŶƚŽŵĂƐĚŽĚŝĂďĞƚĞƐƟƉŽϮƐĆŽƐŝůĞŶĐŝŽƐŽƐ͕ĂƚƌĂƐĂŶĚŽŽĚŝĂŐŶſƐƟĐŽĞŽŝŶşĐŝŽĚŽ
ƚƌĂƚĂŵĞŶƚŽ͘
ͻ YƵĂůƋƵĞƌƵŵĚŽƐƐŝŶƚŽŵĂƐůŝƐƚĂĚŽƐĂĐŝŵĂ;ŽƟƉŽϭͿ͖
ͻ /ŶĨĞĐĕƁĞƐĨƌĞƋƵĞŶƚĞƐ͖
ͻ sŝƐĆŽƚƵƌǀĂ͖
ͻ ŽƌƚĞƐͬŵĂĐŚƵĐĂĚŽƐƋƵĞĚĞŵŽƌĂŵĂĐŝĐĂƚƌŝnjĂƌ͖
ͻ &ŽƌŵŝŐƵĞŝƌŽŽƵĚŽƌŵġŶĐŝĂͬŶĂƐŵĆŽƐͬƉĠƐ͖
ͻ ZĞĐŽƌƌĞŶƚĞƉĞůĞ͕ŐĞŶŐŝǀĂ͕ŽƵŝŶĨĞĐĕƁĞƐĚĂďĞdžŝŐĂ͘

Entendendo os
sinais e sintomas
do diabetes
Poliúria
WŽůŝƷƌŝĂĠƵŵĂĐŽŶĚŝĕĆŽĞŵƋƵĞŽĐŽƌƉŽƵƌŝŶĂŵĂŝƐĚŽƋƵĞŽŚĂďŝƚƵĂů͕ƉĂƐƐĂŶĚŽĂĞůŝŵŝŶĂƌƋƵĂŶƟĚĂĚĞƐ
ĞdžĐĞƐƐŝǀĂƐĚĞƵƌŝŶĂĂĐĂĚĂŵŝĐĕĆŽ͕ƋƵĂŶƟĚĂĚĞƐƐƵƉĞƌŝŽƌĞƐĂϯůŝƚƌŽƐƉŽƌĚŝĂĞŵĐŽŵƉĂƌĂĕĆŽĐŽŵĂ
ƉƌŽĚƵĕĆŽĚŝĄƌŝĂŶŽƌŵĂůĚĞƵƌŝŶĂĞŵĂĚƵůƚŽƐƋƵĞĠĚĞĐĞƌĐĂĚĞƵŵĂĚŽŝƐůŝƚƌŽƐ͘

ƐƚĞĠƵŵĚŽƐƉƌŝŶĐŝƉĂŝƐƐŝŶƚŽŵĂƐĚĞĚŝĂďĞƚĞƐ;ĂŵďŽƐŽƐƟƉŽƐĚĞĚŝĂďĞƚĞƐϭĞϮͿĞƉŽĚĞůĞǀĂƌĂ
ĚĞƐŝĚƌĂƚĂĕĆŽŐƌĂǀĞ͘YƵĂŶĚŽŶĆŽƚƌĂƚĂĚĂƉŽĚĞĂĨĞƚĂƌĂĨƵŶĕĆŽƌĞŶĂů͘

WĂƌƚĞĚŽĞdžĐĞƐƐŽĚĞŐůŝĐŽƐĞŶĂĐŽƌƌĞŶƚĞƐĂŶŐƵşŶĞĂĚŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽ͕ŶĆŽĠƌĞĂďƐŽƌǀŝĚĂƉĞůŽƐ
ƌŝŶƐ͕ĂĞůŝŵŝŶĂĕĆŽĚĞƐƚĞĞdžĐĞƐƐŽƉƌŽǀŽĐĂƵŵĂƵŵĞŶƚŽĚŽǀŽůƵŵĞĚĞƵƌŝŶĂ͘

13 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Polidipsia

WŽůŝĚŝƉƐŝĂĠŽƚĞƌŵŽƵƐĂĚŽƋƵĂŶĚŽƐĞƚĞŵƐĞĚĞĞdžĐĞƐƐŝǀĂĞĠƵŵĚŽƐƐŝŶƚŽŵĂƐŝŶŝĐŝĂŝƐĚŽĚŝĂďĞƚĞƐ͘
dĂŵďĠŵĠŐĞƌĂůŵĞŶƚĞĂĐŽŵƉĂŶŚĂĚĂƉŽƌƐĞĐƵƌĂƚĞŵƉŽƌĄƌŝĂŽƵƉƌŽůŽŶŐĂĚĂĚĂďŽĐĂ͕ĂdžĞƌŽƐƚŽŵŝĂ͘
dŽĚŽƐŶſƐƚĞŵŽƐƐĞĚĞĞŵǀĄƌŝŽƐŵŽŵĞŶƚŽƐĚƵƌĂŶƚĞŽĚŝĂ͕ŶŽĞŶƚĂŶƚŽ͕ƐĞŶƟƌƐĞĚĞƚŽĚŽŽƚĞŵƉŽŽƵ
ƐĞĂƐĞĚĞĠŵĂŝƐĨŽƌƚĞĚŽƋƵĞŽŚĂďŝƚƵĂůĞĐŽŶƟŶƵĂƌŵĞƐŵŽĚĞƉŽŝƐĚĂŝŶŐĞƐƚĂĚĞĄŐƵĂ͕ĚĞǀĞŵŽƐ
ĮĐĂƌĂƚĞŶƚŽƐ͘
ƉŽůŝĚƉŝƐŝĂĞŵƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐĠĐĂƵƐĂĚĂĚĞǀŝĚŽĂŽƐŶşǀĞŝƐĞůĞǀĂĚŽƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ
;ŚŝƉĞƌŐůŝĐĞŵŝĂͿ͕ĐŽŶƐĞƋƵġŶĐŝĂĚŽĞdžĐĞƐƐŽĚĞĞůŝŵŝŶĂĕĆŽĚĞůşƋƵŝĚŽƐĐĂƵƐĂĚĂƉĞůĂƉŽůŝƷƌŝĂ͘

Polifagia

WŽůŝĨĂŐŝĂŽƵŚŝƉĞƌĨĂŐŝĂĠŽƚĞƌŵŽŵĠĚŝĐŽƵƐĂĚŽƉĂƌĂĚĞƐĐƌĞǀĞƌƋƵĂŶĚŽƐĞƚĞŵƵŵĂƵŵĞŶƚŽĞdžĐĞƐƐŝǀŽ
ĚĂĨŽŵĞŽƵĂƉĞƟƚĞ͕ĞƐƚĞĠƵŵĚŽƐϯƐŝŶƚŽŵĂƐŵĂŝƐĐŽŵƵŶƐĞŵƋƵĞŵƚĞŵĚŝĂďĞƚĞƐ͘

WŽůŝĨĂŐŝĂƉŽĚĞŽĐŽƌƌĞƌƋƵĂŶĚŽƐĞĂƉƌĞƐĞŶƚĂĚĞƐĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽ͗ŚŝƉĞƌŐůŝĐĞŵŝĂŽƵŚŝƉŽŐůŝĐĞŵŝĂ͘

YƵĂŶĚŽŽĐŽƌƌĞĂŚŝƉĞƌŐůŝĐĞŵŝĂ͕ƚĞŵŽƐƵŵĂƵŵĞŶƚŽĚĂŐůŝĐŽƐĞŶĂĐŽƌƌĞŶƚĞƐĂŶŐƵşŶĞĂ͕ƉŽŝƐĂŐůŝĐŽƐĞ
ŶĆŽĞƐƚĄƐĞŶĚŽƚƌĂŶƐƉŽƌƚĂĚĂƉĂƌĂĚĞŶƚƌŽĚĂƐĐĠůƵůĂƐƉĂƌĂƐĞƌƚƌĂŶƐĨŽƌŵĂĚĂĞŵĞŶĞƌŐŝĂ͕ŝƐƚŽŽĐŽƌƌĞ
ĚĞǀŝĚŽĂ͗

ͻƵƐġŶĐŝĂĚĂƐĞĐƌĞĕĆŽĚĞŝŶƐƵůŝŶĂ͖
ͻYƵĂŶƟĚĂĚĞĚĞŝŶƐƵůŝŶĂƐĞĐƌĞƚĂĚĂŝŶƐƵĮĐŝĞŶƚĞ͖
ͻZĞƐŝƐƚġŶĐŝĂ/ŶƐƵůşŶŝĐĂ͘

ŶĆŽĐŽŶǀĞƌƐĆŽĚŽƐĂůŝŵĞŶƚŽƐŝŶŐĞƌŝĚŽƐĞŵĞŶĞƌŐŝĂ͕ƉĂƌĂŽĨƵŶĐŝŽŶĂŵĞŶƚŽĚŽŶŽƐƐŽĐŽƌƉŽ͕ĨĂnjĐŽŵ
ƋƵĞŽĐŽƌƌĂƵŵĂƵŵĞŶƚŽĚĂĨŽŵĞ͘

KƐŝŵƉůĞƐĂƚŽĚĞƐĞĂůŝŵĞŶƚĂƌ͕ŶĆŽŝƌĄĚŝŵŝŶƵŝƌŽĂƉĞƟƚĞ͕ƉŽŝƐŽĂůŝŵĞŶƚŽĐŽŶƟŶƵĂƐĞŵĨŽƌŶĞĐĞƌ
ĞŶĞƌŐŝĂƉĂƌĂŽĐŽƌƉŽ͕ǀŝƌĂŶĚŽƵŵĐŝĐůŽǀŝĐŝŽƐŽ͘WĂƌĂƐŽůƵĐŝŽŶĂƌĞƐƚĂƋƵĞƐƚĆŽ͕ĠŶĞĐĞƐƐĄƌŝŽƉƌŽĐƵƌĂƌ
ĂũƵĚĂŵĠĚŝĐĂ͕ƉĂƌĂĨĂnjĞƌŽĚŝĂŐŶſƐƟĐŽĚĞĚŝĂďĞƚĞƐ͕ƋƵĂŶĚŽĂŝŶĚĂŶĆŽƐĞƚĞŵ͕ŽƵĨĂnjĞƌƌĞǀŝƐĆŽĚŽ
ƚƌĂƚĂŵĞŶƚŽƋƵĂŶĚŽƐĞƚĞŵĚŝĂŐŶſƐƟĐŽ͕ĐŽŵĂũƵƐƚĞĚĞĚŽƐĞƐĚĞŵĞĚŝĐĂĕĆŽ͕ŽƵĂƚĠŵĞƐŵŽƚƌŽĐĂĚĞ
ŵĞĚŝĐĂĕĆŽ͘

ƌŝƐĞƐĚĞŚŝƉŽŐůŝĐĞŵŝĂĚĞǀŝĚŽĂŽƵƐŽĚĞĂŐĞŶƚĞƐŚŝƉŽŐůŝĐĞŵŝĂŶƚĞƐ;ŝŶƐƵůŝŶĂƐ͕ŵĞĚŝĐĂŵĞŶƚŽƐŽƌĂŝƐͿ͕ĨĂnj
ĐŽŵƋƵĞŶŽƐƐŽŽƌŐĂŶŝƐŵŽĚĞŵĂŶĚĞƉŽƌĞŶĞƌŐŝĂ͕ĂƵŵĞŶƚĂŶĚŽĂĨŽŵĞ͕ƉĂƌĂƐƵƉƌŝƌĞƐƚĂŶĞĐĞƐƐŝĚĂĚĞ͘

Fadiga

&ĂĚŝŐĂĠŽĐĂŶƐĂĕŽĞdžƚƌĞŵŽƋƵĞŶĆŽƉĂƐƐĂŶĞŵĐŽŵƵŵĂďŽĂŶŽŝƚĞĚĞƐŽŶŽ͘ƐƚĞĞƵŵƐŝŶƚŽŵĂ
ŵƵŝƚŽĐŽŵƵŵĚŽĚŝĂďĞƚĞƐ͘ůĂƉŽĚĞŽĐŽƌƌĞƌĚĞǀŝĚŽĂ͗

14 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ ĨĂůƚĂĚĞŝŶƐƵůŝŶĂŽƵĂƌĞƐŝƐƚġŶĐŝĂŝŶƐƵůşŶŝĐĂĂĨĞƚĂŵĂĐĂƉĂĐŝĚĂĚĞĚŽĐŽƌƉŽĞŵƚƌĂŶƐƉŽƌƚĂƌĂ
ŐůŝĐŽƐĞƉĂƌĂŽŝŶƚĞƌŝŽƌĚĂƐĐĠůƵůĂƐ͕ĐĂƵƐĂŶĚŽŚŝƉĞƌŐůŝĐĞŵŝĂ͕ĚĞƐƚĂŵĂŶĞŝƌĂĂƐŶĞĐĞƐƐŝĚĂĚĞƐĞŶĞƌŐĠƟĐĂƐ
ĚŽĐŽƌƉŽŶĆŽƐĆŽĂƚĞŶĚŝĚĂƐ͘

ͻ KƵƐŽĚĞŝŶƐƵůŝŶĂĞŵĚŽƐĞŵĂŝŽƌƋƵĞĂŶĞĐĞƐƐĄƌŝĂŽƵƵƐŽĚĞŵĞĚŝĐĂĕƁĞƐŚŝƉŽŐůŝĐĞŵŝĂŶƚĞƐ
;ŐůŝďĞŶĐůĂŵŝĚĂ͕ ŐůŝĐĂnjŝĚĂ͕ ĞƚĐ͘Ϳ͕ ƉŽĚĞŵ ƉƌŽǀŽĐĂƌ ƵŵĂ ďĂŝdžĂ ĚĞ ŐůŝĐŽƐĞ ŶĂ ĐŽƌƌĞŶƚĞ ƐĂŶŐƵşŶĞĂ
;ŚŝƉŽŐůŝĐĞŵŝĂͿĞĐŽŶƐĞƋƵĞŶƚĞŵĞŶƚĞĂĨĂůƚĂĚĞĞŶĞƌŐŝĂŶŽĐŽƌƉŽ͘

^ĆŽƐŝŶƚŽŵĂƐĚĞĨĂĚŝŐĂ͗
ͻ ĂŶƐĂĕŽŽƵĨĂůƚĂĚĞĞŶĞƌŐŝĂ
ͻ ŝĮĐƵůĚĂĚĞŶĂƌĞĂůŝnjĂĕĆŽĚĞƚĂƌĞĨĂƐĚŝĄƌŝĂƐƐŝŵƉůĞƐ
ͻ ^ĞŶƟƌͲƐĞƉĂƌĂďĂŝdžŽŽƵĚĞƉƌŝŵŝĚŽ;ĨĂĚŝŐĂŵĞŶƚĂůͿ

ŵƵŝƚŽŝŵƉŽƌƚĂŶƚĞ͕ĨĂnjĞƌŽƚĞƐƚĞĚĞŐůŝĐĞŵŝĂĐĂƉŝůĂƌ͕ƉĂƌĂĚĞƚĞƌŵŝŶĂƌƐĞŽƐƐŝŶƚŽŵĂƐĞƐƚĆŽƐĞŶĚŽ
ƉĞƌĐĞďŝĚŽƐƉŽƌŚŝƉĞƌŽƵŚŝƉŽŐůŝĐĞŵŝĂ͘

Perda de peso

ƉĞƌĚĂĚĞƉĞƐŽƐĞŵĞdžƉůŝĐĂĕĆŽ͕ĚĞǀĞƐĞƌĂĐŽŵƉĂŶŚĂĚĂĚĞƉĞƌƚŽĞƋƵĂŶĚŽĂƐƐŽĐŝĂĚĂĂƵŵĂƵŵĞŶƚŽ
ĚĞĂƉĞƟƚĞĞĐĂŶƐĂĕŽĞdžĐĞƐƐŝǀŽ͕ĚĞǀĞŵŽƐŶŽƐƉƌĞŽĐƵƉĂƌĐŽŵĚŝĂďĞƚĞƐ͘

KƉĞƐŽĚĞƵŵĂƉĞƐƐŽĂĠĚĞƚĞƌŵŝŶĂĚŽƉŽƌƵŵĂƐĠƌŝĞĚĞĨĂƚŽƌĞƐ͕ƚĂŝƐĐŽŵŽ͗ŝĚĂĚĞ͕ƋƵĂŶƟĚĂĚĞĚĞ
ĐĂůŽƌŝĂƐĚŝĄƌŝĂƐŝŶŐĞƌŝĚĂƐ͕ĞƐƟůŽĚĞǀŝĚĂ͕ƐĞĚĞŶƚĂƌŝƐŵŽ͘

/ŶĚŝǀşĚƵŽƐĐŽŵĚŝĂďĞƚĞƐĂƉƌĞƐĞŶƚĂŵƉĞƌĚĂĚĞƉĞƐŽŝŶĞdžƉůŝĐĄǀĞů͕ĚĞǀŝĚŽĂŶĆŽƵƟůŝnjĂĕĆŽĚĂŐůŝĐŽƐĞ
ĨŽƌŶĞĐŝĚĂƉĞůĂĚŝŐĞƐƚĆŽĚŽƐĂůŝŵĞŶƚŽƐŝŶŐĞƌŝĚŽƐ͕ŶŽĨŽƌŶĞĐŝŵĞŶƚŽĚĂŶĞĐĞƐƐŝĚĂĚĞĚĞĞŶĞƌŐŝĂĚŝĄƌŝĂ͘

WĂƌĂ ƋƵĞ Ž ŽƌŐĂŶŝƐŵŽ ĐŽŶƟŶƵĞ ƐĞƵ ĨƵŶĐŝŽŶĂŵĞŶƚŽ ͞ŶŽƌŵĂů͕͟ ĐĠůƵůĂƐ ĚĞ ŐŽƌĚƵƌĂ ƉĂƐƐĂŵ Ă ƐĞƌ
ƋƵĞŝŵĂĚĂƐ͕ƉĂƌĂĨŽƌŶĞĐĞƌĂĞŶĞƌŐŝĂŶĞĐĞƐƐĄƌŝĂƉĂƌĂƋƵĞŽĐŽƌƉŽĨƵŶĐŝŽŶĞ͘

ƐƚĂĐŽŶĚŝĕĆŽĠŵƵŝƚŽŵĂŝƐĨĂĐŝůŵĞŶƚĞŶŽƚĂĚĂĞŵŝŶĚŝǀşĚƵŽƐĐŽŵĚŝĂďĞƚĞƐƟƉŽϭ͕ŵĂƐƉŽĚĞŽĐŽƌƌĞƌ͕
ƚĂŵďĠŵ͕ĞŵŝŶĚŝǀşĚƵŽƐĐŽŵĚŝĂďĞƚĞƐƟƉŽϮ͘

Porque tratar
o Diabetes?

15 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
K KďũĞƟǀŽ ĚŽ ƚƌĂƚĂŵĞŶƚŽ ĚŽ ĚŝĂďĞƚĞƐ Ġ ĐŽŶƚƌŽůĂƌ ŽƐ ŶşǀĞŝƐ ĚĞ ŐůŝĐŽƐĞ ŶŽ ƐĂŶŐƵĞ Ğ ĞǀŝƚĂƌ ĂƐ
ĐŽŵƉůŝĐĂĕƁĞƐĂŐƵĚĂƐĞĐƌƀŶŝĐĂƐ͕ƋƵĞĐŽŵƉƌŽŵĞƚĞŵƐĞǀĞƌĂŵĞŶƚĞĂƐĂƷĚĞĚĞƋƵĞŵƚĞŵĚŝĂďĞƚĞƐ͘
ƐƚĞĐŽŶƚƌŽůĞĠĨĞŝƚŽĂƚƌĂǀĠƐĚĞƵŵƉůĂŶŽŶƵƚƌŝĐŝŽŶĂů͕ĂƟǀŝĚĂĚĞİƐŝĐĂƌĞŐƵůĂƌĞŵĞĚŝĐĂĕĆŽ͘

ŝĂďĞƚĞƐƉŽĚĞƉƌŽǀŽĐĂƌĐŽŵƉůŝĐĂĕƁĞƐĂĐƵƌƚŽĞůŽŶŐŽƉƌĂnjŽ

Complicações
Agudas:
^ĆŽ ĐŽŶƐŝĚĞƌĂĚĂƐ ĐŽŵŽ ĐŽŵƉůŝĐĂĕƁĞƐ ĂŐƵĚĂƐ ĚŽ ĚŝĂďĞƚĞƐ ĂƐ ĐƌŝƐĞƐ ĚĞ HIPOGLICEMIA e de
HIPERGLICEMIA͘

ŚŝƉŽŐůŝĐĞŵŝĂƐĞĐĂƌĂĐƚĞƌŝnjĂƉĞůŽƐďĂŝdžŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞ;ĂĕƷĐĂƌͿŶŽƐĂŶŐƵĞ͕ŶŽƌŵĂůŵĞŶƚĞĂďĂŝdžŽ
ĚĞϳϬŵŐͬĚ>ĚĞƐĂŶŐƵĞ͘

sĞũĂĂďĂŝdžŽĂůŐƵŶƐŵŽƟǀŽƐƋƵĞůĞǀĂŵĂŚŝƉŽŐůŝĐĞŵŝĂŶĂƐƉĞƐƐŽĂƐƋƵĞƚġŵĚŝĂďĞƚĞƐ͗

ͻ WƵůĂƌƵŵĂƌĞĨĞŝĕĆŽ
ͻ ƉůŝĐĂƌĚŽƐĞŝŶĐŽƌƌĞƚĂĚĞŝŶƐƵůŝŶĂ͕ŵĂŝŽƌƋƵĞĂŶĞĐĞƐƐĄƌŝĂŶĂƋƵĞůĞŵŽŵĞŶƚŽ͖

16 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ hƐĂƌŵĞĚŝĐĂŵĞŶƚŽŽƌĂůŚŝƉŽŐůŝĐĞŵŝĂŶƚĞ͕ƐĞŵƐĞĂůŝŵĞŶƚĂƌĐŽŶĨŽƌŵĞŽƌŝĞŶƚĂĕĆŽĚŽƉƌŽĮƐƐŝŽŶĂů
ͻ ƟǀŝĚĂĚĞİƐŝĐĂĞŵĞdžĐĞƐƐŽ͕ƐĞŵŽĚĞǀŝĚŽŵŽŶŝƚŽƌĂŵĞŶƚŽ

^ĞƵƐŝŶĂŝƐĞƐŝŶƚŽŵĂƐƐĆŽ͗

ͻ &ŽŵĞĞdžĐĞƐƐŝǀĂ͖
ͻ ^ƵĚŽƌĞƐĞĞdžĐĞƐƐŝǀĂ͖
ͻ dŽŶƚƵƌĂ͖
ͻ dƌĞŵŽƌĞƐ͖
ͻ ŶƐŝĞĚĂĚĞ͖
ͻ ŽƌĚĞĐĂďĞĕĂ͖
ͻ &ĂůĂĂƌƌĂƐƚĂĚĂ͖
ͻ &ŽƌŵŝŐĂŵĞŶƚŽ͖
ͻ /ƌƌŝƚĂďŝůŝĚĂĚĞ͖
ͻ WĂůŝĚĞnj͖
ͻ ^ŽŶŽůġŶĐŝĂ͖
ͻ sŝƐĆŽĞŵďĂĕĂĚĂ͖
ͻ ƉĂƟĂ͖
ͻ ŽŶĨƵƐĆŽŵĞŶƚĂů͖
ͻ WĞƌĚĂĚĞĐŽŶƐĐŝġŶĐŝĂ͘

ŚŝƉŽŐůŝĐĞŵŝĂƉŽĚĞƐĞƌƚƌĂƚĂĚĂĂƚƌĂǀĠƐĚĂŝŶŐĞƐƚĆŽĚĞĂůŝŵĞŶƚŽƐƌŝĐŽƐĞŵĂĕƷĐĂƌĞƐ;ƐƵĐŽ͕ƌĞĨƌŝŐĞƌĂŶƚĞ
ŶĆŽ ĚŝĞƚĠƟĐŽ͕ ďĂůĂƐ͕ ĄŐƵĂ ĐŽŵ ĂĕƷĐĂƌ͕ ĞƚĐͿ͕ ƋƵĂŶĚŽ Ă ƉĞƐƐŽĂ ƐĞ ĞŶĐŽŶƚƌĂ ĐŽŶƐĐŝĞŶƚĞ͘ YƵĂŶĚŽ Ă
ƉĞƐƐŽĂƐĞĞŶĐŽŶƚƌĂĚĞƐĂĐŽƌĚĂĚĂ͕ŽŝĚĞĂůĠĐŚĂŵĂƌŽ^DhŽƵůĞǀĄͲůĂĂŽŚŽƐƉŝƚĂůŵĂŝƐƉƌſdžŝŵŽ͕ƉĂƌĂ
ŽƚƌĂƚĂŵĞŶƚŽĂĚĞƋƵĂĚŽ͘

 ŚŝƉĞƌŐůŝĐĞŵŝĂ ƐĞ ĐĂƌĂĐƚĞƌŝnjĂ ƉĞůŽƐ ĂůƚŽƐ ŶşǀĞŝƐ ĚĞ ŐůŝĐŽƐĞ ;ĂĕƷĐĂƌͿ ŶŽ ƐĂŶŐƵĞ͕ ŶŽƌŵĂůŵĞŶƚĞ
ĂĐŽŵƉĂŶŚĂĚĂ ĚĞ ĂůƚŽƐ ŶşǀĞŝƐ ĚĞ ĂĕƷĐĂƌ ŶĂ ƵƌŝŶĂ͘ YƵĂŶĚŽ ƐĞ ĞŶĐŽŶƚƌĂŵ ĂĐŝŵĂ ĚĞ ϮϰϬŵŐͬĚ> ĚĞ
ƐĂŶŐƵĞ͕ĚĞǀĞͲƐĞŵĞĚŝƌŽŶşǀĞůĚĞĐĞƚŽŶĂƐ͕ƚĂŶƚŽŶĂƵƌŝŶĂ;ĐĞƚŽŶƷƌŝĂͿĐŽŵŽŶŽƐĂŶŐƵĞ;ĐĞƚŽŶĞŵŝĂͿ͘
ƉƌĞƐĞŶĕĂĚĞĐŽƌƉŽƐĐĞƚƀŶŝĐŽƐŶĂƵƌŝŶĂĞͬŽƵŶŽƐĂŶŐƵĞƉŽĚĞŵůĞǀĂƌăĚĞƐĐŽŵƉĞŶƐĂĕĆŽŵĞƚĂďſůŝĐĂ͕
ĨĂnjĞŶĚŽĂŐůŝĐŽƐĞƐƵďŝƌĂŝŶĚĂŵĂŝƐ͘ƐƚĞĨĞŶƀŵĞŶŽƐĞĐŚĂŵĂĐĞƚŽĂĐŝĚŽƐĞĚŝĂďĠƟĐĂ͘

ŚŝƉĞƌŐůŝĐĞŵŝĂƉŽĚĞŽĐŽƌƌĞƌĚĞǀŝĚĂĂ͗

ͻ ŽƐĞŝŶĐŽƌƌĞƚĂĚĞŝŶƐƵůŝŶĂ͕ŵĞŶŽƌƋƵĞĂƋƵĂŶƟĚĂĚĞŶĞĐĞƐƐĄƌŝĂ͖
ͻ džĐĞƐƐŽĚĞĂůŝŵĞŶƚĂĕĆŽ͖
ͻ &ĂůƚĂĚĞĂƟǀŝĚĂĚĞİƐŝĐĂ͖
ͻ ŽĞŶĕĂƐĞŝŶĨĞĐĕƁĞƐĐŽŵŽƉŽƌĞdžĞŵƉůŽŐƌŝƉĞ͖
ͻ ƐƚƌĞƐƐĞĚĞĨŽŶƚĞĞŵŽĐŝŽŶĂů;ĨĂŵŝůŝĂƌ͕ƚƌĂďĂůŚŽ͕ĞƐĐŽůĂͿ͖
ͻ hƐŽĚĞŵĞĚŝĐĂŵĞŶƚŽƐĐŽŵŽƉŽƌĞdžĞŵƉůŽĐŽƌƟĐŽŝĚĞƐ͘

^ĞƵƐŝŶĂŝƐĞƐŝŶƚŽŵĂƐƐĆŽ͗

17 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ &ŽŵĞĞdžĐĞƐƐŝǀĂ͖
ͻ ^ĞĚĞĞdžĐĞƐƐŝǀĂĞͬŽƵďŽĐĂƐĞĐĂ͖
ͻ hƌŝŶĂĞŵĞdžĐĞƐƐŽ͖
ͻ sŝƐĆŽĞŵďĂĕĂĚĂ͖
ͻ &ĂĚŝŐĂ͖
ͻ ,ĄůŝƚŽĨƌƵƚĂĚŽ
ͻ ^ŽŶŽůġŶĐŝĂ͖
ͻ ŽŶĨƵƐĆŽŵĞŶƚĂů͘

K ƚƌĂƚĂŵĞŶƚŽ ĚĂ ŚŝƉĞƌŐůŝĐĞŵŝĂ ǀĂŝ ĚĞƐĚĞ Ă ŚŝĚƌĂƚĂĕĆŽ͕ ĂũƵƐƚĞƐ ĚĞ ĚŽƐĞ ĚĞ ŵĞĚŝĐĂĕĆŽ ĂƚĠ Ă
ĂĚŵŝŶŝƐƚƌĂĕĆŽ ĚĞ ŝŶƐƵůŝŶĂ͘ ^ĞŐƵŝƌ ƵŵĂ ĚŝĞƚĂ ĞƋƵŝůŝďƌĂĚĂ Ğ ĂƟǀŝĚĂĚĞ İƐŝĐĂ ƌĞŐƵůĂƌ Ġ ĨƵŶĚĂŵĞŶƚĂů
ƉĂƌĂĞƐƚĞĂƵŵĞŶƚŽŶŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͘DƵŝƚĂƐǀĞnjĞƐĠŶĞĐĞƐƐĄƌŝŽƉƌŽĐƵƌĂƌĂƚĞŶĚŝŵĞŶƚŽ
ŵĠĚŝĐŽ͕ ƉĂƌĂ ƵŵĂ ŝŶƚĞƌǀĞŶĕĆŽ ŵĂŝƐ ƌĄƉŝĚĂ͕ ĞǀŝƚĂŶĚŽ ĂƐƐŝŵ ĚĂŶŽƐ ƉĞƌŵĂŶĞŶƚĞƐ Ğ ƐƵƌŐŝŵĞŶƚŽ ĚĞ
ĐŽŵƉůŝĐĂĕƁĞƐĂůŽŶŐŽƉƌĂnjŽ͘

Cetoacidose
Diabética:
ĐĞƚŽĂĐŝĚŽƐĞĚŝĂďĠƟĐĂĠƵŵĂĐƷŵƵůŽĚĞĄĐŝĚŽƐŶŽƐĂŶŐƵĞ͕ƋƵĞƉŽĚĞĂĐŽŶƚĞĐĞƌƋƵĂŶĚŽŽƐŶşǀĞŝƐ
ĚĞŐůŝĐŽƐĞĞƐƚĆŽŵƵŝƚŽĞůĞǀĂĚŽƐ͘WŽĚĞƐĞƌĨĂƚĂů͕ŵĂƐŐĞƌĂůŵĞŶƚĞůĞǀĂŵƵŝƚĂƐŚŽƌĂƐƉĂƌĂƐĞƚŽƌŶĂƌƚĆŽ
ƐĠƌŝŽ͘ůĂƉŽĚĞƐĞƌƚƌĂƚĂĚĂĞŵƵŝƚĂƐǀĞnjĞƐĞǀŝƚĂĚĂ͘

ĐĞƚŽĂĐŝĚŽƐĞĚŝĂďĠƟĐĂŐĞƌĂůŵĞŶƚĞĂĐŽŶƚĞĐĞƉŽƌƋƵĞŽĐŽƌƉŽŶĆŽƚĞŵŝŶƐƵůŝŶĂƐƵĮĐŝĞŶƚĞ͘ƐĐĠůƵůĂƐ
ŶĆŽƉŽĚĞŵƵƐĂƌĂŐůŝĐŽƐĞĚŽƐĂŶŐƵĞƉĂƌĂŽďƚĞƌĞŶĞƌŐŝĂ͕ĞŶƚĆŽŽĐŽƌƉŽƉĂƐƐĂĂƋƵĞŝŵĂƌĂŐŽƌĚƵƌĂ
ƉĂƌĂƚĞƌĞŶĞƌŐŝĂƐƵĮĐŝĞŶƚĞƉĂƌĂĂƐĂƟǀŝĚĂĚĞƐĚŝĄƌŝĂƐ͘

YƵĞŝŵĂƌŐŽƌĚƵƌĂƉƌŽĚƵnjƵŵĂƐƵďƐƚąŶĐŝĂĐŚĂŵĂĚĂĚĞŽƌƉŽƐĐĞƚƀŶŝĐŽƐ͕ƋƵĞƚĞŵƵŵƉ,ĄĐŝĚŽ͕ĞƐƐĞ
ƉƌŽĐĞƐƐŽĐŽŶơŶƵŽƉŽƌŵƵŝƚŽƚĞŵƉŽ͕ĨĂnjĐŽŵƋƵĞĞůĞƐƐĞĂĐƵŵƵůĞŵŶŽƐĂŶŐƵĞ͕ĂůƚĞƌĂŶĚŽŽĞƋƵŝůşďƌŝŽ
ƋƵşŵŝĐŽĚŽĐŽƌƉŽ͘

WĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐƟƉŽϭƚġŵŵĂŝŽƌƌŝƐĐŽĚĞƐŽĨƌĞƌƵŵĂĐĞƚŽĂĐŝĚŽƐĞĚŝĂďĠƟĐĂ͕ƵŵĂǀĞnjƋƵĞƐĞƵ
ƉąŶĐƌĞĂƐŶĆŽƉƌŽĚƵnjŝŶƐƵůŝŶĂ͘ƐĐĞƚŽŶĂƐƚĂŵďĠŵƉŽĚĞŵƐĞĞůĞǀĂƌƋƵĂŶĚŽƐĞƉƵůĂƵŵĂƌĞĨĞŝĕĆŽ͕
ĞƐƚĄĚŽĞŶƚĞŽƵĞƐƚƌĞƐƐĂĚŽ͕ŽƵĂŝŶĚĂ͕ƋƵĂŶĚŽƐĞĞƐƋƵĞĐĞĚĞĂƉůŝĐĂƌƵŵĂĚŽƐĞĚĞŝŶƐƵůŝŶĂ͘

18 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
WĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐƟƉŽϮƚĂŵďĠŵƉŽĚĞŵĂƉƌĞƐĞŶƚĂƌĐĞƚŽĂĐŝĚŽƐĞĚŝĂďĠƟĐĂ͕ŵĂƐĠƌĂƌŽ͘WĞƐƐŽĂƐ
ŝĚŽƐĂƐƋƵĞƚġŵĚŝĂďĞƚĞƐĚŽƟƉŽϮ͕ƐĆŽŵĂŝƐƉƌŽƉĞŶƐĂƐĂĂƉƌĞƐĞŶƚĂƌĂůŐƵŶƐƐŝŶƚŽŵĂƐƐŝŵŝůĂƌĞƐ͕ƋƵĞ
ƉŽĚĞŵůĞǀĂƌĂĚĞƐŝĚƌĂƚĂĕĆŽŐƌĂǀĞĞĂƚĠĂŵŽƌƚĞ͘KŶŽŵĞĚĞƐƚĞĨĞŶƀŵĞŶŽĠ͞^şŶĚƌŽŵĞ,ŝƉĞƌŐůŝĐġŵŝĐĂ
,ŝƉĞƌŽƐŵŽůĂƌEĆŽĞƚſƟĐĂ͘͟

^ŝŶĂŝƐĚĞĂǀŝƐŽ

YƵĂŶĚŽ Ž ŶşǀĞů ĚĞ ŐůŝĐŽƐĞ ŶŽ ƐĂŶŐƵĞ ĞƐƟǀĞƌ ĂĐŝŵĂ ĚĞ ϮϱϬ ŵŐͬĚ> ŽƵ ƐĞ ƟǀĞƌ ĐŽŵ ƐŝŶƚŽŵĂƐ ĚĞ
ŚŝƉĞƌŐůŝĐĞŵŝĂ͕ĐŽŵŽďŽĐĂƐĞĐĂ͕ƐĞŶƐĂĕĆŽĚĞƐĞĚĞŽƵƵƌŝŶĂĞŵĞdžĐĞƐƐŽ͘&ĂnjĞƌŽƚĞƐƚĞĚĞŐůŝĐĞŵŝĂĐĂƉŝůĂƌ
ĠĨƵŶĚĂŵĞŶƚĂůƉĂƌĂĐŽŶĮƌŵĂĕĆŽĚĞƐƚĞƐƐŝŶƚŽŵĂƐ͘ůŐƵŶƐŵĞĚŝĚŽƌĞƐĚĂŐůŝĐŽƐĞŵĞĚĞŵĐĞƚŽŶĂƐ͕ŵĂƐ
ƉƌĞĐŝƐĂŵĚĞƟƌĂƐĚŝĨĞƌĞŶƚĞƐƉĂƌĂŝƐƐŽ͘DĞĚŝĚĂƐĐŽƌƌĞƟǀĂƐĚĂŐůŝĐĞŵŝĂƐĞĨĂnjĞŵŶĞĐĞƐƐĄƌŝĂƐ͕ƚƌĂnjĞŶĚŽ
ŽƐǀĂůŽƌĞƐƉĂƌĂƉĂƚĂŵĂƌĞƐŵĂŝƐďĂŝdžŽƐ͘

KƉĂĐŝĞŶƚĞƋƵĞĞƐƟǀĞƌƐĞŶƟŶĚŽƵŵŽƵŵĂŝƐĚŽƐƐŝŶƚŽŵĂƐĂďĂŝdžŽ͕ĚĞǀĞŵƐĞƌĞŶĐĂŵŝŶŚĂĚŽƐƉĂƌĂƵŵ
ƐĞƌǀŝĕŽŵĠĚŝĐŽ͗

ͻ sƀŵŝƚŽƉŽƌŵĂŝƐĚĞϮŚŽƌĂƐ͘
ͻ EĄƵƐĞĂƐ
ͻ ŽƌĂďĚŽŵŝŶĂů
ͻ ZĞƐƉŝƌĂĕĆŽĐŽŵĐŚĞŝƌŽĨƌƵƚĂĚŽ
ͻ ĂŶƐĂĕŽ
ͻ ŽŶĨƵƐĆŽŵĞŶƚĂů
ͻ dŽŶƚƵƌĂ
ͻ ŝĮĐƵůĚĂĚĞĞŵƌĞƐƉŝƌĂƌ

dƌĂƚĂŵĞŶƚŽĞWƌĞǀĞŶĕĆŽ
EŽŚŽƐƉŝƚĂů͕ŽƚƌĂƚĂŵĞŶƚŽĂĐŽŶƚĞĐĞĐŽŵĂƉůŝĐĂĕƁĞƐĚĞŝŶƐƵůŝŶĂ͕ƉĂƌĂŶŽƌŵĂůŝnjĂƌŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞ
ĞĐŽŵƐŽƌŽǀĞŶŽƐŽ͕ƉĂƌĂƌĞŝĚƌĂƚĂĕĆŽ͘ĞƐƚĂŵĂŶĞŝƌĂŽĞƋƵŝůşďƌŝŽďŝŽƋƵşŵŝĐŽĚŽƐĂŶŐƵĞǀŽůƚĂƌĄĂŽ
ŶŽƌŵĂů͘

ĐĞƚŽĂĐŝĚŽƐĞŶĆŽƚƌĂƚĂĚĂ͕ƉŽĚĞůĞǀĂƌĂĚĞƐŵĂŝŽƐ͕ĐŽŵĂĞĂƚĠĂŵŽƌƚĞ͘

KŵĠĚŝĐŽƉŽĚĞĂůƚĞƌĂƌĂĚŽƐĞĚĞŝŶƐƵůŝŶĂ͕ŽƵŽƟƉŽĚĞŝŶƐƵůŝŶĂƋƵĞĞƐƚĂƐĞŶĚŽƵƐĂĚĂ͕ƉĂƌĂĞǀŝƚĂƌƋƵĞ
ĞƐƚĂƐŝƚƵĂĕĆŽƐĞƌĞƉŝƚĂ͘

KďŽŵĐŽŶƚƌŽůĞĚĂŐůŝĐŽƐĞŶŽƐĂŶŐƵĞĠĨƵŶĚĂŵĞŶƚĂůƉĂƌĂĞǀŝƚĂƌĂĐĞƚŽĂĐŝĚŽƐĞ͘KƉĂĐŝĞŶƚĞĚĞǀĞƐĞƌ
ĂůĞƌƚĂĚŽĚĞ͗

ͻ dŽŵĂƌŽƐŵĞĚŝĐĂŵĞŶƚŽƐĐŽŵŽƉƌĞƐĐƌŝƚŽ
ͻ ^ĞŐƵŝƌƵŵƉůĂŶŽĚĞƌĞĨĞŝĕƁĞƐďĂůĂŶĐĞĂĚĂƐ
ͻ &ĂnjĞƌĂƟǀŝĚĂĚĞİƐŝĐĂƌĞŐƵůĂƌ
ͻ DĞĚŝƌĂŐůŝĐĞŵŝĂƌĞŐƵůĂƌŵĞŶƚĞ͘

19 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ ĞƌƟĮĐĂƌͲƐĞƋƵĞĂŝŶƐƵůŝŶĂĞŵƵƐŽŶĆŽĞƐƚĄǀĞŶĐŝĚĂ͘
ͻ EĆŽƵƐĂƌŝŶƐƵůŝŶĂĐŽŵĂƐƉĞĐƚŽĞƐƚƌĂŶŚŽĂŽĚĞĐŽƐƚƵŵĞŽƵƋƵĞĂƉƌĞƐĞŶƚĞĐŽƌƉŽƐĞƐƚƌĂŶŚŽƐ;
ŝŶƐƵůŝŶĂĚĞǀĞƐĞƌƚƌĂŶƐƉĂƌĞŶƚĞŽƵƵŶŝĨŽƌŵĞŵĞŶƚĞůĞŝƚŽƐĂ͕ŶŽĐĂƐŽĚĂEW,ĞƉƌĠͲŵŝƐƚƵƌĂƐͿ͘
ͻ hƐƵĄƌŝŽ ĚĞ ďŽŵďĂ ŝŶĨƵƐĆŽ ĚĞ ŝŶƐƵůŝŶĂ͕ ĚĞǀĞŵ ǀĞƌŝĮĐĂƌ ĂƚĞŶƚĂŵĞŶƚĞ ƐĞ ŚĄ ǀĂnjĂŵĞŶƚŽƐ ĚĞ
ŝŶƐƵůŝŶĂ͕ŽƵĂƉƌĞƐĞŶĕĂĚĞďŽůŚĂƐĚĞĂƌŶŽĐĂƚĞƚĞƌ͘

Hiperglicemia
do alvorecer
ŚŝƉĞƌŐůŝĐĞŵŝĂĚŽĂůǀŽƌĞĐĞƌϭϬĠŽƚĞƌŵŽƵƐĂĚŽƉĂƌĂĚĞƐĐƌĞǀĞƌŶşǀĞŝƐĚĞŐůŝĐŽƐĞĂůƚŽƐƉĞůĂŵĂŶŚĆ͕
ŵĞƐŵŽĂŽŝƌƉĂƌĂĐĂŵĂ͕ăŶŽŝƚĞ͕ĐŽŵĂŐůŝĐŽƐĞĞŵŶşǀĞŝƐŶŽƌŵĂŝƐ͘ƐƚĞĠƵŵĨĞŶƀŵĞŶŽĐŽŵƵŵĞŵ
ƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐ͘'ĞƌĂůŵĞŶƚĞĂƐĂůƚĞƌĂĕƁĞƐĂĐŽŶƚĞĐĞŵĞŶƚƌĞĂƐϮĞϴŚŽƌĂƐĚĂŵĂŶŚĆ͘

WĞƐƋƵŝƐĂĚŽƌĞƐ ĂĐƌĞĚŝƚĂŵ ƋƵĞ Ă ůŝďĞƌĂĕĆŽ ŶŽƚƵƌŶĂ ĚŽƐ ĐŚĂŵĂĚŽƐ ŚŽƌŵƀŶŝŽƐ ĐŽŶƚƌĂ ƌĞŐƵůĂƚſƌŝŽƐ
;ŚŽƌŵƀŶŝŽƐ ĚĞ ĐƌĞƐĐŝŵĞŶƚŽ͕ ĐŽƌƟƐŽů͕ ŐůƵĐĂŐŽŶ Ğ ĞƉŝŶĞĨƌŝŶĂͿ͕ ĂƵŵĞŶƚĂŵ Ă ƌĞƐŝƐƚġŶĐŝĂ ă ŝŶƐƵůŝŶĂ͕
ĨĂnjĞŶĚŽĐŽŵƋƵĞŽĐŽƌƌĂƵŵĂŚŝƉĞƌŐůŝĐĞŵŝĂ͘

KƵƚƌĂƐĐĂƵƐĂƐƋƵĞƉŽĚĞŵůĞǀĂƌĂŚŝƉĞƌŐůŝĐĞŵŝĂĚĞũĞũƵŵƐĆŽ͗
ͻ ŽƐĞƐŝŶƐƵĮĐŝĞŶƚĞƐĚĞŵĞĚŝĐĂĕĆŽ;ŝŶƐƵůŝŶĂŽƵKƐͿŶŽŝƚĞĂŶƚĞƌŝŽƌ͘
ͻ ŽŶƐƵŵŽĞdžĐĞƐƐŝǀŽĚĞĐĂƌďŽŝĚƌĂƚŽƐĂŽĚĞŝƚĂƌ͘

WĂĐŝĞŶƚĞƐƋƵĞƉĞƌƐŝƐƚĞŵĞŵĂƉƌĞƐĞŶƚĂƌŚŝƉĞƌŐůŝĐĞŵŝĂĚĞũĞũƵŵĐŽŶƐƚĂŶƚĞŵĞŶƚĞ͕ĚĞǀĞŵƐĞƌŽƌŝĞŶƚĂĚŽƐ
ĂƌĞĂůŝnjĂƌƚĞƐƚĞƐĚĞŐůŝĐĞŵŝĂĐĂƉŝůĂƌĞŶƚƌĞĂƐϮĞϯŚŽƌĂƐĚĂŵĂŶŚĆƉŽƌĂůŐƵŶƐĚŝĂƐƐĞŐƵŝĚŽƐ͘ƐƚĂ
ĂƟƚƵĚĞĂƵdžŝůŝĂƌĄĂĚĞƚĞƌŵŝŶĂƌƐĞŽƋƵĞĞƐƚĄŽĐŽƌƌĞŶĚŽĠ,ŝƉĞƌŐůŝĐĞŵŝĂĚŽĂůǀŽƌĞĐĞƌŽƵĂƉƌĞƐĞŶƚĂ
ŽƵƚƌĂĐĂƵƐĂ͘

WĂƌĂƉƌĞǀĞŶŝƌŽƵĐŽƌƌŝŐŝƌĂŚŝƉĞƌŐůŝĐĞŵŝĂĚŽĂůǀŽƌĞĐĞƌ͕ƌĞĐŽŵĞŶĚĂͲƐĞ͗

ͻ ǀŝƚĂƌŽĐŽŶƐƵŵŽĚĞĐĂƌďŽŝĚƌĂƚŽƐĂŽĚĞŝƚĂƌ͘
ͻ ũƵƐƚĂƌĂĚŽƐĞĚĞŵĞĚŝĐĂĕĆŽŽƵŝŶƐƵůŝŶĂ͘
ͻ ůƚĞƌŶĂƌƉĂƌĂƵŵŵĞĚŝĐĂŵĞŶƚŽĚŝĨĞƌĞŶƚĞ͘
ͻ ũƵƐƚĂƌŽŚŽƌĄƌŝŽĚĂĚŽƐĞĚĂŵĞĚŝĐĂĕĆŽŽƵŝŶƐƵůŝŶĂĚŽũĂŶƚĂƌƉĂƌĂĂŚŽƌĂĚĞĚŽƌŵŝƌ͘
ͻ hƐƵĄƌŝŽƐ ĚĞ ^/ ;^ŝƐƚĞŵĂ ĚĞ ŝŶĨƵƐĆŽ ĐŽŶơŶƵĂ ĚĞ ŝŶƐƵůŝŶĂͿ ĚĞǀĞŵ ĂĚŵŝŶŝƐƚƌĂƌ ŝŶƐƵůŝŶĂ ĞdžƚƌĂ
ĚƵƌĂŶƚĞĂƐƉƌŝŵĞŝƌĂƐŚŽƌĂƐĚĂŵĂŶŚĆ͘

20 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Efeito
Somogyi
ĨĞŝƚŽ^ŽŵŽŐLJŝϭϭŽƵŚŝƉĞƌŐůŝĐĞŵŝĂĚĞƌĞďŽƚĞ͕ƌĞĐĞďĞƵŽŶŽŵĞĚĞDŝĐŚĂĞů^ŽŵŽŐLJŝ͕ŽƉĞƐƋƵŝƐĂĚŽƌ
ƋƵĞŽĚĞƐĐƌĞǀĞƵƉĞůĂƉƌŝŵĞŝƌĂǀĞnj͘ŽƚĞƌŵŽƵƐĂĚŽƉĂƌĂƋƵĂŶĚŽƉĂĐŝĞŶƚĞƐĚŝĂďĠƟĐŽƐŝŶƐƵůŝŶŝnjĂĚŽƐ
ĂƉƌĞƐĞŶƚĂŵƵŵĂĂůƚĂĚŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞĂƉſƐƵŵĂĐƌŝƐĞĚĞŚŝƉŽŐůŝĐĞŵŝĂ͘

KĞĨĞŝƚŽ^ŽŵŽŐLJŝĠŵĂŝƐƉƌŽǀĄǀĞůĚĞŽĐŽƌƌĞƌĂƉſƐƵŵĞƉŝƐſĚŝŽĚĞŚŝƉŽŐůŝĐĞŵŝĂŶŽƚƵƌŶĂŶĆŽƚƌĂƚĂĚĂ͕
ƌĞƐƵůƚĂŶĚŽĞŵŶşǀĞŝƐĞůĞǀĂĚŽƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞŶĂƉĂƌƚĞĚĂŵĂŶŚĆ͘

YƵĂŶĚŽƐĞƚĞŵƵŵĂĐƌŝƐĞĚĞŚŝƉŽŐůŝĐĞŵŝĂ͕ŽŽƌŐĂŶŝƐŵŽăƐǀĞnjĞƐƌĞĂŐĞůŝďĞƌĂŶĚŽŚŽƌŵƀŶŝŽƐĐŽŶƚƌĂͲ
ƌĞŐƵůĂĚŽƌĞƐĐŽŵŽŽŐůƵĐĂŐŽŶĞĂĞƉŝŶĞĨƌŝŶĂ͘ƐƐĞƐŚŽƌŵƀŶŝŽƐĞƐƟŵƵůĂŵŽİŐĂĚŽĂĐŽŶǀĞƌƚĞƌƐƵĂƐ
ƌĞƐĞƌǀĂƐĚĞŐůŝĐŽŐġŶŝŽĞŵŐůŝĐŽƐĞ͕ĞůĞǀĂŶĚŽŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͘

WĂƌĂĞǀŝƚĂƌŽĞĨĞŝƚŽ^ŽŵŽŐLJŝĠŶĞĐĞƐƐĄƌŝŽĞǀŝƚĂƌĂƐĐƌŝƐĞƐĚĞŚŝƉŽŐůŝĐĞŵŝĂ͘

Complicações
Crônicas:

21 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ƐĐŽŵƉůŝĐĂĕƁĞƐĐƌƀŶŝĐĂƐĚŽĚŝĂďĞƚĞƐƐĞŝŶƐƚĂůĂŵŐƌĂĚƵĂůŵĞŶƚĞ͘YƵĂŶƚŽŵĂŝƐƚĞŵƉŽĚĞĚŝĂŐŶſƐƟĐŽĞ
ŵĞŶŽƐƐĞĐŽŶƚƌŽůĂŽƐĂůƚŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͕ŵĂŝŽƌĠŽƌŝƐĐŽĚĞƐĞĚĞƐĞŶǀŽůǀĞƌĐŽŵƉůŝĐĂĕƁĞƐ͘

KŽďũĞƟǀŽĚŽƚƌĂƚĂŵĞŶƚŽĠŵĂŶƚĞƌŽƐŶşǀĞŝƐŐůŝĐġŵŝĐŽŵĂŝƐƉƌſdžŝŵŽƐĚŽŶŽƌŵĂů͕ƉĂƌĂĚĞƐƚĂŵĂŶĞŝƌĂ
ƉƌŽƚĞŐĞƌ Ž ƐŝƐƚĞŵĂ ǀĂƐĐƵůĂƌ ĚŽ ŝŶĚŝǀşĚƵŽ͘  ŚŝƉĞƌŐůŝĐĞŵŝĂ Ġ ƉƌĞũƵĚŝĐŝĂů ƉĂƌĂ ƚŽĚŽƐ ŽƐ ƚĞĐŝĚŽƐ ĚŽ
ĐŽƌƉŽ͕ƉŽĚĞŶĚŽůĞǀĂƌĂĐŽŵƉůŝĐĂĕƁĞƐŝŶĐĂƉĂĐŝƚĂŶƚĞƐ͕ƚĂŝƐĐŽŵŽĂŵƉƵƚĂĕƁĞƐĞƉĞƌĚĂĚĂǀŝƐĆŽ͕ĂƐƐŝŵ
ĐŽŵŽĂŽſďŝƚŽ͘

ĞƌƚĂǀĞnjƵŵĐůŝĞŶƚĞŵĞĨĂůŽƵ͗͞ŝĂďĞƚĞƐĠĐŽŵŽĐƵƉŝŵ͕ĞůĞƚĞĐŽŵĞĚĞĚĞŶƚƌŽƉĂƌĂĨŽƌĂ͘͟

ƌĞůĂĕĆŽĞŶƚƌĞĚŝĂďĞƚĞƐĞĚŽĞŶĕĂǀĂƐĐƵůĂƌĠĂƉƌŝŶĐŝƉĂůĨŽŶƚĞĚĞŵŽƌďŝĚĂĚĞĞŵŽƌƚĂůŝĚĂĚĞƚĂŶƚŽŶŽ
ĚŝĂďĞƚĞƐƟƉŽϭƋƵĂŶƚŽŶŽĚŝĂďĞƚĞƐƟƉŽϮ͘'ĞƌĂůŵĞŶƚĞ͕ŽƐĞĨĞŝƚŽƐƉƌĞũƵĚŝĐŝĂŝƐĚĂŚŝƉĞƌŐůŝĐĞŵŝĂƐĆŽ
ƐĞƉĂƌĂĚŽƐĞŵĐŽŵƉůŝĐĂĕƁĞƐŵĂĐƌŽǀĂƐĐƵůĂƌĞƐ;ĚŽĞŶĕĂĂƌƚĞƌŝĂůĐŽƌŽŶĂƌŝĂŶĂ͕ĚŽĞŶĕĂĂƌƚĞƌŝĂůƉĞƌŝĨĠƌŝĐĂ
Ğ ĂĐŝĚĞŶƚĞ ǀĂƐĐƵůĂƌ ĐĞƌĞďƌĂůͿ Ğ ĐŽŵƉůŝĐĂĕƁĞƐ ŵŝĐƌŽǀĂƐĐƵůĂƌĞƐ ;ŶĞĨƌŽƉĂƟĂ ĚŝĂďĠƟĐĂ͕ ŶĞƵƌŽƉĂƟĂ Ğ
ƌĞƟŶŽƉĂƟĂͿ͘

hŵĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽƌŝŐŽƌŽƐŽƌĞĚƵnjĐŽŵƉůŝĐĂĕƁĞƐĂŽůŽŶŐŽĚŽƐĂŶŽƐĚĞĚŝĂŐŶſƐƟĐŽ͘

22 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Complicações
Macrovasculares:
ĞĂĐŽƌĚŽĐŽŵĂ/ŶƚĞƌŶĂƟŽŶĂůŝĂďĞƚĞƐ&ĞĚĞƌĂƟŽŶ;/&Ϳϭ͕ϱϬйĚŽƐſďŝƚŽƐĞŵƉĂĐŝĞŶƚĞƐĚŝĂďĠƟĐŽƐƐĞ
ĚĞǀĞŵĂƉƌŽďůĞŵĂƐĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ͕ĐŽŵŽŝŶĨĂƌƚŽĞs͘EŽĞŶƚĂŶƚŽ͕ƐŽŵĞŶƚĞϯйĚĞƐƐĞƐŝŶĚŝǀşĚƵŽƐ
ƚĞŵĞŵĂƐĐŽŶƐĞƋƵġŶĐŝĂƐĐĂƌĚşĂĐĂƐĚĂĚŽĞŶĕĂ͕ƐĞŐƵŶĚŽƵŵĂƉĞƐƋƵŝƐĂƌĞĐĞŶƚĞĚĂ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂ
ĚĞŝĂďĞƚĞƐ͕ĞŵƉĂƌĐĞƌŝĂĐŽŵŽ/ďŽƉĞ/ŶƚĞůŝŐġŶĐŝĂϭϮ͘
^ĞŐƵŶĚŽŽDŝŶŝƐƚĠƌŝŽĚĂ^ĂƷĚĞ͕ĂƐĚŽĞŶĕĂƐĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐƐĆŽĂƐƉƌŝŶĐŝƉĂŝƐĐĂƵƐĂƐĚĞŵŽƌƚĞŶŽ
ƉĂşƐ͕ƌĞƐƉŽŶĚĞŶĚŽƉŽƌĐĞƌĐĂĚĞϯϬйĚĞƚŽĚŽƐŽƐſďŝƚŽƐƌĞŐŝƐƚƌĂĚŽƐϭϯ͘

KƐĚĂĚŽƐĚŽĞƐƚƵĚŽE,E^///ϭϰŵŽƐƚƌĂŵƋƵĞ͕ĂŽůŽŶŐŽĚŽƐƷůƟŵŽƐϯϬĂŶŽƐ͕ŶŽƐhŽďƐĞƌǀĂͲƐĞ
ƵŵĂƌĞĚƵĕĆŽĚĞŵŽƌƚĂůŝĚĂĚĞĞŶƚƌĞŚŽŵĞŶƐĞŵƵůŚĞƌĞƐƐĞŵĚŝĂďĞƚĞƐ͕ŵĂƐĞƐƚĂƌĞĚƵĕĆŽĨŽŝďĞŵ
ŵĞŶŽƌŶŽƐŚŽŵĞŶƐĞŵƵůŚĞƌĞƐĐŽŵDϮ͘ƉƌĞǀĞŶĕĆŽĚĂƐĚŽĞŶĕĂƐĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐĞŵƉĂĐŝĞŶƚĞƐ
ĐŽŵĚŝĂďĞƚĞƐĠŶĞĐĞƐƐĄƌŝĂ͕ǀŝƐƚŽƋƵĞƐŽŵĞŶƚĞϯйĚŽƐƉĂĐŝĞŶƚĞƐƚĞŵĞŵĂƐĐŽŶƐĞƋƵġŶĐŝĂƐĐĂƌĚşĂĐĂƐ
ĚŽĚŝĂďĞƚĞƐ͕ĐŽŵŽĨŽŝĚĞŵŽŶƐƚƌĂĚŽŶĂWĞƐƋƵŝƐĂŝĂďĞƚĞƐƐĞŵŽŵƉůŝĐĂĕƁĞƐ͘

WĂĐŝĞŶƚĞƐĚŝĂďĠƟĐŽƐƟƉŽϮĂƉƌĞƐĞŶƚĂŵŽƌŝƐĐŽĚĞϮĂϰǀĞnjĞƐŵĂŝŽƌĚĞŝƌĂſďŝƚŽĚĞǀŝĚŽĂƐĚŽĞŶĕĂƐ
ĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ͕ĞŵĐŽŵƉĂƌĂĕĆŽĂŽƌĞƐƚĂŶƚĞĚĂƉŽƉƵůĂĕĆŽϭϱ͘KsŝƐƋƵġŵŝĐŽĠĚĞĚƵĂƐĂƋƵĂƚƌŽ
ǀĞnjĞƐŵĂŝƐĨƌĞƋƵĞŶƚĞĞŵƉĂĐŝĞŶƚĞƐĐŽŵĚŝĂďĞƚĞƐ͘

KĂƵŵĞŶƚŽĚĂŝĚĂĚĞĚŽƉĂĐŝĞŶƚĞĠĚŝƌĞƚĂŵĞŶƚĞƉƌŽƉŽƌĐŝŽŶĂůĂŽĂƵŵĞŶƚŽĚŽƌŝƐĐŽĐĂƌĚŝŽǀĂƐĐƵůĂƌ͘hŵ
ĞƐƚƵĚŽƉŽƉƵůĂĐŝŽŶĂůĐŽŵƋƵĂƐĞϭϬŵŝůŚƁĞƐĚĞĂĚƵůƚŽƐ͕ƐĞŶĚŽϯϴϬŵŝůĐŽŵĚŝĂďĞƚĞƐ͕ŵŽƐƚƌŽƵƋƵĞĂ
ƚƌĂŶƐŝĕĆŽĚŽƌŝƐĐŽŝŶƚĞƌŵĞĚŝĄƌŝŽƉĂƌĂŽĂůƚŽŽĐŽƌƌĞĂŽƐϰϭĂŶŽƐŶŽƐŚŽŵĞŶƐĞĂŽƐϰϴŶĂƐŵƵůŚĞƌĞƐ
ĐŽŵĚŝĂďĞƚĞƐƟƉŽϮ͘KƐƉŽƌƚĂĚŽƌĞƐĚŽĚŝĂďĞƚĞƐĚŽƟƉŽϭĞŶƚƌĂŵŶĂĨĂŝdžĂĚĞĂůƚŽƌŝƐĐŽĂŝŶĚĂŵĂŝƐ
ĐĞĚŽ͕ĂŽƐϯϬĂŶŽƐĚĞŝĚĂĚĞϭϱ͘

KĂĐƷŵƵůŽĚĞƉůĂĐĂƐĚĞŐŽƌĚƵƌĂŶĂƐĂƌƚĠƌŝĂƐ;ĂƚĞƌŽƐĐůĞƌŽƐĞͿĠĂƉƌŝŶĐŝƉĂůĐĂƌĂĐƚĞƌşƐƟĐĂĚĂƐĚŽĞŶĕĂƐ
ĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ͘ƐƚĂƐƉůĂĐĂƐƌĞƚĂƌĚĂŵŽŇƵdžŽƐĂŶŐƵşŶĞŽ͕ĂƵŵĞŶƚĂŵŽƌŝƐĐŽĚĞĐŽĄŐƵůŽƐĞůĞǀĂŵ
ĂŽĞŶĚƵƌĞĐŝŵĞŶƚŽĚĂƐĂƌƚĠƌŝĂƐ͘KĚŝĂďĞƚĞƐĠƵŵĚŽƐƉƌŝŶĐŝƉĂŝƐĂŐƌĂǀĂŶƚĞƐĚĞƐƐĞƉƌŽĐĞƐƐŽ͕ƉŽŝƐŽ
ĞdžĐĞƐƐŽĚĞĂĕƷĐĂƌŶŽƐĂŶŐƵĞĂŐƌŝĚĞŽƌĞǀĞƐƟŵĞŶƚŽĚŽƐǀĂƐŽƐ͕ĨĂǀŽƌĞĐĞŶĚŽŽĚĞƉſƐŝƚŽĚĞŐŽƌĚƵƌĂϭϲ͘

23 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Doença Arterial
Periférica (DAP)
ĚŽĞŶĕĂĂƌƚĞƌŝĂůƉĞƌŝĨĠƌŝĐĂ;WͿĠƵŵĂĐŽŵƉůŝĐĂĕĆŽĚŽĚŝĂďĞƚĞƐƋƵĞĂĐŽŶƚĞĐĞƋƵĂŶĚŽŽƐǀĂƐŽƐ
ƐĂŶŐƵşŶĞŽƐŶĂƐƉĞƌŶĂƐĮĐĂŵďůŽƋƵĞĂĚŽƐŽƵĞƐƚƌĞŝƚĂĚŽƐĚĞǀŝĚŽĂĚĞƉſƐŝƚŽƐĚĞŐŽƌĚƵƌĂ͕ƌĞƐƵůƚĂŶĚŽ
ŶĂƌĞĚƵĕĆŽĚŽŇƵdžŽƐĂŶŐƵşŶĞŽƉĂƌĂƉĞƌŶĂƐĞƉĠƐ͘

ŵĄĐŝƌĐƵůĂĕĆŽƐĂŶŐƵşŶĞĂĂĨĞƚĂĐĞƌĐĂĚĞϭͬϯĚĂƐƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐĂĐŝŵĂĚĞϱϬĂŶŽƐ͕ĞĂƵŵĞŶƚĂ
ŽƌŝƐĐŽĚĞĂƚĂƋƵĞĐĂƌĚşĂĐŽĞĚĞƌƌĂŵĞ͘

&ĂƚŽƌĞƐĐŽŵŽŽƐůŝƐƚĂĚŽƐĂďĂŝdžŽ͕ĂƵŵĞŶƚĂŵŽƐƌŝƐĐŽƐĚĞW͗

ͻ dĂďĂŐŝƐŵŽ
ͻ ,ŝƉĞƌƚĞŶƐĆŽƌƚĞƌŝĂů
ͻ ^ĞĚĞŶƚĂƌŝƐŵŽ
ͻ ^ŽďƌĞƉĞƐŽĞŽďĞƐŝĚĂĚĞ
ͻ ,ŝƐƚſƌŝĐŽĚĞĚŽĞŶĕĂĐĂƌĚşĂĐĂ

DƵŝƚŽƐŝŶĚŝǀşĚƵŽƐŶĆŽĂƉƌĞƐĞŶƚĂŵƐŝŶƚŽŵĂƐĚĞW͘ŶƚƌĞŽƐƐŝŶƚŽŵĂƐŵĂŝƐĐŽŵƵŶƐĞƐƚĆŽ͗

ͻ ĆŝďƌĂƐŶĂƐƉĞƌŶĂƐƉƌŽǀŽĐĂĚĂƐƉŽƌĂŶĚĂƌŽƵƐƵďŝƌĞƐĐĂĚĂƐ
ͻ ^ĞŶƐĂĕĆŽĚĞĚŽƌŽƵĨƌŝŽŶĂƐƉĞƌŶĂƐ
ͻ WƌĞƐĞŶĕĂĚĞƉĂůŝĚĞnjŽƵĐŽƌĂnjƵůĂĚĂĚĂƐƉĞƌŶĂƐ
ͻ /ŶĨĞĐĕƁĞƐŽƵĨĞƌŝĚĂƐŶŽƐƉĠƐŽƵŶĂƐƉĞƌŶĂƐ
ͻ WĞƌĚĂĚĞƉĞůŽƐŶĂƐƉĞƌŶĂƐŽƵŶŽƐƉĠƐ
ͻ WƌŽĐĞƐƐŽĚĞĐƵƌĂƉƌŽůŽŶŐĂĚŽ͘
ͻ ŝƐĨƵŶĕĆŽĞƌĠƟů

WĂƌĂŽĚŝĂŐŶſƐƟĐŽĚĞW͕ƐĞƵƟůŝnjĂŽşŶĚŝĐĞĚĞƉƌĞƐƐĆŽďƌĂƋƵŝĂůĚŽƚŽƌŶŽnjĞůŽ͘^ĞŶĂĐŽŵƉĂƌĂĕĆŽ
ĞŶƚƌĞĂƉƌĞƐƐĆŽĂƌƚĞƌŝĂůŶŽƚŽƌŶŽnjĞůŽĞŶŽďƌĂĕŽĂƉƌŝŵĞŝƌĂƐĞĂƉƌĞƐĞŶƚĂŵĞŶŽƌ͕ĠƐŝŶĂůĚĞĚŽĞŶĕĂ
ĂƌƚĞƌŝĂů ƉĞƌŝĨĠƌŝĐĂ͘ KƵƚƌŽƐ ƚĞƐƚĞƐ ƉĂƌĂ ĚŝĂŐŶŽƐƟĐĂƌ W ƉŽĚĞŵ ŝŶĐůƵŝƌ ĂŶŐŝŽŐƌĂŵĂƐ͕ ƵůƚƌĂͲƐŽŵ Ğ
ƌĞƐƐŽŶąŶĐŝĂŵĂŐŶĠƟĐĂ͘

KƚƌĂƚĂŵĞŶƚŽƉĂƌĂWĠďĂƐĞĂŶĚŽĞŵĐĞƐƐĆŽĚŽƚĂďĂŐŝƐŵŽ͕ĐŽŶƚƌŽůĞĚĂŚŝƉĞƌƚĞŶƐĆŽĞĚŝƐůŝƉŝĚĞŵŝĂ͕
ĐŽŶƚƌŽůĞĚĂŐůŝĐĞŵŝĂ;,ďϭĐфϲ͕ϱйͿ͕ƵƐŽĚĞĂŐĞŶƚĞƐĂŶƟƉůĂƋƵĞƚĄƌŝŽƐ;ĂƐƉŝƌŝŶĂͿĞĂƟǀŝĚĂĚĞİƐŝĐĂ͘

24 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Complicações
Microvasculares:
EĞĨƌŽƉĂƟĂĚŝĂďĠƟĐĂ
^ĞŐƵŶĚŽĂ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞŝĂďĞƚĞƐͲ^͕ĐĞƌĐĂĚĞϯϬйƚĞŵĂƉƌŽďĂďŝůŝĚĂĚĞĚĞĚĞƐĞŶǀŽůǀĞƌ
ĂŶĞĨƌŽƉĂƟĂĚŝĂďĠƟĐĂ͕ƚĞƌŵŽƵƐĂĚŽƋƵĂŶĚŽŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽĂƉƌĞƐĞŶƚĂĚŝƐĨƵŶĕƁĞƐƌĞŶĂŝƐ͘ůĂĠĂ
ƉƌŝŶĐŝƉĂůĐĂƵƐĂĚĞŝŶƐƵĮĐŝġŶĐŝĂƌĞŶĂůĐƌƀŶŝĐĂŶŽŵƵŶĚŽ͕ĂĐŽŵĞƚĞŶĚŽĐĞƌĐĂĚĞϮϬĂϰϬйĚĂƐƉĞƐƐŽĂƐ
ƋƵĞƚĞŵĚŝĂďĞƚĞƐϭϱ͘

dĂŶƚŽĚŝĂďĠƟĐŽƐƟƉŽϭĐŽŵŽƟƉŽϮ͕ƉŽĚĞŵĂƉƌĞƐĞŶƚĂƌŶĞĨƌŽƉĂƟĂ͕ŵĂƐĠƉŽƐƐşǀĞůƉƌĞǀĞŶŝƌŽƵƌĞƚĂƌĚĂƌ
ŽƉƌŽĐĞƐƐŽ͕ĂƚƌĂǀĠƐĚŽĐŽŶƚƌŽůĞĚŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞĞĚĂƉƌĞƐƐĆŽĂƌƚĞƌŝĂů͘
^ĞŐƵŶĚŽĂ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞEĞĨƌŽůŽŐŝĂ͕ĐĞƌĐĂĚĞϭϬйĚŽƐƉĂĐŝĞŶƚĞƐĞǀŽůƵĞŵƉĂƌĂŝŶƐƵĮĐŝġŶĐŝĂ
ƌĞŶĂů͕ƉŽĚĞŶĚŽĞdžŝŐŝƌƚƌĂƚĂŵĞŶƚŽƐĂŐƌĞƐƐŝǀŽƐĞĂƚĠƚƌĂŶƐƉůĂŶƚĞƐϭϳ͘

ŶĞĨƌŽƉĂƟĂĚŝĂďĠƟĐĂĠĂƐƐŝŶƚŽŵĄƟĐĂ͘^ĞƵĚŝĂŐŶſƐƟĐŽƉƌĞĐŽĐĞƐĞĨĂnjĂƚƌĂǀĠƐƚƌŝĂŐĞŵůĂďŽƌĂƚŽƌŝĂů͕
ĂƚƌĂǀĠƐĚŽĂƉĂƌĞĐŝŵĞŶƚŽĚĞŶşǀĞŝƐďĂŝdžŽƐ͕ŵĂƐĂŶŽƌŵĂŝƐ͕ĚĞŵŝĐƌŽĂůďƵŵŝŶƷƌŝĂ͘ŽŵĂƉƌŽŐƌĞƐƐĆŽĚĂ
ĚŽĞŶĕĂ͕ƐĞŝŶƐƚĂůĂĂƉƌŽƚĞŝŶƷƌŝĂ͘

ůŐƵŵĂƐƐŝƚƵĂĕƁĞƐĐŽŵŽŚŝƉĞƌƚĞŶƐĆŽ͕ŝŶĨĞĐĕƁĞƐ͕ĂůƚĞƌĂĕƁĞƐƵƌŝŶĄƌŝĂƐĞŵĞĚŝĐĂŵĞŶƚŽƐƋƵĞƉƌŽǀŽĐĂŵ
ůĞƐƁĞƐƌĞŶĂŝƐ͕ƉŽĚĞŵĚĞƐĞŶĐĂĚĞĂƌŽƵĂŐƌĂǀĂƌŽƋƵĂĚƌŽĚĞŶĞĨƌŽƉĂƟĂ͘

WĂƌĂƉƌĞǀĞŶĕĆŽĚĂŶĞĨƌŽƉĂƟĂƌĞĐŽŵĞŶĚĂͲƐĞ͗

ͻ ŽŶƚƌŽůĞĚĂŚŝƉĞƌƚĞŶƐĆŽ
ͻ ŽŶƚƌŽůĞĂĚĞƋƵĂĚŽĚĂŐůŝĐĞŵŝĂ
ͻ džĂŵĞƐĚĞƐĂŶŐƵĞĞƵƌŝŶĂƐϭǀĞnjĂŽĂŶŽ

25 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ ŝĞƚĂƉŽďƌĞĞŵƐſĚŝŽ
ͻ WĞƌĚĂĚĞƉĞƐŽ
ͻ ŽŶƚƌŽůĞĚĂƐŝŶĨĞĐĕƁĞƐĚŽƚƌĂƚŽƵƌŝŶĄƌŝŽ

Retinopatia
Diabética
ƌĞƟŶĂĠĂĐĂŵĂĚĂŵĂŝƐŝŶƚĞƌŶĂ͕ĚĂƐƚƌġƐƋƵĞƌĞǀĞƐƚĞŵŽŽůŚŽ͘ĐŽŶƐƟƚƵşĚĂĚĞƚĞĐŝĚŽŶĞƌǀŽƐŽ͕
ĐĂƉĂnjĚĞĐĂƉƚĂƌŽƐĞƐơŵƵůŽƐůƵŵŝŶŽƐŽƐĂƐĞƌĞŵƚƌĂŶƐĨŽƌŵĂĚŽƐĞŵŝŵĂŐĞŶƐ͘

ZĞƟŶŽƉĂƟĂĚŝĂďĠƟĐĂŽĐŽƌƌĞĚĞǀŝĚŽĂŽƐĚĂŶŽƐĐĂƵƐĂĚŽƐŶŽƐǀĂƐŽƐƐĂŶŐƵşŶĞŽƐƋƵĞŝƌƌŝŐĂŵĂƌĞƟŶĂ͕
ĚĞǀŝĚŽĂŚŝƉĞƌŐůŝĐĞŵŝĂĐƌƀŶŝĐĂĞŵƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐ͘ĞƉſƐŝƚŽƐĚĞŐŽƌĚƵƌĂŶŽƐĚĞůŝĐĂĚŽƐǀĂƐŽƐ
ƋƵĞŝƌƌŝŐĂŵĂƌĞŐŝĆŽĚĞĨƵŶĚŽĚĞŽůŚŽ;ŵĄĐƵůĂͿ͕ƉŽĚĞŵůĞǀĂƌĂĨŽƌŵĂĕĆŽĚĞĞĚĞŵĂĞŚĞŵŽƌƌĂŐŝĂƐ͕
ĂůĠŵĚĞŝŵƉĞĚŝƌĞŵŽŇƵdžŽƐĂŶŐƵşŶĞŽŶŽƌŵĂů͘

ƐƚĂƐŝƚƵĂĕĆŽĂŵĞĂĕĂĂƋƵĂůŝĚĂĚĞĚĞǀŝĚĂĚŽƉĂĐŝĞŶƚĞ͕ƉŽĚĞŶĚŽůĞǀĂƌĂƉĞƌĚĂƉĂƌĐŝĂůŽƵƚŽƚĂůĚĂ
ǀŝƐĆŽ͘

^ĞŐƵŶĚŽŽŽŶƐĞůŚŽƌĂƐŝůĞŝƌŽĚĞKŌĂůŵŽůŽŐŝĂϭϴ͕ƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐĂƉƌĞƐĞŶƚĂŵƵŵƌŝƐĐŽĚĞ
ƉĞƌĚĞƌĂǀŝƐĆŽϮϱǀĞnjĞƐŵĂŝƐĚŽƋƵĞĂƐƋƵĞŶĆŽƚĞŵĂĚŽĞŶĕĂ͘ůĂĂƟŶŐĞŵĂŝƐĚĞϳϱйĚĂƐƉĞƐƐŽĂƐ
ƋƵĞƚġŵĚŝĂďĞƚĞƐŚĄŵĂŝƐĚĞϮϬĂŶŽƐ͘

YƵĂůƋƵĞƌ ƉĞƐƐŽĂ ĐŽŵ ĚŝĂďĞƚĞƐ͕ ŝŶĚĞƉĞŶĚĞŶƚĞŵĞŶƚĞ ĚŽ ƟƉŽ͕ ĐŽƌƌĞ Ž ƌŝƐĐŽ ĚĞ ĚĞƐĞŶǀŽůǀĞƌ Ă
ƌĞƟŶŽƉĂƟĂ͘

^ĆŽĨĂƚŽƌĞƐĚĞƌŝƐĐŽ͗

ͻ ŽŶƚƌŽůĞŝŶĂĚĞƋƵĂĚŽĚĂŐůŝĐĞŵŝĂ
ͻ WƌĞƐĞŶĕĂŚŝƉĞƌƚĞŶƐĆŽĂƌƚĞƌŝĂů
ͻ WƌĞƐĞŶĕĂĚĞŶĞĨƌŽƉĂƟĂ
ͻ dĂďĂŐŝƐŵŽ
ͻ dĞŵƉŽĚĞĚŝĂŐŶſƐƟĐŽĚĞĚŝĂďĞƚĞƐ
ͻ ŝƐůŝƉŝĚĞŵŝĂ
ͻ 'ƌĂǀŝĚĞnj

26 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
džŝƐƚĞŵĚƵĂƐĨŽƌŵĂƐĚĞƌĞƟŶŽƉĂƟĂĚŝĂďĠƟĐĂ͗ĞdžƐƵĚĂƟǀĂĞƉƌŽůŝĨĞƌĂƟǀĂ

ZĞƟŶŽƉĂƟĂŝĂďĠƟĐĂdžƐƵĚĂƟǀĂ͗ŽĐŽƌƌĞƋƵĂŶĚŽĂƐŚĞŵŽƌƌĂŐŝĂƐĞĂƐŐŽƌĚƵƌĂƐĂĨĞƚĂŵĂŵĄĐƵůĂ͕
ƋƵĞĠŶĞĐĞƐƐĄƌŝĂƉĂƌĂĂǀŝƐĆŽĐĞŶƚƌĂů͕ƵƐĂĚĂƉĂƌĂĂůĞŝƚƵƌĂ͘

ZĞƟŶŽƉĂƟĂŝĂďĠƟĐĂWƌŽůŝĨĞƌĂƟǀĂ͗ĠŽĞƐƚĄŐŝŽŵĂŝƐĂǀĂŶĕĂĚŽĚĂĚŽĞŶĕĂŽĐƵůĂƌĚŝĂďĠƟĐĂ͘ůĂŽĐŽƌƌĞ
ƋƵĂŶĚŽŶĂƌĞƟŶĂĐŽŵĞĕĂĂĐƌĞƐĐĞƌŶŽǀŽƐǀĂƐŽƐƐĂŶŐƵşŶĞŽƐ͘/ƐƐŽĠĐŚĂŵĂĚŽĚĞŶĞŽǀĂƐĐƵůĂƌŝnjĂĕĆŽ͘
ƐƚĞƐ ŶŽǀŽƐ ǀĂƐŽƐ ƐĆŽ ĞdžƚƌĞŵĂŵĞŶƚĞ ĨƌĄŐĞŝƐ͕ ĐŽŵ ƌŽŵƉŝŵĞŶƚŽ ĚĞƐƚĞƐ ǀĂƐŽƐ ƉŽĚĞ ŽĐŽƌƌĞƌ Ƶŵ
ďůŽƋƵĞŝŽƚŽƚĂůĚĂǀŝƐĆŽĚŽƉĂĐŝĞŶƚĞ͘

^ŝŶĂŝƐĞƐŝŶƚŽŵĂƐ͗

ͻ WĞƌĚĂĚĞǀŝƐĆŽĐĞŶƚƌĂůĚŝĮĐƵůƚĂŶĚŽĂůĞŝƚƵƌĂ
ͻ /ŶĐĂƉĂĐŝĚĂĚĞĚĞǀĞƌĐŽƌĞƐ
ͻ sŝƐĆŽĞŵďĂĕĂĚĂ
ͻ ƵƌĂĐŽƐŽƵŵĂŶĐŚĂƐƉƌĞƚĂƐŶĂǀŝƐĆŽ
ͻ sŝƐĆŽĚƵƉůĂ
ͻ ŽƌŶŽƐŽůŚŽƐ

 ĨŽƚŽĐŽĂŐƵůĂĕĆŽ ă ůĂƐĞƌ Ġ ĨƌĞƋƵĞŶƚĞŵĞŶƚĞ ƵƟůŝnjĂĚĂ ŶŽ ƚƌĂƚĂŵĞŶƚŽ ĚĂ ƌĞƟŶŽƉĂƟĂ ĚŝĂďĠƟĐĂ͕

ƌĞĐŽŵĞŶĚĂͲƐĞ͕ĂŝŶĚĂ͕ǀŝƐŝƚĂƐĨƌĞƋƵĞŶƚĞƐĂŽŽŌĂůŵŽůŽŐŝƐƚĂ͕ƉŽŝƐƋƵĂŶƚŽŵĂŝƐƉƌĞĐŽĐĞĨŽƌŽĚŝĂŐŶſƐƟĐŽ͕
ŵĞůŚŽƌĠŽƉƌŽŐŶſƐƟĐŽ͘

Neuropatia
Diabética:
ŶĞƵƌŽƉĂƟĂĠƵŵĂĚĞƐŽƌĚĞŵĚŽƐŝƐƚĞŵĂŶĞƌǀŽƐŽƋƵĞƉŽĚĞĂĨĞƚĂƌƚĂŶƚŽĚŝĂďĠƟĐŽƐƟƉŽϭĐŽŵŽƟƉŽ
Ϯ͘KƚĞƌŵŽŶĞƵƌŽƉĂƟĂƉĞƌŝĨĠƌŝĐĂƌĞĨĞƌĞͲƐĞĂĚĂŶŽƐĚŽƐŶĞƌǀŽƐŽƐƋƵĞĂĨĞƚĂŵƋƵĂůƋƵĞƌŶĞƌǀŽĨŽƌĂĚŽ
ĐĠƌĞďƌŽŽƵŵĞĚƵůĂĞƐƉŝŶŚĂů͘

KƐƐŝŶƚŽŵĂƐĚĞŶĞƵƌŽƉĂƟĂŐĞƌĂůŵĞŶƚĞƐĞŵĂŶŝĨĞƐƚĂŵĐŽŵŽĚŽƌŵġŶĐŝĂŽƵĚŽƌŶĂƐŵĆŽƐ͕ƉĠƐ͕ďƌĂĕŽƐ
ŽƵƉĞƌŶĂƐ͕ŵĂƐƉŽĚĞŵĂĨĞƚĂƌ͕ƚĂŵďĠŵ͕ſƌŐĆŽƐƚĂŝƐĐŽŵŽĐŽƌĂĕĆŽ͕ĂƵŵĞŶƚĂŶĚŽŽƌŝƐĐŽĐĂƌĚşĂĐŽ͕Ğ
ſƌŐĆŽƐƐĞdžƵĂŝƐ͕ůĞǀĂŶĚŽĂĚŝƐĨƵŶĕĆŽĞƌĠƟůŶŽƐŚŽŵĞŶƐĚĞƐĞĐƵƌĂǀĂŐŝŶĂůŶĂƐŵƵůŚĞƌĞƐ͘

KƚĞŵƉŽĚĞĚŽĞŶĕĂ͕ŽĚĞƐĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽĐŽŶƟŶƵŽ͕ŝĚĂĚĞ͕ƐŽďƌĞƉĞƐŽ͕ŚŝƉĞƌƚĞŶƐĆŽ͕ĚŝƐůŝƉŝĚĞŵŝĂ͕
ƐĆŽĨĂƚŽƌĞƐĚĞƌŝƐĐŽƉĂƌĂŽĚĞƐĞŶǀŽůǀŝŵĞŶƚŽĚĂŶĞƵƌŽƉĂƟĂ͘

27 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŶĞƵƌŽƉĂƟĂĚŝĂďĠƟĐĂƉŽĚĞƐĞƌĐĂƚĞŐŽƌŝnjĂĚĂĚĂƐĞŐƵŝŶƚĞĨŽƌŵĂ͗

ͻ EĞƵƌŽƉĂƟĂƐĞŶƐŽƌŝĂů͗ŽĐŽƌƌĞƋƵĂŶĚŽŽƐŶĞƌǀŽƐƋƵĞĚĞƚĞĐƚĂŵŽƚŽƋƵĞĞĂƚĞŵƉĞƌĂƚƵƌĂƐĆŽ
ĚĂŶŝĮĐĂĚŽƐ͘ƐƚĂĨŽƌŵĂĚĞŶĞƵƌŽƉĂƟĂŐĞƌĂůŵĞŶƚĞĂĨĞƚĂŽƐƉĠƐĞĂƐŵĆŽƐ͘

ͻ EĞƵƌŽƉĂƟĂŵŽƚŽƌĂ͗ƌĞƐƵůƚĂĚĞĚĂŶŽƐŶŽƐŶĞƌǀŽƐƋƵĞĂĨĞƚĂŵŽŵŽǀŝŵĞŶƚŽŵƵƐĐƵůĂƌ͘

ͻ EĞƵƌŽƉĂƟĂĂƵƚŽŶƀŵŝĐĂ͗ĚĂŶŽƐŶŽƐŶĞƌǀŽƐƋƵĞĐŽŶƚƌŽůĂŵĂĕƁĞƐŝŶǀŽůƵŶƚĄƌŝĂƐ͕ĐŽŵŽĚŝŐĞƐƚĆŽ
ŽƵĨƌĞƋƵġŶĐŝĂĐĂƌĚşĂĐĂ͘

DĂŶŝĨĞƐƚĂĕƁĞƐůşŶŝĐĂƐĞ^ƵďĐůşŶŝĐĂƐĚĂEĞƵƌŽƉĂƟĂŝĂďĠƟĐĂƵƚŽŶƀŵŝĐĂ 15

ĞŽŽŬϮ͘ϬŝĂďĞƚĞƐŶĂWƌĄƟĐĂůşŶŝĐĂʹ^ϭϱ

^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞŝĂďĞƚĞƐϭϱƌĞĐŽŵĞŶĚĂƋƵĞƉĂĐŝĞŶƚĞƐDϭĨĂĕĂŵŽƌĂƐƚƌĞĂŵĞŶƚŽƉĂƌĂ
ŶĞƵƌŽƉĂƟĂĂƉſƐϱĂŶŽƐĚĞĚŝĂŐŶſƐƟĐŽĞĚĞƉŽŝƐĂŶƵĂůŵĞŶƚĞ͘WĂƌĂƉĂĐŝĞŶƚĞƐDϮ͕ĞƐƚĞƌĂƐƚƌĞĂŵĞŶƚŽ
ĚĞǀĞƐĞƌƌĞĂůŝnjĂĚŽŶŽĚŝĂŐŶſƐƟĐŽĞĚĞƉŽŝƐĂŶƵĂůŵĞŶƚĞ͘

sĞũĂĂďĂŝdžŽĂůŐƵŶƐƐŝŶĂŝƐĞƐŝŶƚŽŵĂƐĚĞĂĐŽƌĚŽĐŽŵĂĚŝƐĨƵŶĕĆŽŝŶƐƚĂůĂĚĂ͗

ͻ ĂƌĚŝŽǀĂƐĐƵůĂƌ͗ ƚŽŶƚƵƌĂƐ ƉŽƌ ŚŝƉŽƚĞŶƐĆŽ ƉŽƐƚƵƌĂů͕ ŚŝƉŽƚĞŶƐĆŽ ƉſƐͲƉƌĂŶĚŝĂů͕ ƚĂƋƵŝĐĂƌĚŝĂ Ğŵ

ƌĞƉŽƵƐŽ͕ŝŶƚŽůĞƌąŶĐŝĂĂŽĞdžĞƌĐşĐŝŽ͕ŝƐƋƵĞŵŝĂŵŝŽĐĄƌĚŝĐĂŽƵŝŶĨĂƌƚŽƐĞŵĚŽƌ͕ĐŽŵƉůŝĐĂĕƁĞƐŶŽƐƉĠƐ͕
ŵŽƌƚĞƐƷďŝƚĂ͘

28 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ ƵƚŽŶƀŵŝĐĂWĞƌŝĨĠƌŝĐĂ͗ĂůƚĞƌĂĕƁĞƐŶĂƚĞdžƚƵƌĂĚĂƉĞůĞ͕ĞĚĞŵĂ͕ƉƌŽĞŵŝŶġŶĐŝĂǀĞŶŽƐĂ͕ĨŽƌŵĂĕĆŽ
ĚĞĐĂůŽ͕ƉĞƌĚĂĚĂƐƵŶŚĂƐ͕ĂŶŽƌŵĂůŝĚĂĚĞĚĂƐƐƵĚŽƌĞƐĞĚŽƐƉĠƐ͘

ͻ 'ĂƐƚƌŽŝŶƚĞƐƟŶĂů͗ ĚŝƐĨĂŐŝĂ͕ ĚŽƌ ƌĞƚƌŽĞƐƚĞƌŶĂů͕ ƉŝƌŽƐĞ͕ ŐĂƐƚƌŽƉĂƌĞƐŝĂ͕ ĐŽŶƐƟƉĂĕĆŽ͕ ĚŝĂƌƌĞŝĂ͕

ŝŶĐŽŶƟŶġŶĐŝĂĨĞĐĂů͘

ͻ 'ĞŶŝƚƵƌŝŶĄƌŝŽ͗ĚŝƐĨƵŶĕĆŽǀĞƐŝĐĂů͕ĞũĂĐƵůĂĕĆŽƌĞƚƌŽŐƌĂĚĂ͕ĚŝƐĨƵŶĕĆŽĞƌĠƟů͕ĚŝƐƉĂƌĞƵŶŝĂ͘

ͻ ^ƵĚŽŵŽƚŽƌĂ͗ĂŶŝĚƌŽƐĞĚŝƐƚĂů͕ƐƵĚŽƌĞƐĞŐƵƐƚĂƚſƌŝĂ

ͻ ZĞƐƉŽƐƚĂƉƵƉŝůĂƌĂŶŽƌŵĂů͗ǀŝƐĆŽŵƵŝƚŽĚŝŵŝŶƵşĚĂŶŽĞƐĐƵƌŽ

ͻ ZĞƐƉŽƐƚĂŶĞƵƌŽĞŶĚſĐƌŝŶĂăŚŝƉŽŐůŝĐĞŵŝĂ͗ŵĞŶŽƐƐĞĐƌĞĕĆŽĚĞŐůƵĐĂŐŽŶ͕ƐĞĐƌĞĕĆŽƌĞƚĂƌĚĂĚĂ
ĚĞĂĚƌĞŶĂůŝŶĂ͘

K ƚƌĂƚĂŵĞŶƚŽ Ġ ďĂƐĞĂĚŽ ŶŽ ĐŽŶƚƌŽůĞ ƌŝŐŽƌŽƐŽ ĚŽƐ ŶşǀĞŝƐ ŐůŝĐġŵŝĐŽƐ Ğ ĚŽƐ ƐŝŶƚŽŵĂƐ ŝŶƐƚĂůĂĚŽƐ͕
ĚĞƉĞŶĚĞŶĚŽĚŽſƌŐĆŽĂĨĞƚĂĚŽ͘ŝĞƚĂ͕ĂƟǀŝĚĂĚĞİƐŝĐĂŽƵŵĞĚŝĐĂĕĆŽƉŽĚĞŵƐĞƌĂũƵƐƚĂĚŽƐƉĂƌĂĂƟŶŐŝƌ
ĞƐƐĂƐŵĞƚĂƐŐůŝĐġŵŝĐĂƐ͘

džĞƌĐşĐŝŽƉŽĚĞƐĞƌƉĂƌƟĐƵůĂƌŵĞŶƚĞĞĮĐĂnj͕ƉŽŝƐĂũƵĚĂŽƉĂĐŝĞŶƚĞĂŵĞůŚŽƌĂƌĂĐŝƌĐƵůĂĕĆŽ͕ĨŽƌƚĂůĞĐĞŽƐ
ŵƷƐĐƵůŽƐĞĂƵdžŝůŝĂŶĂƉĞƌĚĂĚĞƉĞƐŽ͘

ZĞĐŽŵĞŶĚĂͲƐĞƉĂƌĂƌĚĞĨƵŵĂƌĞƌĞĚƵnjŝƌĂƋƵĂŶƟĚĂĚĞĚĞĄůĐŽŽůĐŽŶƐƵŵŝĚĂ͕ĂůĠŵĚĞĚĂƌƵŵĂĂƚĞŶĕĆŽ
ĞƐƉĞĐŝĂůĂŽĐƵŝĚĂĚŽĐŽŵŽƐƉĠƐĞƉĞůĞ͘

Critérios para
diagnóstico do
diabetes:
K ĚŝĂŐŶſƐƟĐŽ ĚŽ ĚŝĂďĞƚĞƐ Ġ ĨĞŝƚŽ ĐŽŵ ďĂƐĞ ŶŽƐ ĐƌŝƚĠƌŝŽƐ ĚĞ ŚĞŵŽŐůŽďŝŶĂ ŐůŝĐĂĚĂ ;ϭͿ Ğ ŐůŝĐŽƐĞ
ƉůĂƐŵĄƟĐĂĞŵũĞũƵŵĞƉſƐͲƉƌĂŶĚŝĂů;dKd'ʹdĞƐƚĞKƌĂůĚĞdŽůĞƌąŶĐŝĂĂ'ůŝĐŽƐĞʹ^ŽďƌĞĐĂƌŐĂĚĞϳϱŐ
ĚĞŐůŝĐŽƐĞͿ͕ĂƐƐŽĐŝĂĚĂĂƐŝŶƚŽŵĂƐ;ƉŽůŝƷƌŝĂ͕ƉŽůŝĚƉŝƐŝĂ͕ƉĞƌĚĂĚĞƉĞƐŽŶĆŽĞdžƉůŝĐĂĚĂĞŵDϭͿϭϵ͘

KƐ ŵĞƐŵŽƐ ƚĞƐƚĞƐ ƐĆŽ ƵƟůŝnjĂĚŽƐ ƉĂƌĂ ĚĞƚĞĐƚĂƌ Ğ ĚŝĂŐŶŽƐƟĐĂƌ ĚŝĂďĞƚĞƐ Ğ ƉƌĠͲĚŝĂďĞƚĞƐ͘ ŝĂďĞƚĞƐ
ƉŽĚĞƐĞƌŝĚĞŶƟĮĐĂĚŽĞŵƋƵĂůƋƵĞƌůƵŐĂƌĂŽůŽŶŐŽĚŽĞƐƉĞĐƚƌŽĚĞĐĞŶĄƌŝŽƐĐůşŶŝĐŽƐ͗ĞŵŝŶĚŝǀşĚƵŽƐ
ĂƉĂƌĞŶƚĞŵĞŶƚĞĚĞďĂŝdžŽƌŝƐĐŽƋƵĞƉĂƐƐĂŵĂƚĞƌƚĞƐƚĞƐĚĞŐůŝĐŽƐĞĂůƚĞƌĂĚŽƐ͕ĞŵŝŶĚŝǀşĚƵŽƐƚĞƐƚĂĚŽƐ
ĐŽŵďĂƐĞŶĂĂǀĂůŝĂĕĆŽĚŽƌŝƐĐŽĚĞĚŝĂďĞƚĞƐ͕ĞĞŵƉĂĐŝĞŶƚĞƐƐŝŶƚŽŵĄƟĐŽƐ͘

29 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
sĞũĂŶŽƋƵĂĚƌŽĂďĂŝdžŽŽƐǀĂůŽƌĞƐƉĂƌĂŽƐĐƌŝƚĠƌŝŽƐĚĞĚŝĂŐŶſƐƟĐŽĚĞĚŝĂďĞƚĞƐ͗

Diagnóstico
de Diabetes
Gestacional:

30 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŵďŽƌĂŶĆŽĞdžŝƐƚĂĐŽŶƐĞŶƐŽƐŽďƌĞƋƵĂůŵĠƚŽĚŽĠŽŵĂŝƐĞĮĐĂnjƉĂƌĂƌĂƐƚƌĞĂŵĞŶƚŽĞĚŝĂŐŶſƐƟĐŽĚŽ
ĚŝĂďĞƚĞƐŐĞƐƚĂĐŝŽŶĂů͕ŽDŝŶŝƐƚĠƌŝŽĚĂ^ĂƷĚĞϮϬƌĞĐŽŵĞŶĚĂƋƵĞŽƌĂƐƚƌĞĂŵĞŶƚŽĚĞǀĞƐĞƌŝŶŝĐŝĂĚŽƉĞůĂ
ĂŶĂŵŶĞƐĞƉĂƌĂĂŝĚĞŶƟĮĐĂĕĆŽĚŽƐĨĂƚŽƌĞƐĚĞƌŝƐĐŽ͗

ͻ /ĚĂĚĞŝŐƵĂůŽƵƐƵƉĞƌŝŽƌĂϯϱĂŶŽƐ͖
ͻ 1ŶĚŝĐĞĚĞŵĂƐƐĂĐŽƌƉŽƌĂů;/DͿхϮϱŬŐͬŵϮ;ƐŽďƌĞƉĞƐŽĞŽďĞƐŝĚĂĚĞͿ͖
ͻ ŶƚĞĐĞĚĞŶƚĞƉĞƐƐŽĂůĚĞĚŝĂďĞƚĞƐŐĞƐƚĂĐŝŽŶĂů͖
ͻ ŶƚĞĐĞĚĞŶƚĞĨĂŵŝůŝĂƌĚĞĚŝĂďĞƚĞƐŵĞůůŝƚƵƐ;ƉĂƌĞŶƚĞƐĚĞƉƌŝŵĞŝƌŽŐƌĂƵͿ͖
ͻ DĂĐƌŽƐƐŽŵŝĂŽƵƉŽůŝŚŝĚƌąŵŶŝŽĞŵŐĞƐƚĂĕĆŽĂŶƚĞƌŝŽƌ͖
ͻ MďŝƚŽĨĞƚĂůƐĞŵĐĂƵƐĂĂƉĂƌĞŶƚĞĞŵŐĞƐƚĂĕĆŽĂŶƚĞƌŝŽƌ͖
ͻ DĂůĨŽƌŵĂĕĆŽĨĞƚĂůĞŵŐĞƐƚĂĕĆŽĂŶƚĞƌŝŽƌ͖
ͻ hƐŽĚĞĚƌŽŐĂƐŚŝƉĞƌŐůŝĐĞŵŝĂŶƚĞƐ;ĐŽƌƟĐŽŝĚĞƐ͕ĚŝƵƌĠƟĐŽƐƟĂnjşĚŝĐŽƐͿ͖
ͻ ^şŶĚƌŽŵĞĚŽƐŽǀĄƌŝŽƐƉŽůŝĐşƐƟĐŽƐ͖
ͻ ,ŝƉĞƌƚĞŶƐĆŽĂƌƚĞƌŝĂůĐƌƀŶŝĐĂ͘

EĂŐƌĂǀŝĚĞnjĂƚƵĂů͕ĞŵƋƵĂůƋƵĞƌŵŽŵĞŶƚŽ͗

ͻ 'ĂŶŚŽĞdžĐĞƐƐŝǀŽĚĞƉĞƐŽ͖
ͻ ^ƵƐƉĞŝƚĂĐůşŶŝĐĂŽƵƵůƚƌĂƐƐŽŶŽŐƌĄĮĐĂĚĞĐƌĞƐĐŝŵĞŶƚŽĨĞƚĂůĞdžĐĞƐƐŝǀŽŽƵƉŽůŝŚŝĚƌąŵŶŝŽ͘

dŽĚĂƐĂƐŐĞƐƚĂŶƚĞƐ͕ŝŶĚĞƉĞŶĚĞŶƚĞŵĞŶƚĞĚĞĂƉƌĞƐĞŶƚĂƌĞŵĨĂƚŽƌĚĞƌŝƐĐŽ͕ĚĞǀĞŵƌĞĂůŝnjĂƌƵŵĂĚŽƐĂŐĞŵ
ĚĞŐůŝĐĞŵŝĂŶŽŝŶşĐŝŽĚĂŐƌĂǀŝĚĞnj͕ĂŶƚĞƐĚĞϮϬƐĞŵĂŶĂƐ͕ŽƵƚĆŽůŽŐŽƐĞũĂƉŽƐƐşǀĞů͘KƌĂƐƚƌĞĂŵĞŶƚŽ
ĠĐŽŶƐŝĚĞƌĂĚŽƉŽƐŝƟǀŽŶĂƐŐĞƐƚĂŶƚĞƐĐŽŵŶşǀĞůĚĞŐůŝĐŽƐĞƉůĂƐŵĄƟĐĂĚĞũĞũƵŵхϴϱŵŐͬĚ>ĞͬŽƵŶĂ
ƉƌĞƐĞŶĕĂĚĞƋƵĂůƋƵĞƌĨĂƚŽƌĚĞƌŝƐĐŽƉĂƌĂŽĚŝĂďĞƚĞƐŐĞƐƚĂĐŝŽŶĂů͘

'ĞƐƚĂŶƚĞƐ ƋƵĞ ŶĆŽ ĂƉƌĞƐĞŶƚĂŵ ĨĂƚŽƌĞƐ ĚĞ ƌŝƐĐŽ ĐŽŵ ŐůŝĐĞŵŝĂ ĚĞ ũĞũƵŵ ч ϴϱŵŐͬĚ>͕ ŶŽ ŝŶşĐŝŽ ĚĂ
ŐĞƐƚĂĕĆŽ͕ĚĞǀĞŵƌĞƉĞƟƌĂŐůŝĐĞŵŝĂĚĞũĞũƵŵĞŶƚƌĞĂϮϰǐĞϮϴǐƐĞŵĂŶĂĚĞŐĞƐƚĂĕĆŽ͘

ƵĂƐŐůŝĐĞŵŝĂƐƉůĂƐŵĄƟĐĂƐĚĞũĞũƵŵшϭϮϲŵŐͬĚ>ĐŽŶĮƌŵĂŵŽĚŝĂŐŶſƐƟĐŽĚĞĚŝĂďĞƚĞƐŐĞƐƚĂĐŝŽŶĂů͕
ƐĞŵŶĞĐĞƐƐŝĚĂĚĞĚĞƐĞĨĂnjĞƌŽdKd'͘

ŽŝƐŽƵŵĂŝƐǀĂůŽƌĞƐĚĞǀĞŵĞƐƚĂƌĂĐŝŵĂĚŽŶŽƌŵĂůƉĂƌĂĐŽŶĮƌŵĂĕĆŽĚŝĂŐŶſƐƟĐĂ͘ZĞĐŽŵĞŶĚĂͲƐĞ
ĂŝŶĚĂĂĚŽƐĂŐĞŵĚĞŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂŶŽƐĐĂƐŽƐĚĞĚŝĂďĞƚĞƐĞŐĞƐƚĂĕĆŽ͕ĚĞǀŝĚŽăƐƵĂĂƐƐŽĐŝĂĕĆŽ͕
ƋƵĂŶĚŽĂƵŵĞŶƚĂĚĂ͕ĐŽŵŵĂůĨŽƌŵĂĕƁĞƐ͘

31 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Situações em que a
HbA1c NÃO É ADEQUADA
para o DIAGNÓSTICO
de diabetes:
ͻ dK^ĂƐĐƌŝĂŶĕĂƐĞũŽǀĞŶƐ
ͻ WĂĐŝĞŶƚĞƐĚĞƋƵĂůƋƵĞƌŝĚĂĚĞĐŽŵƐƵƐƉĞŝƚĂĚĞĚŝĂďĞƚĞƐƟƉŽϭ
ͻ WĂĐŝĞŶƚĞƐĐŽŵƐŝŶƚŽŵĂƐĚĞĚŝĂďĞƚĞƐƉŽƌŵĞŶŽƐĚĞϮŵĞƐĞƐ
ͻ WĂĐŝĞŶƚĞƐĚĞĂůƚŽƌŝƐĐŽƋƵĞĞƐƚĆŽĂŐƵĚĂŵĞŶƚĞĚŽĞŶƚĞƐ;ƉŽƌĞdžĞŵƉůŽ͕ĂƋƵĞůĞƐƋƵĞŶĞĐĞƐƐŝƚĂŵ
ĚĞŝŶƚĞƌŶĂĕĆŽŚŽƐƉŝƚĂůĂƌͿ
ͻ WĂĐŝĞŶƚĞƐƋƵĞƚŽŵĂŵŵĞĚŝĐĂŵĞŶƚŽƐƋƵĞƉŽĚĞŵĐĂƵƐĂƌĂƵŵĞŶƚŽƌĄƉŝĚŽĚĂŐůŝĐŽƐĞ;ĐŽƌƟĐŽŝĚĞƐ͕
ĂŶƟƉƐŝĐſƟĐŽƐͿ
ͻ WĂĐŝĞŶƚĞƐĐŽŵĚĂŶŽƉĂŶĐƌĞĄƟĐŽĂŐƵĚŽ͕ŝŶĐůƵŝŶĚŽĐŝƌƵƌŐŝĂƉĂŶĐƌĞĄƟĐĂ
ͻ EĂŐƌĂǀŝĚĞnj
ͻ WƌĞƐĞŶĕĂ ĚĞ ĨĂƚŽƌĞƐ ŐĞŶĠƟĐŽƐ͕ ŚĞŵĂƚŽůſŐŝĐŽƐ Ğ ƌĞůĂĐŝŽŶĂĚŽƐ ă ĚŽĞŶĕĂ ƋƵĞ ŝŶŇƵĞŶĐŝĂŵ Ă
,ďϭĐĞƐƵĂŵĞĚŝĕĆŽϭϵ͘

dƌĂƚĂŵĞŶƚŽĚĞŝĂďĞƚĞƐ͗

DĂŶƚĞƌĐŽŶƚƌŽůĂĚŽŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞĠŽŽďũĞƟǀŽĚŽƚƌĂƚĂŵĞŶƚŽ͘ĞƐƚƌĂƚĠŐŝĂƉĂƌĂŝƐƐŽĠďĂƐĞĂĚĂ
ŶĂƚƌşĂĚĞĚĞŐůŝĐŽƐĞ͕ĂďƌĂŶŐĞŶĚŽŽƐϯĐŽŵƉŽŶĞŶƚĞƐĚĂĮŐƵƌĂĂďĂŝdžŽ͗

32 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
džŝƐƚĞŵ ƵŵĂ ƐĠƌŝĞ ĚĞ ƚƌĂƚĂŵĞŶƚŽƐ ĚŝƐƉŽŶşǀĞŝƐ ƉĂƌĂ ŐĞƌĞŶĐŝĂƌ Ğ ĐŽŶƚƌŽůĂƌ ŽƐ ŶşǀĞŝƐ ĚĞ ŐůŝĐŽƐĞ ŶŽ
ƐĂŶŐƵĞ͕ŵĂƐŽƋƵĞŶĆŽƐĞĚĞǀĞŶĞŐůŝŐĞŶĐŝĂƌ͕ĠĂŝŶĚŝǀŝĚƵĂůŝĚĂĚĞĚĞĐĂĚĂƉĂĐŝĞŶƚĞ͘dŽĚŽŵƵŶĚŽĠ
ĚŝĨĞƌĞŶƚĞ͕ĞŶƚĆŽŽƚƌĂƚĂŵĞŶƚŽŝƌĄǀĂƌŝĂƌĚĞƉĞŶĚĞŶĚŽĚĞƐƵĂƐƉƌſƉƌŝĂƐŶĞĐĞƐƐŝĚĂĚĞƐŝŶĚŝǀŝĚƵĂŝƐ͘

ƐŵĞƚĂƐĚĞĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽǀĂƌŝĂŵĚĞĂĐŽƌĚŽĐŽŵĂŝĚĂĚĞĞĐŽŵŽƌďŝĚĂĚĞƐƉƌĠͲĞdžŝƐƚĞŶƚĞƐ͘

Ɛ ĐƌŝĂŶĕĂƐ Ğ ŝĚŽƐŽƐ ƚĞŵ ŵĞƚĂƐ ŐůŝĐġŵŝĐĂƐ ŵĂŝƐ ƚŽůĞƌĂŶƚĞƐ͕ ƉŽŝƐ ŶĞƐƚĂƐ Ϯ ĨĂŝdžĂƐ ĞƚĄƌŝĂƐ ĚĞǀĞŵŽƐ
ĞǀŝƚĂƌĂƐĐƌŝƐĞƐĚĞŚŝƉŽŐůŝĐĞŵŝĂ͘

 ƌĞůĂĕĆŽ ĞŶƚƌĞ ŚŝƉŽŐůŝĐĞŵŝĂ Ğ ƉŽƐƐşǀĞů ĐŽŵƉƌŽŵĞƟŵĞŶƚŽ ŶĞƵƌŽƉƐŝĐŽůſŐŝĐŽ Ġ ŵƵŝƚŽ ŵĂŝƐ

ƉƌĞŽĐƵƉĂŶƚĞ ƉĂƌĂ Ă ĐƌŝĂŶĕĂ ŵƵŝƚŽ ũŽǀĞŵ ĚŽ ƋƵĞ ƉĂƌĂ ĐƌŝĂŶĕĂƐ ŵĂŝŽƌĞƐ Ğ ĂĚŽůĞƐĐĞŶƚĞƐϮϮ͘ ĂĚŽƐ
ƐƵďƐƚĂŶĐŝĂŝƐƐƵŐĞƌĞŵƋƵĞŽĐĠƌĞďƌŽĞŵĚĞƐĞŶǀŽůǀŝŵĞŶƚŽĠŵĂŝƐǀƵůŶĞƌĄǀĞůĂŽƐĞĨĞŝƚŽƐƉƌĞũƵĚŝĐŝĂŝƐ
ĚĂŚŝƉŽŐůŝĐĞŵŝĂ͘

K ĞŶǀĞůŚĞĐŝŵĞŶƚŽ Ğ Ž ĚŝĂďĞƚĞƐ ƐĆŽ ĂŵďŽƐ ĨĂƚŽƌĞƐ ĚĞ ƌŝƐĐŽ ƉĂƌĂ Ž ĐŽŵƉƌŽŵĞƟŵĞŶƚŽ ĨƵŶĐŝŽŶĂů͘
/ĚŽƐŽƐƐĆŽŵĂŝƐƉƌŽƉĞŶƐŽƐĂƋƵĞĚĂƐ͕ƋƵĞƉŽĚĞŵůĞǀĂƌĂĨƌĂƚƵƌĂƐĞſďŝƚŽ͕ƉŽƌĞƐƚĞŵŽƟǀŽĚĞǀĞŵŽƐ
ĞǀŝƚĂƌĂƐĐƌŝƐĞƐĚĞŚŝƉŽŐůŝĐĞŵŝĂ͘

ŚŝƉŽŐůŝĐĞŵŝĂĞƐƚĄůŝŐĂĚĂăĚŝƐĨƵŶĕĆŽĐŽŐŶŝƟǀĂĚĞĨŽƌŵĂďŝĚŝƌĞĐŝŽŶĂů͗ŽĐŽŵƉƌŽŵĞƟŵĞŶƚŽĐŽŐŶŝƟǀŽ
ĂƵŵĞŶƚĂŽƌŝƐĐŽƐƵďƐĞƋƵĞŶƚĞĚĞŚŝƉŽŐůŝĐĞŵŝĂ͕ĞƵŵŚŝƐƚſƌŝĐŽĚĞŚŝƉŽŐůŝĐĞŵŝĂŐƌĂǀĞĞƐƚĄĂƐƐŽĐŝĂĚŽ
ăŝŶĐŝĚġŶĐŝĂĚĞĚĞŵġŶĐŝĂϮϯ͘

33 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Pilares do
tratamento
do diabetes:
ĞǀĞŵŽƐďĂƐĞĂƌŽƚƌĂƚĂŵĞŶƚŽĞŵϱƉŝůĂƌĞƐ͕ƋƵĞĞŶǀŽůǀĞŵŵƵĚĂŶĕĂĚĞĞƐƟůŽĚĞǀŝĚĂ;ĂůŝŵĞŶƚĂĕĆŽ
ďĂůĂŶĐĞĂĚĂ Ğ ĂƟǀŝĚĂĚĞ İƐŝĐĂ ƌĞŐƵůĂƌͿ͕ ŵĞĚŝĐĂĕĆŽ ;ŽƌĂů ŽƵ ŝŶũĞƚĄǀĞů͕ ƋƵĂŶĚŽ ŶĞĐĞƐƐĄƌŝŽͿ͕
ĂƵƚŽŵŽŶŝƚŽƌĂŵĞŶƚŽĞĞĚƵĐĂĕĆŽĞŵƐĂƷĚĞ͘

Educação
em Diabetes:
KƚƌĂƚĂŵĞŶƚŽĚĞĚŝĂďĞƚĞƐǀĂŝĂůĠŵĚĂƌĞůĂĕĆŽŵĠĚŝĐŽͲƉĂĐŝĞŶƚĞ͘ĞƋƵŝƉĞŵƵůƟĚŝƐĐŝƉůŝŶĂƌĠŶĞĐĞƐƐĄƌŝĂ
ĞũĄĠƵŵĂƌĞĂůŝĚĂĚĞĞŵĚŝǀĞƌƐŽƐƐĞƌǀŝĕŽƐĚĞƐĂƷĚĞĞƐƉĂůŚĂĚŽƐƉĞůŽƌĂƐŝů͘

34 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
WƌŽĮƐƐŝŽŶĂŝƐ ĐŽŵŽ ƉƐŝĐſůŽŐŽƐ͕ ĞŶĨĞƌŵĞŝƌŽƐ͕ ĮƐŝŽƚĞƌĂƉĞƵƚĂƐ͕ ĞĚƵĐĂĚŽƌĞƐ İƐŝĐŽƐ͕ ŶƵƚƌŝĐŝŽŶŝƐƚĂƐ Ğ
ĨĂƌŵĂĐġƵƟĐŽƐ͕ĞƐƚĆŽĐĂĚĂǀĞnjŵĂŝƐĞŶǀŽůǀŝĚŽƐŶŽƚƌĂƚĂŵĞŶƚŽĚŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽ͘

^ĞŐƵŶĚŽ Ă ^ϭϱ͕ Ă ͞ĚƵĐĂĕĆŽ Ğŵ ŝĂďĞƚĞƐ ĚĞǀĞ ƐĞƌ ĐŽŶƐŝĚĞƌĂĚĂ Ğ ŝŶĐŽƌƉŽƌĂĚĂ ĚƵƌĂŶƚĞ ƚŽĚŽ Ž
ƉƌŽĐĞƐƐŽ ĚŽ ĂĐŽŵƉĂŶŚĂŵĞŶƚŽ ĚŽƐ ƉĂĐŝĞŶƚĞƐ͕ ǀŝƐĂŶĚŽ ŐĂƌĂŶƟƌ Ž ĐŽŶƚƌŽůĞ ĚŽ ĚŝĂďĞƚĞƐ Ğ ĚĞ ƐƵĂƐ
ĐŽŵƉůŝĐĂĕƁĞƐĞŶĆŽƐĞƌĞƐƚƌŝŶŐŝƌăƐƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐ͕ŵĂƐƐŝŵĞŶǀŽůǀĞƌĂƚŽĚŽƐ͕ŝŶĐůƵŝŶĚŽŽƐ
ƉƌŽĮƐƐŝŽŶĂŝƐĚĞƐĂƷĚĞ͕ŽƐŐĞƐƚŽƌĞƐĚŽƐƐĞƌǀŝĕŽƐ͕ŽƐĨĂŵŝůŝĂƌĞƐ͕ĞƚŽĚĂĂĐŽŵƵŶŝĚĂĚĞ͘͟

KŵĠĚŝĐŽůŝŽƚ:ŽƐůŝŶ͕ĨƵŶĚĂĚŽƌĚŽ͞:ŽƐůŝŶŝĂďĞƚĞƐĞŶƚĞƌ͟ĞŵŽƐƚŽŶŶŽƐh͕ĂĮƌŵŽƵĞŵϭϵϯϬ͗

͞ĚƵĐĂĕĆŽĞŵŝĂďĞƚĞƐŶĆŽĠƐŽŵĞŶƚĞƉĂƌƚĞĚŽdƌĂƚĂŵĞŶƚŽĚŽŝĂďĞƚĞƐ͘Ž
ƉƌſƉƌŝŽƚƌĂƚĂŵĞŶƚŽ͘͟

KƉĂƉĞůĚŽĞĚƵĐĂĚŽƌĞŵĚŝĂďĞƚĞƐϮϭĠĨĂĐŝůŝƚĂƌĂŵƵĚĂŶĕĂĞŝŵƉůĞŵĞŶƚĂƌƉƌŽĐĞƐƐŽƐĞƉƌŽŐƌĂŵĂƐ
ƉĂƌĂŵĞůŚŽƌĂƌŽĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽĚŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽ͘

ZĞĐŽŵĞŶĚĂͲƐĞĂŽĨĂƌŵĂĐġƵƟĐŽƵƟůŝnjĂƌĂƐƵĂĞdžƉĞƌŝġŶĐŝĂĐůşŶŝĐĂŶĂŵŽŶŝƚŽƌŝnjĂĕĆŽĞŐĞƐƚĆŽĚĞƉůĂŶŽƐ
ĚĞ ŵĞĚŝĐĂĕĆŽ ƉĂƌĂ ĚŝĂďĞƚĞƐ͕ ĚĞƐƚĂ ŵĂŶĞŝƌĂ ŝŵƉĂĐƚĂƌ ƉŽƐŝƟǀĂŵĞŶƚĞ ŽƐ ƌĞƐƵůƚĂĚŽƐ ĚŽ ĐŽŶƚƌŽůĞ
ŐůŝĐġŵŝĐŽĞĐĂƉĂĐŝƚĂƌŽƐƉĂĐŝĞŶƚĞƐƉĂƌĂŐĞƌĞŶĐŝĂƌĂƟǀĂŵĞŶƚĞĂƐƵĂƐĂƷĚĞ͘

Atividade física
e o controle da
glicemia
 ĂƟǀŝĚĂĚĞ İƐŝĐĂ ƌĞŐƵůĂƌ Ġ ĞƐƐĞŶĐŝĂů ŶĂ ƉƌŽŵŽĕĆŽ ĚĞ ƐĂƷĚĞ ŶĂ ǀŝĚĂ ĚĞ ƋƵĂůƋƵĞƌ ƉĞƐƐŽĂ Ğ ĞƐƚĄ
ĚŝƌĞƚĂŵĞŶƚĞůŝŐĂĚĂĂŽŐĂƐƚŽĞŶĞƌŐĠƟĐŽ͘

KĐŽƌƉŽƵƐĂϮĨŽŶƚĞƐĚĞĞŶĞƌŐŝĂŶĂĂƟǀŝĚĂĚĞİƐŝĐĂ͕ĂŐůŝĐŽƐĞĞŽƐĄĐŝĚŽƐŐƌĂdžŽƐůŝǀƌĞƐ͘ŐůŝĐŽƐĞƐĞ
ĞŶĐŽŶƚƌĂŶŽƐĂŶŐƵĞ͕İŐĂĚŽĞŵƷƐĐƵůŽƐ͘ŐůŝĐŽƐĞĂƌŵĂnjĞŶĂĚĂŶŽİŐĂĚŽĞŵƷƐĐƵůŽƐƐĞĞŶĐŽŶƚƌĂŶĂ
ĨŽƌŵĂĚĞŐůŝĐŽŐġŶŝŽ͘

ƵƌĂŶƚĞŽƐƉƌŝŵĞŝƌŽƐϭϱŵŝŶƵƚŽƐĚĞĞdžĞƌĐşĐŝŽ͕ĂŵĂŝŽƌƉĂƌƚĞĚĂŐůŝĐŽƐĞĐŽŶƐƵŵŝĚĂǀĞŵĚĂĐŽƌƌĞŶƚĞ
ƐĂŶŐƵşŶĞĂ ŽƵ ĚŽ ŐůŝĐŽŐġŶŝŽ ŵƵƐĐƵůĂƌ͕ ƋƵĞ Ġ ĐŽŶǀĞƌƟĚŽ ŶŽǀĂŵĞŶƚĞ Ğŵ ŐůŝĐŽƐĞ͘ EŽƐ ϭϱ ŵŝŶƵƚŽƐ
ƉŽƐƚĞƌŝŽƌĞƐ͕ĂŐůŝĐŽƐĞĐŽŶƐƵŵŝĚĂĠŽƌŝŐŝŶĂĚĂĚŽŐůŝĐŽŐġŶŝŽĂƌŵĂnjĞŶĂĚŽŶŽİŐĂĚŽ͘ƉſƐϯϬŵŝŶƵƚŽƐ

35 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ĚĞĞdžĞƌĐşĐŝŽ͕ŽĐŽƌƉŽĐŽŵĞĕĂĂŽďƚĞƌĞŶĞƌŐŝĂĚŽƐĄĐŝĚŽƐŐƌĂdžŽƐůŝǀƌĞƐ͘

ůĠŵĚŽĐŽŶƐƵŵŽĚĂŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͕İŐĂĚŽĞŵƷƐĐƵůŽƐ͕ĂĂƟǀŝĚĂĚĞİƐŝĐĂĂƵŵĞŶƚĂĂƐĞŶƐŝďŝůŝĚĂĚĞ
ĚĂƐĐĠůƵůĂƐĂŝŶƐƵůŝŶĂ͕ŵĞůŚŽƌĂŶĚŽĂƐƐŝŵ͕ĂĐĂƉĂĐŝĚĂĚĞĐĞůƵůĂƌĚĞĂďƐŽƌĕĆŽĚĞŐůŝĐŽƐĞ͘

KƐďĞŶĞİĐŝŽƐĚĂƉƌĂƟĐĂĚĞĞdžĞƌĐşĐŝŽƐİƐŝĐŽƐǀĆŽĂůĠŵĚŽĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽĞŵƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐ͕
ĂũƵĚĂŵƚĂŵďĠŵŶĂ͗

ͻ WĞƌĚĂŽƵŵĂŶƵƚĞŶĕĆŽĚŽƉĞƐŽĐŽƌƉŽƌĂů͖
ͻ ŽŶƚƌŽůĞĚĂŚŝƉĞƌƚĞŶƐĆŽ
ͻ ŽŶƚƌŽůĞĚŽƐŶşǀĞŝƐĚĞĐŽůĞƐƚĞƌŽů
ͻ DĞůŚŽƌĂĚĞĨƵŶĕĆŽĐĂƌĚşĂĐĂ
ͻ ZĞĚƵnjĂƉĞƌĚĂĚĞŵĂƐƐĂſƐƐĞĂ
ͻ ZĞĚƵnjĂĚĞƉƌĞƐƐĆŽĞĂŶƐŝĞĚĂĚĞ

Hipoglicemia
e Atividade física:
ŽŵŽƌĞƐƵůƚĂĚŽĚŽƵƐŽĚĂŐůŝĐŽƐĞĐŽŵŽĞŶĞƌŐŝĂŶĂĂƟǀŝĚĂĚĞİƐŝĐĂ͕ĂƐƌĞƐĞƌǀĂƐĚĞŐůŝĐŽƐĞĞŐůŝĐŽŐġŶŝŽ
ƉŽĚĞŵƐĞĞƐŐŽƚĂƌ͕ĂƵŵĞŶƚĂŶĚŽŽƌŝƐĐŽĚĞŚŝƉŽŐůŝĐĞŵŝĂϮϰ͘

KƐĚŝĂďĠƟĐŽƐƟƉŽϭĞŶĐŽŶƚƌĂŵͲƐĞĞŵŵĂŝŽƌƌŝƐĐŽĚĞŚŝƉŽŐůŝĐĞŵŝĂĚŽƋƵĞĂƐĐŽŵƟƉŽϮ͕ĂŶĆŽƐĞƌ
ƋƵĞĞƐƚĞƐĞƐƚĞũĂŵĞŵƚƌĂƚĂŵĞŶƚŽĐŽŵŝŶƐƵůŝŶĂŽƵĚƌŽŐĂƐŚŝƉŽŐůŝĐĞŵŝĂŶƚĞƐ͘

^ĞŐƵŶĚŽĂ^͕͞KĚĞƐĂĮŽĠĂƉƌĞŶĚĞƌĂĂĚĞƋƵĂƌĂĂůŝŵĞŶƚĂĕĆŽĞƚĞƌĂƉŝĂŝŶƐƵůşŶŝĐĂƉĂƌĂƉĞƌŵŝƟƌ
ƵŵĂƉĂƌƟĐŝƉĂĕĆŽƐĞŐƵƌĂĞŵĂƟǀŝĚĂĚĞƐİƐŝĐĂƐ͕ƉƌŽŐƌĂŵĂĚĂƐĞŶĆŽƉƌŽŐƌĂŵĂĚĂƐ͕ŽďƚĞŶĚŽŽƐŵĂŝŽƌĞƐ
ďĞŶĞİĐŝŽƐĐŽŵŵşŶŝŵŽƐĞĨĞŝƚŽƐĂĚǀĞƌƐŽƐ͘͟

ƐĐƌŝƐĞƐĚĞŚŝƉŽŐůŝĐĞŵŝĂƉŽĚĞŵŽĐŽƌƌĞƌŵĞƐŵŽĂƚĠϮϰŚŽƌĂƐĂƉſƐĂĂƟǀŝĚĂĚĞİƐŝĐĂ͘WĂƌĂŵŝŶŝŵŝnjĂƌ
ŽƌŝƐĐŽ͕ƌĞĐŽŵĞŶĚĂͲƐĞ͗

ͻ KĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽĚĞǀĂƐĞƌŽŵĞůŚŽƌƉŽƐƐşǀĞů͘KĂƵƚŽŵŽŶŝƚŽƌĂŵĞŶƚŽĚĂŐůŝĐĞŵŝĂĐĂƉŝůĂƌ
ĚĞǀĞƐĞƌƌĞĂůŝnjĂĚŽĂŶƚĞƐ͕ĚƵƌĂŶƚĞĞĂƉſƐĂĂƟǀŝĚĂĚĞİƐŝĐĂ͘
ͻ ǀŝƚĂƌŽĞdžĞƌĐşĐŝŽŶŽĂƵŐĞĚŽƉŝĐŽĚĞĂĕĆŽĚĂŝŶƐƵůŝŶĂ͘
ͻ ŽŶĐůƵŝƌŽƐĞdžĞƌĐşĐŝŽƐϮŚŽƌĂƐĂŶƚĞƐĚĞĚĞŝƚĂƌ͘

36 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ ǀŝƚĂƌŽĐŽŶƐƵŵŽĚĞĄůĐŽŽůĂŶƚĞƐŽƵŝŵĞĚŝĂƚĂŵĞŶƚĞĂƉſƐĂĂƟǀŝĚĂĚĞİƐŝĐĂ͘
ͻ ǀŝƚĂƌďĂŶŚĞŝƌĂƐĚĞŚŝĚƌŽŵĂƐƐĂŐĞŵĞƐĂƵŶĂƐĂƉſƐŽĞdžĞƌĐşĐŝŽ͘ƐƚĞƐĐŽŶƟŶƵĂŵĂŵĂŶƚĞƌƵŵ
ĂƵŵĞŶƚŽĚĂĨƌĞƋƵġŶĐŝĂĐĂƌĚşĂĐĂĞƉŽĚĞŵĐŽŶƟŶƵĂƌĂĚŝŵŝŶƵŝƌĂŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͘
ͻ ƵŵĞŶƚĞ Ă ĨƌĞƋƵġŶĐŝĂ ĚĞ ŵĞĚŝĕƁĞƐ ĚĞ ŐůŝĐĞŵŝĂ ĐĂƉŝůĂƌ ĂƉſƐ ĂƟǀŝĚĂĚĞƐ İƐŝĐĂƐ ŝŶƚĞŶƐĂƐ Ă
ŵŽĚĞƌĂĚĂƐ͕ƉŽŝƐĂƐĐƌŝƐĞƐĚĞŚŝƉŽŐůŝĐĞŵŝĂƉŽĚĞŵŽĐŽƌƌĞƌŶĂƐƉƌſdžŝŵĂƐϮϰŚŽƌĂƐĂƉſƐŽĞdžĞƌĐşĐŝŽ͘

Dieta e controle
glicêmico
ŵĂŝŽƌĚƷǀŝĚĂĚĞƋƵĞŵƚĞŵĚŝĂďĞƚĞƐĠ͗͞KƋƵĞƉŽƐƐŽĐŽŵĞƌ͍͟

WĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐƚġŵĂƐŵĞƐŵĂƐŶĞĐĞƐƐŝĚĂĚĞƐŶƵƚƌŝĐŝŽŶĂŝƐƋƵĞƋƵĂůƋƵĞƌŽƵƚƌĂƉĞƐƐŽĂ͕ĚĞǀĞŶĚŽ
ƚĞƌƵŵĂĚŝĞƚĂƌŝĐĂĞŵĮďƌĂƐ͕ŵĂŶƚĞŶĚŽĂŚŝĚƌĂƚĂĕĆŽ͕ĂŝŶŐĞƐƚĆŽĚĞĨƌƵƚĂƐĞǀĞƌĚƵƌĂƐ͕ĐĂƌŶĞƐŵĂŐƌĂƐ͕
ĂůŝŵĞŶƚŽƐƌŝĐŽƐĞŵŶƵƚƌŝĞŶƚĞƐ͘

ƉƌĞŶĚĞƌĂƉůĂŶĞũĂƌĂƐƌĞĨĞŝĕƁĞƐĠĞƐƐĞŶĐŝĂůƉĂƌĂƵŵďŽŵŐĞƌĞŶĐŝĂŵĞŶƚŽĚŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽ
ƐĂŶŐƵĞ͘

DƵŝƚŽƐĚŝĂďĠƟĐŽƐĂĐƌĞĚŝƚĂŵƋƵĞƚŽĚŽƐŽƐĂůŝŵĞŶƚŽƐǀĆŽŝŶŇƵĞŶĐŝĂƌŶĂŐůŝĐŽƐĞĚŽƐĂŶŐƵĞĚĞĨŽƌŵĂ
ŶĞŐĂƟǀĂ͘ĐƌĞĚŝƚĂŵƚĂŵďĠŵƋƵĞĂůŝŵĞŶƚŽƐŶĂƚƵƌĂŝƐ͕ĐŽŵŽĂƐĨƌƵƚĂƐĞĂĕƷĐĂƌŵĂƐĐĂǀŽƉŽƌĞdžĞŵƉůŽ͕
ƉŽĚĞŵƐĞƌĐŽŶƐƵŵŝĚŽƐŝŶĚŝƐĐƌŝŵŝŶĂĚĂŵĞŶƚĞ͘

KƋƵĞĚĞĨĂƚŽĞdžŝƐƚĞ͕ĠŵƵŝƚŽĚĞƐĞŶĐŽŶƚƌŽĚĞŝŶĨŽƌŵĂĕƁĞƐƌĞůĂĐŝŽŶĂĚĂƐĂŽĐŽŶŚĞĐŝŵĞŶƚŽĚŽƐĂůŝŵĞŶƚŽƐ͕
ƚƌĂŶƐĨŽƌŵĂŶĚŽĂĚŝĞƚĂĞŵƵŵĂŵĞƚĂƋƵĂƐĞŝŵƉŽƐƐşǀĞůĚĞĐƵŵƉƌŝƌ͘

WĞƌŐƵŶƚĂƐĚŽƟƉŽ͗

ͻ ŐŽƌĚƵƌĂĂƵŵĞŶƚĂŽĚŝĂďĞƚĞƐ͍
ͻ hŵĂƉĞƐƐŽĂĐŽŵĚŝĂďĞƚĞƐƉŽĚĞĐŽŵĞƌĐŚƵƌƌĂƐĐŽ͍
ͻ dĞŶŚŽĚŝĂďĞƚĞƐ͘WŽƐƐŽĐŽŵĞƌĐĂƌŶĞĚĞƉŽƌĐŽ͍
ͻ WŽƐƐŽĐŽŵĞƌƉĆŽŝŶƚĞŐƌĂůăǀŽŶƚĂĚĞ͍
ͻ hŵĂĐƌŝĂŶĕĂĐŽŵĚŝĂďĞƚĞƐƉƌĞĐŝƐĂƵƐĂƌůĞŝƚĞĚĞƐŶĂƚĂĚŽ͍
ͻ dƵĚŽƋƵĞŶĂƐĐĞĞŵďĂŝdžŽĚĂƚĞƌƌĂĠƉƌŽŝďŝĚŽƉĂƌĂƋƵĞŵƚĞŵĚŝĂďĞƚĞƐ͍

ŚĞŐĂŵƚŽĚŽŵŽŵĞŶƚŽŶŽƐďĂůĐƁĞƐĚĂƐĨĂƌŵĄĐŝĂƐĞĐŽŶƐƵůƚſƌŝŽƐŵĠĚŝĐŽƐ͘

37 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ʹŵĞƌŝĐĂŶŝĂďĞƚĞƐƐƐŽĐŝĂƟŽŶƌĞĐŽŵĞŶĚĂƋƵĞŽƉůĂŶŽŶƵƚƌŝĐŝŽŶĂůĚŽƉĂĐŝĞŶƚĞĚŝĂďĠƟĐŽ
ĂĚƵůƚŽƚĞŶŚĂĐŽŵŽŽďũĞƟǀŽƐϮϱ͗

ͻ WƌŽŵŽǀĞƌ Ğ ĂƉŽŝĂƌ ƉĂĚƌƁĞƐ ƐĂƵĚĄǀĞŝƐ ĚĞ ĂůŝŵĞŶƚĂĕĆŽ͕ ĞŶĨĂƟnjĂŶĚŽ ƵŵĂ ǀĂƌŝĞĚĂĚĞ ĚĞ
ĂůŝŵĞŶƚŽƐĚĞŶƐŽƐĞŵŶƵƚƌŝĞŶƚĞƐĞŵƚĂŵĂŶŚŽĚĞƉŽƌĕĆŽĂƉƌŽƉƌŝĂĚŽ͕ĂĮŵĚĞŵĞůŚŽƌĂƌĂƐĂƷĚĞŐĞƌĂů
ĞĞƐƉĞĐŝĮĐĂŵĞŶƚĞƉĂƌĂĂƟŶŐŝƌŵĞƚĂƐŐůŝĐġŵŝĐĂƐ͕ĚĞƉƌĞƐƐĆŽĂƌƚĞƌŝĂůĞůŝƉşĚŝĐĂƐŝŶĚŝǀŝĚƵĂůŝnjĂĚĂƐ͘
ͻ ůĐĂŶĕĂƌĞŵĂŶƚĞƌŵĞƚĂƐĚĞƉĞƐŽĐŽƌƉŽƌĂů͘
ͻ ƚƌĂƐĂƌŽƵƉƌĞǀĞŶŝƌĐŽŵƉůŝĐĂĕƁĞƐĚĂĚŝĂďĞƚĞƐ͘
ͻ ďŽƌĚĂƌĂƐŶĞĐĞƐƐŝĚĂĚĞƐŶƵƚƌŝĐŝŽŶĂŝƐŝŶĚŝǀŝĚƵĂŝƐĐŽŵďĂƐĞŶĂƐƉƌĞĨĞƌġŶĐŝĂƐƉĞƐƐŽĂŝƐĞĐƵůƚƵƌĂŝƐ͕
ĂůĨĂďĞƟnjĂĕĆŽ Ğŵ ƐĂƷĚĞ͕ ĂĐĞƐƐŽ Ă ĞƐĐŽůŚĂƐ ĂůŝŵĞŶƚĂƌĞƐ ƐĂƵĚĄǀĞŝƐ͕ ǀŽŶƚĂĚĞ Ğ ĐĂƉĂĐŝĚĂĚĞ ĚĞ ĨĂnjĞƌ
ŵƵĚĂŶĕĂƐĐŽŵƉŽƌƚĂŵĞŶƚĂŝƐ͕ďĞŵĐŽŵŽďĂƌƌĞŝƌĂƐăŵƵĚĂŶĕĂ͘
ͻ DĂŶƚĞƌ Ž ƉƌĂnjĞƌ ĚĞ ĐŽŵĞƌ͕ ĨŽƌŶĞĐĞŶĚŽ ŵĞŶƐĂŐĞŶƐ ƉŽƐŝƟǀĂƐ ƐŽďƌĞ ĞƐĐŽůŚĂƐ ĂůŝŵĞŶƚĂƌĞƐ͕
ůŝŵŝƚĂŶĚŽĂƐĞƐĐŽůŚĂƐĂůŝŵĞŶƚĂƌĞƐĂƉĞŶĂƐƋƵĂŶĚŽŝŶĚŝĐĂĚŽƉŽƌĞǀŝĚġŶĐŝĂƐĐŝĞŶơĮĐĂƐ͘
ͻ &ŽƌŶĞĐĞƌ ĂŽ ŝŶĚŝǀşĚƵŽ ĐŽŵ ĚŝĂďĞƚĞƐ ĨĞƌƌĂŵĞŶƚĂƐ ƉƌĄƟĐĂƐ ƉĂƌĂ Ž ƉůĂŶĞũĂŵĞŶƚŽ ĚŝĄƌŝŽ ĚĞ
ƌĞĨĞŝĕƁĞƐ͕ĞŵǀĞnjĚĞƐĞĐŽŶĐĞŶƚƌĂƌĞŵŵĂĐƌŽŶƵƚƌŝĞŶƚĞƐŝŶĚŝǀŝĚƵĂŝƐ͕ŵŝĐƌŽŶƵƚƌŝĞŶƚĞƐŽƵĂůŝŵĞŶƚŽƐ
ŝƐŽůĂĚŽƐ͘

KƐŐƌĂŶĚĞƐǀŝůƁĞƐĚĂĂůŝŵĞŶƚĂĕĆŽĚĞƵŵĂƉĞƐƐŽĂĐŽŵĚŝĂďĞƚĞƐƐĆŽ͗

ͻ WĆŽďƌĂŶĐŽ͖
ͻ ĕƷĐĂƌďƌĂŶĐŽ͖
ͻ ĂůĂƐ͖
ͻ ŚŽĐŽůĂƚĞƐ͖
ͻ ŽůŽƐ͖
ͻ ŝƐĐŽŝƚŽƐĚŽĐĞƐ͖
ͻ ZĞĨƌŝŐĞƌĂŶƚĞƐ͖
ͻ ^ƵĐŽƐŝŶĚƵƐƚƌŝĂůŝnjĂĚŽƐ͖
ͻ ŽƌĂŶƚĞƐ͖
ͻ ŽŶƐĞƌǀĂŶƚĞƐ͖
ͻ dŽĚŽƐŽƐĞdžĂŐĞƌŽƐ͕ŝŶĐůƵƐŝǀĞĚĞĨƌƵƚĂƐĞƐƵĐŽƐŶĂƚƵƌĂŝƐ͊

ŽƐĂůŝŵĞŶƚŽƐĐŝƚĂĚŽƐ͕ŵƵŝƚŽƐ͕ĐŽŵŽĂƐďĂůĂƐ͕ŶĂĚĂƚƌĂnjĞŵĂůĠŵĚĞĐŽƌĂŶƚĞƐĞƉƌŽĚƵƚŽƐƋƵşŵŝĐŽƐ͘
KƵƚƌŽƐ͕ĐŽŵŽďŝƐĐŽŝƚŽƐ͕ŶŽƐůĞǀĂŵĂŽĞdžĂŐĞƌŽ͕ŶƵŶĐĂĐŽŵĞŵŽƐƵŵƐſ͘^ƵĐŽƐŝŶĚƵƐƚƌŝĂůŝnjĂĚŽƐĐŚĞŐĂŵ
ĂĐŽŶƚĞƌϰϱŐƌĂŵĂƐĚĞĐĂƌďŽŝĚƌĂƚŽƐƉŽƌůĂƚĂ͘

38 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Os grupos
Alimentares
ŽŶŚĞĐĞƌ ŽƐ ŐƌƵƉŽƐ ĂůŝŵĞŶƚĂƌĞƐ Ğ ĐŽŵŽ ĞůĞƐ ŝŵƉĂĐƚĂŵ ŶĂ ŐůŝĐĞŵŝĂ ĚĂƐ ƉĞƐƐŽĂƐ ĐŽŵ ĚŝĂďĞƚĞƐ Ġ
ĨƵŶĚĂŵĞŶƚĂů͘

KƐ ŶƵƚƌŝĞŶƚĞƐ ƐĆŽ ĚŝǀŝĚŝĚŽƐ Ğŵ Macronutrientes e Micronutrientes͘ KƐ DĂĐƌŽŶƵƚƌŝĞŶƚĞƐ ƐĆŽ ŽƐ
ĐĂƌďŽŝĚƌĂƚŽƐ͕ĂƐƉƌŽƚĞşŶĂƐĞĂƐŐŽƌĚƵƌĂƐ͘^ĆŽĐŚĂŵĂĚŽƐĚĞDĂĐƌŽŶƵƚƌŝĞŶƚĞƐƉŽƌƋƵĞƐĆŽŵĂŝŽƌĞƐ͕
ŵĂŝƐŝŵƉŽƌƚĂŶƚĞƐ͕ŶĞĐĞƐƐŝƚĂŶĚŽĚĞƐĞƌŝŶŐĞƌŝĚŽƐĞŵŵĂŝŽƌƋƵĂŶƟĚĂĚĞ͘

KƐ DŝĐƌŽŶƵƚƌŝĞŶƚĞƐ ƐĆŽ ĂƐ ǀŝƚĂŵŝŶĂƐ Ğ ŽƐ ƐĂŝƐ ŵŝŶĞƌĂŝƐ͕ ŝŶŐĞƌŝĚŽƐ Ğŵ ŵĞŶŽƌ ƋƵĂŶƟĚĂĚĞ͕ ŵĂƐ
ŶƵƚƌŝĞŶƚĞƐĨƵŶĚĂŵĞŶƚĂŝƐ͘ŽŵŽ͕ƉŽƌĞdžĞŵƉůŽƚĞŵŽƐ͕ŽĨĞƌƌŽƋƵĞƉƌŽƚĞŐĞĚĂĂŶĞŵŝĂ͕ŽĐĄůĐŝŽƋƵĞ
ĞǀŝƚĂ Ă ŽƐƚĞŽƉŽƌŽƐĞ͖ ĐůŽƌĞƚŽ ĚĞ ƐſĚŝŽ͕ ƉŽƚĄƐƐŝŽ Ğ ĨſƐĨŽƌŽ ƋƵĞ ĂŐĞŵ ŶĂ ĐŽŶƚƌĂĕĆŽ ŵƵƐĐƵůĂƌ͕ ŶŽƐ
ďĂƟŵĞŶƚŽƐĐĂƌĚşĂĐŽƐĞĂƚƵĂŵŶĂŚŝĚƌĂƚĂĕĆŽ͘

K ĐĂƌďŽŝĚƌĂƚŽ Ġ Ž ŵĂĐƌŽŶƵƚƌŝĞŶƚĞ ŵĂŝƐ ƚĞŵŝĚŽ ƉŽƌ ƋƵĂůƋƵĞƌ ƉĞƐƐŽĂ ĐŽŵ ĚŝĂďĞƚĞƐ͘ DƵŝƚŽƐ͕ ĂŽ
ĚĞƐĐŽďƌŝƌŽĚŝĂŐŶſƐƟĐŽĚĞĚŝĂďĞƚĞƐ͕ĚĞŝdžĂŵĚĞŝŶŐĞƌŝƌĐĂƌďŽŝĚƌĂƚŽƐĞ͕ƚƌĂŶƐĨŽƌŵĂŵĂĚŝĞƚĂĞŵĂůŐŽ
ŝŵƉŽƐƐşǀĞůĚĞƐĞƌƐƵƐƚĞŶƚĂĚŽ͘

^ĞŐƵŶĚŽĂ^ʹ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞŝĂďĞƚĞƐ͕ϰϱйĚĂƐĐĂůŽƌŝĂƐĚĂĚŝĞƚĂĚĞƵŵĂƉĞƐƐŽĂĐŽŵ

39 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ĚŝĂďĞƚĞƐĚĞǀĞŵǀŝƌĚŽƐĐĂƌďŽŝĚƌĂƚŽƐ͘hŵĂƉĞƐƐŽĂƋƵĞŶĆŽƚĞŵĚŝĂďĞƚĞƐĐŚĞŐĂĂĐŽŶƐƵŵŝƌϳϬйĚĂƐ
ĐĂůŽƌŝĂƐĚŝĄƌŝĂƐĂĚǀŝŶĚĂƐĚŽƐĐĂƌďŽŝĚƌĂƚŽƐ͕ŽƋƵĞŶĆŽĠƐĂƵĚĄǀĞů͘

KƐ ĐĂƌďŽŝĚƌĂƚŽƐ ƐĆŽ ĚŝǀŝĚŝĚŽƐ Ğŵ ĚŽŝƐ ŐƌƵƉŽƐ͗ ƐŝŵƉůĞƐ Ğ ĐŽŵƉůĞdžŽƐ͕ ĐŽŶĨŽƌŵĞ Ă ƐƵĂ ĞƐƚƌƵƚƵƌĂ
ŵŽůĞĐƵůĂƌ͘KƐĐĂƌďŽŝĚƌĂƚŽƐƐŝŵƉůĞƐƐĆŽŵĞŶŽƌĞƐĞƌĂƉŝĚĂŵĞŶƚĞĂďƐŽƌǀŝĚŽƐ͕ĚĞǀĞŶĚŽƐĞƌĐŽŶƐƵŵŝĚŽƐ
ĐŽŵĐƵŝĚĂĚŽƉĂƌĂĞǀŝƚĂƌĂƵŵĞŶƚŽďƌƵƐĐŽĚĂŐůŝĐĞŵŝĂ͘

KƐ ĐĂƌďŽŝĚƌĂƚŽƐ ĐŽŵƉůĞdžŽƐ ƚġŵ ĞƐƚƌƵƚƵƌĂ ŵĂŝŽƌĞƐ͕ ĨŽƌŵĂĚŽƐ ƉŽƌ ǀĄƌŝĂƐ ŵŽůĠĐƵůĂƐ͕ ƐƵĂ ĨƵŶĕĆŽ
ƉƌŝŶĐŝƉĂůĠĨŽƌŶĞĐĞƌĞŶĞƌŐŝĂ͘WŽƌĠŵ͕ĚĞƉĞŶĚĞŶĚŽĚŽƟƉŽ͕ƉŽĚĞŵƚĞƌŽƵƚƌĂƐĨƵŶĕƁĞƐ͕ĐŽŵŽŶŽĐĂƐŽ
ĚĂƐĮďƌĂƐ͘

ƐĮďƌĂƐĐĂƵƐĂŵĚŝŵŝŶƵŝĕĆŽĚĂĂďƐŽƌĕĆŽĚĞŐŽƌĚƵƌĂ͕ŐůŝĐŽƐĞĞĚŝŵŝŶƵŝĕĆŽĚŽĂƉĞƟƚĞ͘ƌĞĐŽŵĞŶĚĂĕĆŽ
ĚĂŝŶŐĞƐƚĆŽĚĞĮďƌĂƐĠĚĞϮϬĂϯϬŐƌĂŵĂƐƉŽƌĚŝĂ͘WĂƌĂĂƟŶŐŝƌĞƐƐĂƌĞĐŽŵĞŶĚĂĕĆŽ͕ĠŶĞĐĞƐƐĄƌŝĂĂ
ŝŶŐĞƐƚĆŽĚĞϰϬϬŐĚĞǀĞƌĚƵƌĂƐ͕ůĞŐƵŵĞĞĨƌƵƚĂƐƚŽĚŽƐŽƐĚŝĂƐ͘

1ŶĚŝĐĞ ŐůŝĐġŵŝĐŽ ;/'Ϳ ƌĞĨĞƌĞͲƐĞ ă ǀĞůŽĐŝĚĂĚĞ Ğŵ ƋƵĞ Ž ĂůŝŵĞŶƚŽ Ġ ĚŝŐĞƌŝĚŽ Ğ ĂďƐŽƌǀŝĚŽ ŶŽ ƚƌĂƚŽ
ĚŝŐĞƐƚſƌŝŽŶŽƉĞƌşŽĚŽƉſƐͲƉƌĂŶĚŝĂů͘K/'ĚĞĂůŝŵĞŶƚŽƐĠƚĞƐƚĂĚŽĞĞdžƉƌĞƐƐŽĞŵǀĂůŽƌĞƐƉĞƌĐĞŶƚƵĂŝƐ
ƌĞůĂƟǀŽƐăĐƵƌǀĂĚĞĂďƐŽƌĕĆŽĚĂŐůŝĐŽƐĞŽƵĚŽƉĆŽďƌĂŶĐŽ͕ƵƟůŝnjĂŶĚŽͲƐĞĂŵĞƐŵĂƋƵĂŶƟĚĂĚĞĚĞ
ŽƵƚƌŽƐĐĂƌďŽŝĚƌĂƚŽƐĞŵĚŝǀĞƌƐŽƐĂůŝŵĞŶƚŽƐƚĞƐƚĂĚŽƐĞĐůĂƐƐŝĮĐĂĚŽƐĚĞĂĐŽƌĚŽĐŽŵƐĞƵƉŽƚĞŶĐŝĂůĞŵ
ĂƵŵĞŶƚĂƌĂŐůŝĐĞŵŝĂ͘

Contagem
de Carboidratos:

40 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŽŶƚĂŐĞŵĚĞĂƌďŽŝĚƌĂƚŽƐƚĞŵƉŽƌĮŶĂůŝĚĂĚĞĞŶƐŝŶĂƌĂƐƉĞƐƐŽĂƐĂŵĞŶƐƵƌĂƌĞŵŽƐĐĂƌďŽŝĚƌĂƚŽƐ
ĚĞƐƵĂĚŝĞƚĂ͘

KƐĂůŝŵĞŶƚŽƐƚġŵĚŝĨĞƌĞŶƚĞƐƋƵĂŶƟĚĂĚĞƐĚĞĐĂƌďŽŝĚƌĂƚŽĞ͕ĞŵĐŽŶƐĞƋƵġŶĐŝĂ͕ĚŝĨĞƌĞŶƚĞƐŝŵƉĂĐƚŽƐ
ŶĂŐůŝĐĞŵŝĂ͘WŽƌĠŵ͕ĐŽŶƐĞŐƵŝŶĚŽŵĞŶƐƵƌĂƌĂƋƵĂŶƟĚĂĚĞĚĞĐĂƌďŽŝĚƌĂƚŽƐĚŽƐĂůŝŵĞŶƚŽƐ͕ĠƉŽƐƐşǀĞů
ƉƌĞǀĞƌĞƐƚĞŝŵƉĂĐƚŽ͘KƐŵĂŶƵĂŝƐĚĞĐŽŶƚĂŐĞŵĨŽƌĂŵĐƌŝĂĚŽƐƉĂƌĂĨĂĐŝůŝƚĂƌĞƐƐĞĐŽŶŚĞĐŝŵĞŶƚŽ͘

EŽůŝŶŬĂƐĞŐƵŝƌ͕ǀŽĐġĞŶĐŽŶƚƌĂƌĄŽDĂŶƵĂůĚĞĐŽŶƚĂŐĞŵ^͘

ŚƩƉ͗ͬͬǁǁǁ͘ŶƵƚƌŝĐĂŽǁĞď͘ĐŽŵ͘ďƌͬƵƉůŽĂĚƐͬĐŽŶƚĞƵĚŽͬϱͬŵĂŶƵĂůͺŽĮĐŝĂůͺĐŽŶƚĂŐĞŵͺĐĂƌďŽŝĚƌĂƚŽƐͺϮϬϬϵ͘W&

Impacto dos
macronutrientes
na glicemia

41 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
100% do carboidratoŝŶŐĞƌŝĚŽǀĆŽƐĞƌƚƌĂŶƐĨŽƌŵĂĚŽƐĞŵĂĕƷĐĂƌŶŽƉĞƌşŽĚŽĚĞϭϱŵŝŶƵƚŽƐĂĚƵĂƐ
ŚŽƌĂƐĂƉſƐĂŝŶŐĞƐƚĆŽ͘hŵĂĨĂƟĂĚĞƉĆŽĐŽŶƚĠŵϭϮŐƌĂŵĂƐĚĞĐĂƌďŽŝĚƌĂƚŽ͘ƐƐĞƐϭϮŐƌĂŵĂƐƐĞƌĆŽ
ƚŽƚĂůŵĞŶƚĞƚƌĂŶƐĨŽƌŵĂĚŽƐĞŵŐůŝĐŽƐĞŶĞƐƐĞŝŶƚĞƌǀĂůŽĚĞƚĞŵƉŽ͘

ϲϬй ĚĂƐ ƉƌŽƚĞşŶĂƐ ŝŶŐĞƌŝĚĂƐ ƐĞƌĆŽ ƚƌĂŶƐĨŽƌŵĂĚĂƐ Ğŵ ŐůŝĐŽƐĞ ĚĞƉŽŝƐ ĚĞ ϯ Ă ϰ ŚŽƌĂƐ ĚĂ ŝŶŐĞƐƚĆŽ͘
ŝŐĂŵŽƐƋƵĞĂƋƵĞůĂŵĞƐŵĂĨĂƟĂĚĞƉĆŽƚĞŶŚĂƐŝĚŽĨĞŝƚĂĐŽŵŽǀŽ͕ĞĐŽŶƚĞŶŚĂϱŐƌĂŵĂƐĚĞƉƌŽƚĞşŶĂ
ĞŵƐƵĂĐŽŵƉŽƐŝĕĆŽ͘KƵƐĞũĂ͕ϯŐƌĂŵĂƐ;ϲϬйͿĚĞƐƐĂƉƌŽƚĞşŶĂƐĞƌĆŽƚƌĂŶƐĨŽƌŵĂĚŽƐĞŵŐůŝĐŽƐĞĂƉſƐ
ĞƐƐĞŝŶƚĞƌǀĂůŽĚĞƚĞŵƉŽ͘KŝŵƉĂĐƚŽƐŽďƌĞĂŐůŝĐĞŵŝĂĠŵĞŶŽƌŶĂŝŶŐĞƐƚĆŽĚĞƉƌŽƚĞşŶĂƐ͘

ϭϬйĚŽƐůŝƉşĚŝŽƐ;ŐŽƌĚƵƌĂƐͿƐĞƌĆŽƚƌĂŶƐĨŽƌŵĂĚŽƐĞŵĞŶĞƌŐŝĂŶŽƉĞƌşŽĚŽĚĞϱŚŽƌĂƐŽƵŵĂŝƐĂƉſƐ
ĂŝŶŐĞƐƚĆŽ͘^ĞĂƋƵĞůĂĨĂƟĂĚĞƉĆŽĐŽŶƟŶŚĂϭϬŐƌĂŵĂƐĚĞŐŽƌĚƵƌĂ͕ĂƉſƐϱŚŽƌĂƐŽƵŵĂŝƐ͕ĂƉĞŶĂƐϭ
ŐƌĂŵĂƐĞƌĄƚƌĂŶƐĨŽƌŵĂĚŽĞŵŐůŝĐŽƐĞ͘KŝŵƉĂĐƚŽƐŽďƌĞĂŐůŝĐĞŵŝĂĠŵƵŝƚŽƉĞƋƵĞŶŽ͕ƋƵĂƐĞŶƵůŽ͘

KĐŽŶƚƌŽůĞĚŽŝŵƉĂĐƚŽĚŽƋƵĞƐĞŝŶŐĞƌĞƐŽďƌĞĂŐůŝĐĞŵŝĂĠĂƉĂƌƟƌĚĞϭϱŐƌĂŵĂƐ͘ĂƌďŽŝĚƌĂƚŽƐ͕ĐŽŵŽ
ǀŽĐġƉŽĚĞŶŽƚĂƌŶŽƐŶƷŵĞƌŽƐĂĐŝŵĂ͕ŝŵƉĂĐƚĂŵŵƵŝƚŽŵĂŝƐĚŽƋƵĞĂƐƉƌŽƚĞşŶĂƐĞĂƐŐŽƌĚƵƌĂƐ͘

Monitorando
os níveis de glicose
KĂƵƚŽŵŽŶŝƚŽƌĂŵĞŶƚŽĚĂŐůŝĐĞŵŝĂĐĂƉŝůĂƌĠƵŵĂĚĂƐĨĞƌƌĂŵĞŶƚĂƐĨƵŶĚĂŵĞŶƚĂŝƐ͕ƉŽŝƐĞůĂƉŽƐƐŝďŝůŝƚĂ
ĐŽŶŚĞĐĞƌ ŽƐ ŶşǀĞŝƐ ĚĞ ŐůŝĐĞŵŝĂ ĚƵƌĂŶƚĞ Ž ĚŝĂ͕ Ğŵ ŵŽŵĞŶƚŽƐ ƋƵĞ ŝŶƚĞƌĞƐƐĂŵ ƉĂƌĂ ĂĐŽŵƉĂŶŚĂƌ Ğ

42 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ĂǀĂůŝĂƌĂĞĮĐŝġŶĐŝĂĚŽƉůĂŶŽĂůŝŵĞŶƚĂƌ͕ĚĂĂƟǀŝĚĂĚĞİƐŝĐĂ͕ĚĂŵĞĚŝĐĂĕĆŽŽƌĂůĞƉƌŝŶĐŝƉĂůŵĞŶƚĞĚĂ
ĂĚŵŝŶŝƐƚƌĂĕĆŽĚĞŝŶƐƵůŝŶĂ͕ĂƐƐŝŵĐŽŵŽŽƌŝĞŶƚĂƌĂƐŵƵĚĂŶĕĂƐŶŽƚƌĂƚĂŵĞŶƚŽ͘

ƚĠŽƐĂŶŽƐϭϵϳϬ͕ƐſĞƌĂƉŽƐƐşǀĞůŵĞĚŝƌŽƐŶşǀĞŝƐĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞĨĂnjĞŶĚŽŽƐƚĞƐƚĞƐĞŵůĂďŽƌĂƚſƌŝŽ͘
EĆŽŚĂǀŝĂŽƵƚƌĂŵĂŶĞŝƌĂ͘ƉĂƌƟƌĚĞƐƐĂĚĠĐĂĚĂ͕ƐƵƌŐŝƌĂŵĂƐƟƌĂƐƋƵĞŵĞĚŝĂŵĂŐůŝĐŽƐĞĂƚƌĂǀĠƐĚĂ
ƵƌŝŶĂ͕ĐŚĂŵĂĚĂƐ'ůŝĐŽƐƷƌŝĂ͘

KƐƌĞƐƵůƚĂĚŽƐĚĂŐůŝĐŽƐƷƌŝĂŶĆŽƌĞǀĞůĂŵĂŐůŝĐŽƐĞĚŽŵŽŵĞŶƚŽ͕ĐŽŵŽĂĐŽŶƚĞĐĞĐŽŵŽĞdžĂŵĞŐůŝĐĞŵŝĂ
ĐĂƉŝůĂƌ͕ƉŽŝƐƉĂƌĂƋƵĞĂŐůŝĐŽƐĞĐŚĞŐƵĞăƵƌŝŶĂ͕ŚĄƵŵŝŶƚĞƌǀĂůŽĚĞƵŵĂĂĚƵĂƐŚŽƌĂƐ͕ŶĆŽŐĞƌĂŶĚŽ
ƵŵƉĂƌąŵĞƚƌŽĚĞŵŽŵĞŶƚŽŵƵŝƚŽĂƐƐĞƌƟǀŽ͘ĞƐƚĂŵĂŶĞŝƌĂ͕ĚĞƚĞƌŵŝŶĂƌŚŝƉŽĞŚŝƉĞƌŐůŝĐĞŵŝĂĮĐĂ
ĐŽŵƉƌŽŵĞƟĚŽ͘ŝŶŐĞƐƚĆŽĚĞůşƋƵŝĚŽƐĞŽƵƐŽĚĞŵĞĚŝĐĂŵĞŶƚŽƐƋƵĞŝŶƚĞƌĨĞƌĞŵŶĂĐŽƌĚĂƵƌŝŶĂ͕
ƉŽĚĞŵŝŶƚĞƌĨĞƌŝƌŶŽƌĞƐƵůƚĂĚŽĚĂŐůŝĐĞŵŝĂ͘

ƉĂƌƟƌĚŽƐĂŶŽƐϵϬ͕ƐƵƌŐŝƌĂŵǀĄƌŝĂƐŵĂŶĞŝƌĂƐŵĂŝƐĞĮĐŝĞŶƚĞƐĚĞŵĞĚŝƌĂŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͘ĞŶƚƌĞ
ĞůĂƐ͕ŽŐůŝĐŽƐşŵĞƚƌŽ͕ŶŽƋƵĂůĂĮƚĂǀĞƌŝĮĐĂĚŽƌĂƌĞĂŐĞŝŵĞĚŝĂƚĂŵĞŶƚĞĐŽŵĂŐůŝĐŽƐĞĂƉĂƌƟƌĚĞƵŵĂ
ŐŽƚĂĚĞƐĂŶŐƵĞ͘

ƚƵĂůŵĞŶƚĞ͕ĂůĠŵĚŽƐĞdžĂŵĞƐůĂďŽƌĂƚŽƌŝĂŝƐ;ŐůŝĐŽƐĞĞŵũĞũƵŵ͕dKd'ĞŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂͿ͕ĞdžŝƐƚĞ
Ž'D^͕ƵŵƐŝƐƚĞŵĂĐŽŶơŶƵŽĚĞŵĞĚŝĕĆŽĚĞŐůŝĐŽƐĞĞŽƐŐůŝĐŽƐşŵĞƚƌŽƐ͕ĐŽŵŽƐƋƵĂŝƐĠƉŽƐƐşǀĞů
ŵŽŶŝƚŽƌĂƌĂŐůŝĐŽƐĞĞŵĐĂƐĂ͘

CGMS
K 'D^ ;ŽŶƟŶƵŽƵƐ 'ůƵĐŽƐĞ DŽŶŝƚŽƌŝŶŐ ^LJƐƚĞŵͿ Ġ Ž ^ŝƐƚĞŵĂ ŽŶơŶƵŽ ĚĞ DŽŶŝƚŽƌĂŵĞŶƚŽ ĚĞ
'ůŝĐŽƐĞ͘ŝŶĚŝĐĂĚŽƉĂƌĨĂnjĞƌĂũƵƐƚĞƐŶŽƚƌĂƚĂŵĞŶƚŽ͗

ͻ ^ĞĂƋƵĂŶƟĚĂĚĞĚĞŝŶƐƵůŝŶĂĞƐƚĄĂĚĞƋƵĂĚĂ
ͻ ^ĞĂŵĞĚŝĐĂĕĆŽŽƌĂůĞƐƚĄĨĂnjĞŶĚŽĞĨĞŝƚŽ
ͻ YƵĂůŽŝŵƉĂĐƚŽĚĂĂůŝŵĞŶƚĂĕĆŽŶĂŐůŝĐĞŵŝĂ
ͻ YƵĂůŽŝŵƉĂĐƚŽĚĂĂƟǀŝĚĂĚĞİƐŝĐĂŶĂŐůŝĐĞŵŝĂ͘

ƵŵƐŝƐƚĞŵĂĚĞŵŽŶŝƚŽƌĂŵĞŶƚŽƋƵĞĂƚƵĂϮϰŚŽƌĂƐ͘dĂŵďĠŵƐĞƌǀĞƉĂƌĂŝĚĞŶƟĮĐĂƌĂƐƚĞŶĚġŶĐŝĂƐĚĞ
ŚŝƉŽĞĚĞŚŝƉĞƌŐůŝĐĞŵŝĂ͘

KĂƉĂƌĞůŚŽĮĐĂůŝŐĂĚŽĂŽƉĂĐŝĞŶƚĞĂƚƌĂǀĠƐĚĞƵŵĐĂƚĞƚĞƌŝŶƚƌŽĚƵnjŝĚŽŶĂƌĞŐŝĆŽĚŽĂďĚƀŵĞŶĞƉŽĚĞ
ƐĞƌĐĂƌƌĞŐĂĚŽĂĐŽƉůĂĚŽĂƵŵĐŝŶƚŽ͘&ĂnjĂŵĞĚŝĕĆŽĚĂŐůŝĐŽƐĞĂĐĂĚĂĐŝŶĐŽŵŝŶƵƚŽƐĞƉŽĚĞƉĞƌŵĂŶĞĐĞƌ

43 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ůŝŐĂĚŽ ĂŽ ƉĂĐŝĞŶƚĞ ƉŽƌ ĂƚĠ ϳϮ ŚŽƌĂƐ͘ ƵƌĂŶƚĞ ĞƐƐĞ ƉĞƌşŽĚŽ͕ Ġ ƉƌĞĐŝƐŽ ĂŶŽƚĂƌ ƚŽĚĂƐ ĂƐ ĂƟǀŝĚĂĚĞƐ
ƌĞĂůŝnjĂĚĂƐƉĂƌĂĐŽŵƉĂƌĂĕĆŽĐŽŵĂƐŵĞĚŝĕƁĞƐĚŽ'D^͘

 ĂŶĄůŝƐĞ ĚĂ ŐůŝĐŽƐĞ Ġ ĨĞŝƚĂ ŶŽ ĨƵŶĚŽ ŝŶƚĞƌƐƟĐŝĂů͕ ŽƵ ƐĞũĂ͕ ĂƚƌĂǀĠƐ ĚŽƐ ůşƋƵŝĚŽƐ ƋƵĞ ĮĐĂŵ ĞŶƚƌĞ ĂƐ
ĐĠůƵůĂƐ͘ƐƐĂŐůŝĐŽƐĞĂƉƌĞƐĞŶƚĂĚŝĨĞƌĞŶĕĂĚĞϭϳŵŝŶƵƚŽƐĐŽŵƌĞůĂĕĆŽăŐůŝĐŽƐĞƐĂŶŐƵşŶĞĂĞŽĂƉĂƌĞůŚŽ
ĠĐĂůŝďƌĂĚŽƉĂƌĂƌĞǀĞƌƚĞƌĞƐƐĂĚŝĨĞƌĞŶĕĂ͕ĐŽůŽĐĂŶĚŽĂŵĞĚŝĕĆŽĚĂŐůŝĐŽƐĞĞdžĂƚĂŵĞŶƚĞŶŽŵŽŵĞŶƚŽ
ĞŵƋƵĞŽĐŽƌƌĞƵĐĂĚĂĂƟǀŝĚĂĚĞ͘

EĆŽ Ġ ƉŽƐƐşǀĞů ǀĞƌ ŽƐ ƌĞƐƵůƚĂĚŽƐ ŝŵĞĚŝĂƚĂŵĞŶƚĞ͕ ĂƉĞŶĂƐ ŶĂ ƌĞƟƌĂĚĂ ĚŽ ĂƉĂƌĞůŚŽ ƉĞůĂ ĐůşŶŝĐĂ
ƌĞƐƉŽŶƐĄǀĞůƉŽƌƐƵĂĐŽůŽĐĂĕĆŽ͘KƐĚĂĚŽƐƐĆŽŝŶƐĞƌŝĚŽƐĞŵƵŵĐŽŵƉƵƚĂĚŽƌĞƐĞƌĄŐĞƌĂĚŽƵŵŐƌĄĮĐŽ
ĐŽŵ ĂƐ ŵĞĚŝĕƁĞƐ ĚĞ ŐůŝĐŽƐĞ͘ K ŵĠĚŝĐŽ͕ ĞŶƚĆŽ͕ ĐŽŵƉĂƌĂŶĚŽ ĞƐƐĞƐ ƌĞƐƵůƚĂĚŽƐ ĐŽŵ Ž ƌĞůĂƚſƌŝŽ ĚĞ
ĂƟǀŝĚĂĚĞƐĚŝĄƌŝĂƐ͕ĐŽŶƐĞŐƵĞƚƌĂĕĂƌƵŵƉĂŶŽƌĂŵĂĚĂŐůŝĐĞŵŝĂ͘

Hemoglobina
Glicada
ĞƉĞŶĚĞŶĚŽĚĂƌĞŐŝĆŽŽŶĚĞĞƐƟǀĞƌŵŽƐ͕ĂŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂƚĂŵďĠŵƉŽĚĞƐĞƌĐŽŶŚĞĐŝĚĂƉŽƌ
,ĞŵŽŐůŽďŝŶĂ'ůŝĐŽƐŝůĂĚĂ͕,ďϭĐ͕'ůŝĐŽĞŵŽŐůŽďŝŶĂ͕ϭĐ͕,ď'͘dŽĚŽƐĞƐƐĞƐƐĆŽŽŵĞƐŵŽƚĞƐƚĞ͕ŶŽ
ƋƵĂůŽƐƌĞƐƵůƚĂĚŽƐƐĆŽŐĞƌĂĚŽƐĞŵƉĞƌĐĞŶƚƵĂů;йͿĞŽŝĚĞĂůĠŵĂŶƚĞƌͲƐĞĂďĂŝdžŽĚĞϲ͕ϱйĂϳй͘

ƐƐĞĞdžĂŵĞŵĞĚĞĂƐƚĞŶĚġŶĐŝĂƐĚĞŚŝƉŽŐůŝĐĞŵŝĂĞƚĂŵďĠŵĨĂnjĂŵĠĚŝĂĚĂƐŐůŝĐĞŵŝĂƐĚŽƐƷůƟŵŽƐ
ϭϮϬĚŝĂƐ͘ĐŚĂŵĂĚŽ͞ĞdžĂŵĞĚĞĚŽĚƵƌŽ͘͟

ŚĞŵŽŐůŽďŝŶĂĠƌĞƐƉŽŶƐĄǀĞůƉŽƌĐĂƌƌĞŐĂƌŽŽdžŝŐġŶŝŽĚŽƉƵůŵĆŽƉĂƌĂŽƐĚĞŵĂŝƐƚĞĐŝĚŽƐĐŽƌƉŽƌĂŝƐ͘
ŵĞŵďƌĂŶĂĚĂŚĞŵĄĐŝĂĠƉĞƌŵĞĄǀĞůƉĂƌĂĂŐůŝĐŽƐĞ͘ĂƉĂƌƟƌĚŽŵŽŵĞŶƚŽƋƵĞĂŐůŝĐŽƐĞĞŶƚƌĂŶĂ
ŚĞŵĄĐŝĂ͕ůŝŐĂͲƐĞăŚĞŵŽŐůŽďŝŶĂ͘ƐƐĂůŝŐĂĕĆŽĠŝƌƌĞǀĞƌƐşǀĞů͘

44 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ƐŚĞŵĄĐŝĂƐƚġŵǀŝĚĂŵĠĚŝĂĚĞϭϮϬĚŝĂƐ͘ĞƐƚĂŵĂŶĞŝƌĂĐŽŶƐĞŐƵŝŵŽƐĚĞƚĞƌŵŝŶĂƌĂŐůŝĐĞŵŝĂŵĠĚŝĂ
ŶŽƉĞƌşŽĚŽ͘

ŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂƚĂŵďĠŵĠƵŵŝŵƉŽƌƚĂŶƚĞŵĂƌĐĂĚŽƌĚĞĐŽŵƉůŝĐĂĕƁĞƐĐƌƀŶŝĐĂƐŵŝĐƌŽǀĂƐĐƵůĂƌĞƐ͘
WŽƌƚĂŶƚŽ͕ƋƵĂůƋƵĞƌƌĞĚƵĕĆŽĚĂŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂƋƵĞĞƐƟǀĞƌĞůĞǀĂĚĂƌĞĚƵnjŵƵŝƚŽŽƌŝƐĐŽĚĞƐƐĂƐ
ĐŽŵƉůŝĐĂĕƁĞƐŵŝĐƌŽǀĂƐĐƵůĂƌĞƐ͘

KƚĞƐƚĞĚĞŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂĚĞǀĞƐĞƌƌĞĂůŝnjĂĚŽ͕ŶŽŵşŶŝŵŽ͕ĚƵĂƐǀĞnjĞƐĂŽĂŶŽƉĞůĂƐƉĞƐƐŽĂƐƋƵĞ
ƚġŵĚŝĂďĞƚĞƐ͘WŽƌĐĞŶƚĂŐĞŶƐĂůƚĂƐĚĞŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂƌĞƋƵĞƌĞŵƌĞǀŝƐĆŽŶŽƚƌĂƚĂŵĞŶƚŽ͘

Glicemia
Laboratorial
KĞdžĂŵĞĚĞŐůŝĐĞŵŝĂĞŵũĞũƵŵĞŽdKd'ʹdĞƐƚĞKƌĂůĚĞdŽůĞƌġŶĐŝĂĂ'ůŝĐŽƐĞ͕ŵŽƐƚƌĂŵŽƐŶşǀĞŝƐ
ĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞŶŽŵŽŵĞŶƚŽĞƐƉĞĐşĮĐŽĚŽĞdžĂŵĞ͕ĚŝĨĞƌĞŶƚĞĚĂŵĠĚŝĂŽďƟĚĂĚĞϭϮϬĚŝĂƐĚĂ
ŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂ͘KŵĠĚŝĐŽƐĞƵƟůŝnjĂĚĞĂŵďŽƐƉĂƌĂĚŝĂŐŶŽƐƟĐĂƌĐĂĚĂƉĂĐŝĞŶƚĞ͘

ĚŝĨĞƌĞŶĕĂƉĂƌĂŽĞdžĂŵĞůĂďŽƌĂƚŽƌŝĂůĚĂŐůŝĐŽƐĞƉĂƌĂŽĞdžĂŵĞĚĞŐůŝĐĞŵŝĂĐĂƉŝůĂƌĠƋƵĞ͕ŶŽůĂďŽƌĂƚſƌŝŽ
ƐĞƵƐĂƐŽŵĞŶƚĞŽƉůĂƐŵĂ͕ĚĞƐƚĂŵĂŶĞŝƌĂĞůŝŵŝŶĂͲƐĞĂŝŶƚĞƌĨĞƌġŶĐŝĂĚĞƉƌŽƚĞşŶĂƐŶŽƚĞƐƚĞ͘

KďƚĠŵͲƐĞ͕ ƉĞůŽ ĞdžĂŵĞ ĚĞ ŐůŝĐŽƐĞ ůĂďŽƌĂƚŽƌŝĂů͕ Ƶŵ ǀĂůŽƌ ĐŽƌƌĞƚŽ ĚĞ ĚŝĂŐŶſƐƟĐŽ ĚĞ ŐůŝĐĞŵŝĂ͕ ĂŽ
ƉĂƐƐŽƋƵĞŽƚĞƐƚĞĚĞŐůŝĐĞŵŝĂĐĂƉŝůĂƌĠƵƟůŝnjĂĚŽƐŽŵĞŶƚĞƉĂƌĂĐŽŶƚƌŽůĞ͕ƉŽŝƐĠŵĞŶŽƐĞƐƉĞĐşĮĐŽ͘
ŶĞĐĞƐƐĄƌŝŽƵŵũĞũƵŵƚŽƚĂůĚĞϴŚŽƌĂƐĂŶƚĞƐĚŽĞdžĂŵĞĞŵůĂďŽƌĂƚſƌŝŽ͘

Automonitoração
ĂƵƚŽŵŽŶŝƚŽƌĂĕĆŽ͕ŽƵƚĞƐƚĞŐůŝĐĞŵŝĂĐĂƉŝůĂƌ͕ĠĨĞŝƚĂƵƟůŝnjĂŶĚŽƵŵŐůŝĐŽƐşŵĞƚƌŽ͕ƚĂŵďĠŵĠĐŽŶŚĞĐŝĚŽ
ĐŽŵŽĞdžƚƌŽŽƵ,'d;,ĞŵŽŐůƵĐŽƚĞƐƚĞͿ͘

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ůŐƵŶƐĂƉĂƌĞůŚŽƐŵĞĚĞŵĚĞƐĚĞϮϬŵŐͬĚ>ĚĞƐĂŶŐƵĞĂƚĠϲϬϬŵŐͬĚ>ĚĞƐĂŶŐƵĞ͘ůŐƵŶƐƉŽƐƐƵĞŵ
ĚĂƚĂĞŚŽƌĂĞŵŵĞŵſƌŝĂŝŶƚĞƌŶĂƉĂƌĂĂĐŽŵƉĂŶŚĂŵĞŶƚŽ͕ŽƵŵĞƐŵŽĂƉŽƐƐŝďŝůŝĚĂĚĞĚĞƚƌĂŶƐĨĞƌġŶĐŝĂ
ĚŽƐĚĂĚŽƐƉĂƌĂĐŽŵƉƵƚĂĚŽƌƉĂƌĂĂƌĞĂůŝnjĂĕĆŽĚĞŐƌĄĮĐŽƐĞƌĞůĂƚſƌŝŽƐ͘

hŵĂ ĚĞƐǀĂŶƚĂŐĞŵ ĚŽ ĂƉĂƌĞůŚŽ ĚĞ ŵĞĚŝĕĆŽ ĚĞ ŐůŝĐŽƐĞ Ġ Ž ĐƵƐƚŽ ĞůĞǀĂĚŽ ĚĂ ĮƚĂ ŵĞĚŝĚŽƌĂ͘ KƐ
ĐŽŵƉŽŶĞŶƚĞƐĚŽĂƉĂƌĞůŚŽƐĆŽŝŵƉŽƌƚĂĚŽƐ͘

ĚĞƐŝŶĨŽƌŵĂĕĆŽĞŵĚŝĂďĞƚĞƐĠŽƵƚƌĂĚĞƐǀĂŶƚĂŐĞŵĚŽƵƐŽĚĂĂƵƚŽŵŽŶŝƚŽƌĂĕĆŽ͘WŽƌĞdžĞŵƉůŽ͕ŶĆŽ
ƐĞƉŽĚĞƌĞĂůŝnjĂƌŽƚĞƐƚĞĐŽŵƉƌĞĐŝƐĆŽĞƐƚĂŶĚŽĐŽŵĂƐŵĆŽƐƐƵũĂƐĚĞĂůŝŵĞŶƚŽ͕ŽƵĂŝŶĚĂŵŽůŚĂĚĂƐ
ĚĞƉŽŝƐĚĞůĂǀĄͲůĂƐŽƵůŝŵƉĄͲůĂƐĐŽŵĄůĐŽŽůϳϬ͘^ĞĐĂƌďĞŵĂƐŵĆŽƐĨĂnjĚŝĨĞƌĞŶĕĂ͕ƉŽŝƐƌĞƐƚŽƐĚĞĄŐƵĂ
ŽƵĄůĐŽŽůĚŝůƵĞŵĂĂŵŽƐƚƌĂĚĞƐĂŶŐƵĞĞĂƉƌĞƐĞŶƚĂŵƌĞƐƵůƚĂĚŽƐĞƌƌĂĚŽƐ͘

ŽŵŽũĄĨŽŝǀŝƐƚŽ͕ŽƐŐůŝĐŽƐşŵĞƚƌŽƐŶĆŽŝŶĚŝĐĂŵƵŵĚŝĂŐŶſƐƟĐŽ͘ůĞŝŶĨŽƌŵĂĂƐŝƚƵĂĕĆŽĚŽĚŝĂďĠƟĐŽ
ŶĂƋƵĞůĞĞƐƉĞĐşĮĐŽŵŽŵĞŶƚŽ͘WŽƐƐŝďŝůŝƚĂŽďƚĞƌŽƉĂŶŽƌĂŵĂĚĞŝŵƉĂĐƚŽŐůŝĐġŵŝĐŽĚĞĐĂĚĂƌĞĨĞŝĕĆŽ͕
ĨĂnjĞŶĚŽͲƐĞĂŵĞĚŝĕĆŽĂŶƚĞƐĞƚĂŵďĠŵĞŶƚƌĞƵŵĂĂĚƵĂƐŚŽƌĂƐĂƉſƐĂƌĞĨĞŝĕĆŽ͘

KƵƚƌŽ ŵŽƟǀŽ ĚĞ ŶĆŽ ĂĚĞƐĆŽ ĂŽ ĂƵƚŽŵŽŶŝƚŽƌĂŵĞŶƚŽ Ġ Ž ĚĞƐĐŽŶĨŽƌƚŽ İƐŝĐŽ Ğ ƉƐŝĐŽůſŐŝĐŽ ĚŽƐ
ŵĞĚŝĚŽƌĞƐĚĞŐůŝĐŽƐĞ͘DƵŝƚĂƐƉĞƐƐŽĂƐƚġŵŵĞĚŽĚĞĂŐƵůŚĂƐ͕ŝŶĐŽŵŽĚĂŵͲƐĞĞŵĨƵƌĂƌŽĚĞĚŽ͘Ġ
ƐĂďŝĚŽƋƵĞ͕ƋƵĂŶƚŽŵĂŝƐƚĞƐƚĞƐƵŵĂƉĞƐƐŽĂĚŝĂďĠƟĐĂƌĞĂůŝnjĂƉŽƌĚŝĂ͕ŵĞůŚŽƌŽƐĞƵĐŽŶƚƌŽůĞĞŵĞůŚŽƌ
ŽĐŽŶŚĞĐŝŵĞŶƚŽƐŽďƌĞƐĞƵƉƌſƉƌŝŽŽƌŐĂŶŝƐŵŽ͘

KĚŝĂďĞƚĞƐƚĞŵƚƌĂƚĂŵĞŶƚŽŝŶĚŝǀŝĚƵĂůŝnjĂĚŽ͕ƐĞŶĚŽĞƐƉĞĐşĮĐŽƉĂƌĂĐĂĚĂƉĞƐƐŽĂ͘KƵƐŽĚŽŐůŝĐŽƐşŵĞƚƌŽ
ƉŽƐƐŝďŝůŝƚĂŽĂƵƚŽĐŽŶŚĞĐŝŵĞŶƚŽ;ĐŽŵŽĂƐĂƟǀŝĚĂĚĞƐİƐŝĐĂƐ͕ĂĂůŝŵĞŶƚĂĕĆŽĞĂŵĞĚŝĐĂĕĆŽĂĨĞƚĂŵĂ
ŐůŝĐĞŵŝĂͿ͘KƐƌĞƐƵůƚĂĚŽƐƐĆŽŽďƟĚŽƐĞŵŵĞŶŽƐĚĞϭŵŝŶƵƚŽ͘

KƐĂƉĂƌĞůŚŽƐĚĞŵĞĚŝĕĆŽĚĞŐůŝĐŽƐĞĞƐƚĆŽĐĂĚĂĚŝĂŵĂŝƐŵŽĚĞƌŶŽƐ͕ĐĂĚĂǀĞnjƉƌĞĐŝƐĂŵĚĞŵĞŶŽƌ
ƋƵĂŶƟĚĂĚĞĚĞĂŵŽƐƚƌĂ;ƐĂŶŐƵĞͿ͘ƉŽƐƐŝďŝůŝĚĂĚĞĚĞĚĞƚĞƌŵŝŶĂƌŽƋƵĂŶƚŽĂůĂŶĐĞƚĂƉĞŶĞƚƌĂŶĂƉĞůĞ͕
ƉŽĚĞŶĚŽͲƐĞƌĞŐƵůĂƌĞƐƐĂƉƌŽĨƵŶĚŝĚĂĚĞĠƵŵĨĂƚŽƌĚĞĂĚĞƐĆŽĂƐŵĞĚŝĕƁĞƐĚĞŐůŝĐŽƐĞ͘

>ĞŵďƌĞͲƐĞ͗ŽƐŵĞůŚŽƌĞƐŵŽŵĞŶƚŽƐƉĂƌĂĂĂƵƚŽŵŽŶŝƚŽƌŝnjĂĕĆŽƐĆŽĂŶƚĞƐĚĂƐƌĞĨĞŝĕƁĞƐĞĚĞƵŵĂĂ
ĚƵĂƐŚŽƌĂƐĂƉſƐĂƌĞĨĞŝĕĆŽ͘

 ŐƌĂŶĚĞ ŵĂŝŽƌŝĂ ĚĂƐ ƉĞƐƐŽĂƐ ƋƵĞ ƚĞŵ ĚŝĂďĞƚĞƐ ƟƉŽ Ϯ ƌĞĂůŝnjĂ ƐŽŵĞŶƚĞ ƵŵĂ ŵĞĚŝĕĆŽ ĂŽ ĚŝĂ͕
ŶŽƌŵĂůŵĞŶƚĞ Ğŵ ũĞũƵŵ͘ ƐƚĂƐ ƉĞƐƐŽĂƐ ƋƵĂŶĚŽ ĞŶĐŽŶƚƌĂŵ ƌĞƐƵůƚĂĚŽƐ ĚĞ ŶŽƌŵŽŐůŝĐġŵŝĐĂ ƉŽƌ Ƶŵ
ůŽŶŐŽƉĞƌşŽĚŽ͕ĂĐƌĞĚŝƚĂŵƋƵĞĞƐƚĆŽĐƵƌĂĚĂƐĞĚĞƐƚĂŵĂŶĞŝƌĂĂďĂŶĚŽŶĂŵŽƚƌĂƚĂŵĞŶƚŽ͘dƵĚŽŝƐƐŽ
ĚĞǀŝĚŽ Ă ĚĞƐŝŶĨŽƌŵĂĕĆŽ͕ ƉŽŝƐ ŶĆŽ ĐŽŵƉƌĞĞŶĚĞŵ ƋƵĞ Ž ŽďũĞƟǀŽ ĚŽ ƚƌĂƚĂŵĞŶƚŽ Ġ ĂůĐĂŶĕĂƌ ŶşǀĞŝƐ
ĚĞŐůŝĐŽƐĞŽŵĂŝƐƉƌſdžŝŵŽĚŽƐŶşǀĞŝƐŶŽƌŵĂŝƐ;фϵϵŵŐͬĚ>ĚĞƐĂŶŐƵĞĞŵũĞũƵŵŽƵфϭϰϬŵŐͬĚ>ĚĞ
ƐĂŶŐƵĞĂƚĠϮŚŽƌĂƐĂƉDzƐŽƵŵĂƌĞĨĞŝĕĆŽͿ͘

hŵĞƐƋƵĞŵĂƐŝŵƉůĞƐƉĂƌĂƋƵĞŵĐŽƐƚƵŵĂĨĂnjĞƌĂƉĞŶĂƐƵŵĂŵĞĚŝĕĆŽĚŝĄƌŝĂĠŽƐĞŐƵŝŶƚĞ͗

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ͻ ϭǑĚŝĂʹŵĞĚŝƌĂŶƚĞƐĚŽĐĂĨĠĚĂŵĂŶŚĆ͘
ͻ ϮǑĚŝĂʹŵĞĚŝƌϮŚŽƌĂƐĂƉſƐŽĐĂĨĠĚĂŵĂŶŚĆ͘
ͻ ϯǑĚŝĂʹŵĞĚŝƌĂŶƚĞƐĚŽĂůŵŽĕŽ͘
ͻ ϰǑĚŝĂʹŵĞĚŝƌϮŚŽƌĂƐĂƉſƐŽĂůŵŽĕŽ͘
ͻ ϱǑĚŝĂʹŵĞĚŝƌĂŶƚĞƐĚŽũĂŶƚĂƌ͘
ͻ ϲǑĚŝĂʹŵĞĚŝƌϮŚŽƌĂƐĂƉſƐŽũĂŶƚĂƌ͘
ͻ ϳǑĚŝĂʹŵĞĚŝƌĂŶƚĞƐĚĞĚĞŝƚĂƌ͘

K ŝŵƉŽƌƚĂŶƚĞ Ġ ŶĆŽ ŵĞĚŝƌ Ă ŐůŝĐŽƐĞ ƐĞŵƉƌĞ Ğŵ Ƶŵ ŵĞƐŵŽ ŚŽƌĄƌŝŽ͕ ƉŽŝƐ ŝƐƐŽ ŶĆŽ ĚĄ Ă ǀŽĐġ Ž
ĐŽŶŚĞĐŝŵĞŶƚŽĚĞĐŽŵŽƐƵĂŐůŝĐĞŵŝĂĞƐƚĄŶĂƐĚĞŵĂŝƐŚŽƌĂƐĚŽƐĞƵĚŝĂ͘WƌĞĮƌĂĨĂnjĞƌĂĂƵƚŽŵŽŶŝƚŽƌŝnjĂĕĆŽ
ĞŵŚŽƌĄƌŝŽƐĂůƚĞƌŶĂƟǀŽƐ͘
hŵĂŽƌŝĞŶƚĂĕĆŽƉĂƌĂĂĂƵƚŽŵŽŶŝƚŽƌŝnjĂĕĆŽĠƵƐĂƌĂƉŽŶƚĂŽƵĂůĂƚĞƌĂůĚŽĚĞĚŽ͕ƋƵĞĂƉƌĞƐĞŶƚĂŵŵĞŶŽƐ
ƚĞƌŵŝŶĂĕƁĞƐŶĞƌǀŽƐĂƐƋƵĞĂĨƌĞŶƚĞ;ƉĂƌƚĞĚŽƚĂƚŽͿĞĐĂƵƐĂŵŵĞŶŽƐĚĞƐĐŽŶĨŽƌƚŽ͘KƵƚƌĂŽƌŝĞŶƚĂĕĆŽĠ
ĞǀŝƚĂƌĂŵĞĚŝĕĆŽŶŽƐĚĞĚŽƐƉŽůĞŐĂƌĞŝŶĚŝĐĂĚŽƌ͕ƋƵĞƐĞƌǀĞŵĐŽŵŽƉŝŶĕĂĞƋƵĞŐĞƌĂůŵĞŶƚĞĐŽůŽĐĂŵŽƐ
ĞŵĐŽŶƚĂƚŽĐŽŵĚŝǀĞƌƐĂƐƐƵƉĞƌİĐŝĞƐ͘^ĞŶĚŽĂƐƐŝŵ͕ŚĄƌŝƐĐŽĚĞĂůŐƵŵĂŝŶĨĞĐĕĆŽŶŽůŽĐĂů͕ĂůĠŵĚĞ
ĮĐĂƌĚŽůŽƌŝĚŽ͘WƌĞĮƌĂŽƐĚĞĚŽƐŵşŶŝŵŽ͕ĂŶƵůĂƌĞŵĠĚŝŽƉĂƌĂŽƐƚĞƐƚĞƐ͘

ĞƚĞƌŵŝŶĂĕĆŽĚŽƉĞƌĮůŐůŝĐġŵŝĐŽ26͗

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K ĐĄůĐƵůŽ ĚĂ 'ůŝĐĞŵŝĂ DĠĚŝĂ ^ĞŵĂŶĂů͕ ƉĞƌŵŝƚĞ ĚĞƚĞĐƚĂƌ ŐƌĂŶĚĞƐ ŽƐĐŝůĂĕƁĞƐ ĚĂ ŐůŝĐĞŵŝĂ Ğŵ Ƶŵ
ĚĞƚĞƌŵŝŶĂĚŽ ƉĞƌşŽĚŽ͘ WĂƌĂ ƋƵĞ Ž ĚŝĂďĞƚĞƐ ƐĞũĂ ĐŽŶƐŝĚĞƌĂĚŽ ďĞŵ ĐŽŶƚƌŽůĂĚŽ Ͳ Ă ŐůŝĐĞŵŝĂ ŵĠĚŝĂ
ƐĞŵĂŶĂůĚĞǀĞƐĞƌŵĞŶŽƌƋƵĞϭϱϬŵŐͬĚ>ĞĂǀĂƌŝĂĕĆŽĞŶƚƌĞŽƐǀĂůŽƌĞƐŐůŝĐġŵŝĐŽƐŶĆŽĚĞǀĞƵůƚƌĂƉĂƐƐĂƌ
ϱϬŵŐͬĚ>͘/ƐƚŽĞƋƵŝǀĂůĞĂƵŵĂŚĞŵŽŐůŽďŝŶĂŐůŝĐĂĚĂĚĞϲ͕ϵй͘ƐŵĞĚŝĕƁĞƐƐĆŽƌĞĂůŝnjĂĚĂƐĞŵƐĞŝƐŽƵ
ƐĞƚĞŵŽŵĞŶƚŽƐĚŝĨĞƌĞŶƚĞƐĚŽĚŝĂ͕ĚƵƌĂŶƚĞƉĞůŽŵĞŶŽƐƚƌġƐĚŝĂƐ͘

ĂƵƚŽŵŽŶŝƚŽƌŝnjĂĕĆŽƐſĠũƵƐƟĮĐĂĚĂƋƵĂŶĚŽϮϳ͗

ͻ KƉĂĐŝĞŶƚĞƌĞĐĞďĞƌŽƌŝĞŶƚĂĕĆŽĂĚĞƋƵĂĚĂƐŽďƌĞŽĚŝĂďĞƚĞƐĞĂŝŵƉŽƌƚąŶĐŝĂĚĞƐĞƵĐŽŶƚƌŽůĞ͘
ͻ KƐƌĞƐƵůƚĂĚŽƐĚĂĂƵƚŽŵŽŶŝƚŽƌŝnjĂĕĆŽĨŽƌĞŵĞĨĞƟǀĂŵĞŶƚĞƵƟůŝnjĂĚŽƐƉĂƌĂĂŽƌŝĞŶƚĂĕĆŽͬĐŽƌƌĞĕĆŽ
ĚĂĐŽŶĚƵƚĂƚĞƌĂƉġƵƟĐĂ͘
ͻ KƐƉƌŽƚŽĐŽůŽƐƐŽďƌĞĨƌĞƋƵġŶĐŝĂƐĚĞƚĞƐƚĞƐĨŽƌĞŵŝŶĚŝǀŝĚƵĂůŝnjĂĚŽƐƉĂƌĂĂƚĞŶĚĞƌăƐŶĞĐĞƐƐŝĚĂĚĞƐ
ĐůşŶŝĐĂƐ͕ĞĚƵĐĂĐŝŽŶĂŝƐĞƚĞƌĂƉġƵƟĐĂƐĚĞĐĂĚĂƉĂĐŝĞŶƚĞ͘

sĞũĂĂďĂŝdžŽĂůŐƵŶƐĚŽƐƉƌŝŶĐŝƉĂŝƐŵĞĚŝĚŽƌĞƐĐŽŵĞƌĐŝĂůŝnjĂĚŽƐŶŽƌĂƐŝů͗

48 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
KƋƵĞƚĞŵŽƐĚĞŵĂŝƐŵŽĚĞƌŶŽĂƚƵĂůŵĞŶƚĞ͕ĠŽ&ƌĞĞ^ƚLJůĞ>ŝďƌĞĚŽĨĂďƌŝĐĂŶƚĞďďŽƩ͘dƌĂƚĂͲƐĞĚĞƵŵ
ƐĞŶƐŽƌ͕ĐŽůŽĐĂĚŽƐŽďĂƉĞůĞ͘KƐĞŶƐŽƌƚĞŵŽƚĂŵĂŶŚŽĚĞƵŵĂŵŽĞĚĂĞŵĞĚĞĂŐůŝĐŽƐĞĂƚƌĂǀĠƐĚŽ
ĨƵŶĚŽŝŶƚĞƌƐƟĐŝĂů͕ŐĞƌĂŶĚŽƌĞƐƵůƚĂĚŽŝŵĞĚŝĂƚŽĂŽƉĂƐƐĂƌŽƐĐĂŶŶĞƌ͘

ƐƚĞƐĞŶƐŽƌĨĂnjϰŵĞĚŝĕƁĞƐƉŽƌŚŽƌĂ͕ŽƵƐĞũĂ͕ĂĐĂĚĂϭϱŵŝŶƵƚŽƐ͕ĨĂnjĞŶĚŽϵϲŵĞĚŝĕƁĞƐŶŽĮŶĂůĚĞϮϰ
ŚŽƌĂƐ͘KƐĞŶƐŽƌĚĞǀĞƐĞƌƚƌŽĐĂĚŽĂĐĂĚĂϭϰĚŝĂƐ͘

ƐƚĂ Ġ ƵŵĂ ŵƵĚĂŶĕĂ ĚĞ ƉĂƌĂĚŝŐŵĂ͕ ƉŽŝƐ ĞůĞ ƉĞƌŵŝƚĞ Ă ŝĚĞŶƟĮĐĂĕĆŽ ĚĞ ƚĞŶĚġŶĐŝĂƐ ĚĞ ŚŝƉŽ Ğ
ŚŝƉĞƌŐůŝĐĞŵŝĂ͕ƉĞƌŵŝƟŶĚŽĂũƵƐƚĞƐŵĂŝƐƉƌĞĐŝƐŽƐŶŽƚƌĂƚĂŵĞŶƚŽ͘

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Tratamento
farmacológico
do Diabetes
džŝƐƚĞƵŵĂƐĠƌŝĞĚĞŵĞĚŝĐĂŵĞŶƚŽƐĚŝƐƉŽŶşǀĞŝƐƉĂƌĂŽƚƌĂƚĂŵĞŶƚŽĚŽĚŝĂďĞƚĞƐ͘ůĠŵĚĂƐŝŶƐƵůŝŶĂƐ͕
ƉƌĞƐĐƌŝƚĂƉĂƌĂƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐƟƉŽϭĞƉĂƌĂƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐƟƉŽϮƋƵĞŶĆŽƌĞƐƉŽŶĚĞƌĂŵ
ƚĆŽďĞŵĂŽƚƌĂƚĂŵĞŶƚŽĐŽŵŵĞĚŝĐĂĕĆŽŽƌĂů͘

WƌŽŐƌĞƐƐĆŽĚĂƐĞĐƌĞĕĆŽĚĞŝŶƐƵůŝŶĂŶĂĞǀŽůƵĕĆŽĚŽĚŝĂďĞƚĞƐƟƉŽϮ

ƐĞĐƌĞĕĆŽĚĞŝŶƐƵůŝŶĂƉĞůŽƐƉŽƌƚĂĚŽƌĞƐĚĞĚŝĂďĞƚĞƐƟƉŽϮĚŝŵŝŶƵŝĐŽŵŽƉĂƐƐĂƌƚĞŵƉŽƉŽƌĐĂƵƐĂ
ĚĂƚŽdžŝĐŝĚĂĚĞĚĂĂůƚĂƚĂdžĂĚĞŐůŝĐŽƐĞŶĂĐŽƌƌĞŶƚĞƐĂŶŐƵşŶĞĂƋƵĞĚĞƐƚƌſŝĂƐĐĠůƵůĂƐďĞƚĂƉĂŶĐƌĞĄƟĐĂƐ͘
ŶƚĆŽ͕ŽĚŝĂďĠƟĐŽƟƉŽϮƉĂƐƐĂƉŽƌƋƵĂƚƌŽĞƚĂƉĂƐĚĞĞǀŽůƵĕĆŽĚĂĚŽĞŶĕĂ͘

EĂƉƌŝŵĞŝƌĂĞƚĂƉĂ͕ƋƵĂŶĚŽŽƉąŶĐƌĞĂƐĂŝŶĚĂĠĐĂƉĂnjĚĞƐĞĐƌĞƚĂƌŝŶƐƵůŝŶĂĚĞŵŽĚŽĂƌĞĚƵnjŝƌŽƐŶşǀĞŝƐ
ĚĞŐůŝĐŽƐĞŶŽƐĂŶŐƵĞ͕ƐĆŽƵƟůŝnjĂĚŽƐŵĞĚŝĐĂŵĞŶƚŽƐƚĂŝƐĐŽŵŽŵĞƞŽƌŵŝŶĂ͕ƉŝŽŐůŝƚĂnjŽŶĂ͕ĂĐĂƌďŽƐĞ͕Ğ
ƚŽĚŽƐŽƐŝŶŝďŝĚŽƌĞƐĚĞWWͲ/s;ƐŝƚĂŐůŝƉƟŶĂǀŝůĚĂŐůŝƉƟŶĂ͕ƐĂdžĂŐůŝƉƟŶĂ͕ůŝŶĂŐůŝƉƟŶĂͿ͘

EĂ ĞƚĂƉĂ ĚŽŝƐ͕ ƋƵĂŶĚŽ ĐŽŵĞĕĂ Ă ĚŝŵŝŶƵŝƌ Ă ƐĞĐƌĞĕĆŽ ĚĞ ŝŶƐƵůŝŶĂ ƉĞůŽ ƉąŶĐƌĞĂƐ͕ ĞƐƚĆŽ ŝŶĚŝĐĂĚĂƐ
ĐŽŵďŝŶĂĕƁĞƐĚĞŵĞĚŝĐĂĕƁĞƐƚĂŝƐĐŽŵŽƐƵůĨĂƐ͕ŝŶŝďŝĚŽƌĞƐĚĞWWͲ/s͕ĂŶĄůŽŐŽƐĚĞ'>WͲϭĞĂƐŵĞĚŝĐĂĕƁĞƐ
ĚĞĞůŝŵŝŶĂĕĆŽĚĞŐůŝĐŽƐĞƉĞůĂƵƌŝŶĂ͘

,ĂǀĞŶĚŽĂŝŶĚĂŵĂŝŽƌƌĞĚƵĕĆŽĚĞƐĞĐƌĞĕĆŽĚĞŝŶƐƵůŝŶĂƉĞůŽƉąŶĐƌĞĂƐ͕ŶĂĞƚĂƉĂƚƌġƐ͕ƉŽĚĞͲƐĞƚĞƌƵŵĂ
ĐŽŵďŝŶĂĕĆŽĚĂƐŵĞĚŝĐĂĕƁĞƐŽƌĂŝƐĐŽŵĂŝŶƐƵůŝŶĂŶŽƚƵƌŶĂ;ĂƉůŝĐĂĚĂĂŽĚĞŝƚĂƌͿ͘

 ĐŚĞŐĂͲƐĞ ĂŽ ƉŽŶƚŽ Ğŵ ƋƵĞ Ă ŝŶƐƵůŝŶĂ ƐĞĐƌĞƚĂĚĂ ƉĞůŽ ƉąŶĐƌĞĂƐ ŶĆŽ ĐŽŶƐĞŐƵĞ ŵĂŝƐ ƉƌŽŵŽǀĞƌ Ž
ĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽ͘ƐƐĂĠĂƋƵĂƌƚĂĞƚĂƉĂ͕ĂĞƚĂƉĂĚĂŝŶƐƵůŝŶŝnjĂĕĆŽƉůĞŶĂ͘

hƟůŝnjĂͲƐĞ ŶĂ ƋƵĂƌƚĂ ĞƚĂƉĂ Ă ŝŶƐƵůŝŶĂ ďĂƐĂů Ğ ĂƐ ŝŶƐƵůŝŶĂƐ ƉƌĠͲƉƌĂŶĚŝĂů Ğ ƉſƐͲƉƌĂŶĚŝĂů ƉĂƌĂ ƋƵĞ ƐĞ

50 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

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ƉŽƐƐĂƚĞƌŽĐŽŶƚƌŽůĞĚĂŐůŝĐĞŵŝĂ͕ĞǀŝƚĂŶĚŽĂƐƐŝŵĐŽŶƐĞƋƵġŶĐŝĂƐĐŽŵŽŝŶƐƵĮĐŝġŶĐŝĂƌĞŶĂů͕s͕ĂƚĂƋƵĞ
ĐĂƌĚşĂĐŽ͕ŶĞƵƌŽƉĂƟĂƐ͕ƌĞƟŶŽƉĂƟĂƉƌŽŵŽǀŝĚŽƐƉĞůŽĚĞƐĐŽŶƚƌŽůĞŐůŝĐġŵŝĐŽ͘

KƐŵĞĚŝĐĂŵĞŶƚŽƐƉĂƌĂƚƌĂƚĂƌŽĚŝĂďĞƚĞƐƟƉŽϮƐĆŽĂŐƌƵƉĂĚŽƐƉĞůĂƐŝŵŝůĂƌŝĚĂĚĞŶŽŵĞĐĂŶŝƐŵŽĚĞ
ĂĕĆŽ͕ĞƐĆŽĚŝǀŝĚŝĚŽƐĞŵƋƵĂƚƌŽĐĂƚĞŐŽƌŝĂƐ͗

ͻ DĞĚŝĐĂŵĞŶƚŽƐƋƵĞĂƵŵĞŶƚĂŵĂƐĞĐƌĞĕĆŽĚĞŝŶƐƵůŝŶĂ͘

ͻ DĞĚŝĐĂŵĞŶƚŽƐƋƵĞŶĆŽĂƵŵĞŶƚĂŵĂƐĞĐƌĞĕĆŽĚĞŝŶƐƵůŝŶĂ͘

ͻ DĞĚŝĐĂŵĞŶƚŽƐ ƋƵĞ ĂƵŵĞŶƚĂŵ Ă ƐĞĐƌĞĕĆŽ ĚĞ ŝŶƐƵůŝŶĂ ĚĞƉĞŶĚĞŶĚŽ ĚŽƐ ŶşǀĞŝƐ ĚĞ ŐůŝĐŽƐĞ Ğ
ĚŝŵŝŶƵĞŵĂĕĆŽĚŽŐůƵĐĂŐŽŶ͘

ͻ DĞĚŝĐĂŵĞŶƚŽƐƋƵĞĞůŝŵŝŶĂŵŐůŝĐŽƐĞƉĞůĂƵƌŝŶĂ͘

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CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
52 O GUIA PARA O FARMACÊUTICO CLÍNICO NO
CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
53 O GUIA PARA O FARMACÊUTICO CLÍNICO NO
CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
54 O GUIA PARA O FARMACÊUTICO CLÍNICO NO
CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
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CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
56 O GUIA PARA O FARMACÊUTICO CLÍNICO NO
CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Insulinoterapia
ƚĠϭϵϮϭ͕ĂƐƉĞƐƐŽĂƐĐŽŵĚŝĂŐŶſƐƟĐŽĚĞĚŝĂďĞƚĞƐŶĆŽƟŶŚĂŵƉŽƐƐŝďŝůŝĚĂĚĞĚĞƚƌĂƚĂŵĞŶƚŽ͕ƐŽŵĞŶƚĞ
ĂƉĂƌƟƌĚĞƐƚĂĚĂƚĂĂŝŶƐƵůŝŶĂĨŽŝĞdžƚƌĂşĚĂĚŽƉąŶĐƌĞĂƐĐĂŶŝŶŽƉĞůŽƐĐŝĞŶƟƐƚĂƐĐĂŶĂĚĞŶƐĞƐ&ƌĞĚĞƌŝĐŬ
ĂŶƟŶŐĞŚĂƌůĞƐĞƐƚ͘

ŵďŽƌĂĂŝŶƐƵůŝŶĂŶĆŽƐĞũĂĂĐƵƌĂĚŽĚŝĂďĞƚĞƐ͕ĠƵŵĂĚĂƐŵĂŝŽƌĞƐĚĞƐĐŽďĞƌƚĂƐĚĂŵĞĚŝĐŝŶĂ͘YƵĂŶĚŽ
ĐŚĞŐŽƵ͕ĨŽŝĐŽŵŽƵŵŵŝůĂŐƌĞ͘WĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐŐƌĂǀĞ͕ĞĂƉĞŶĂƐĚŝĂƐĚĞǀŝĚĂĨŽƌĂŵƐĂůǀĂƐ͕͘
ĞŶƋƵĂŶƚŽĞůĞƐĐŽŶƟŶƵĂƌĂŵƌĞĐĞďĞŶĚŽĂŝŶƐƵůŝŶĂ͕ĞůĞƐƉŽĚĞƌŝĂŵǀŝǀĞƌƵŵĂǀŝĚĂƋƵĂƐĞŶŽƌŵĂů͘

WŽƌ ƐĞƌ Ž ŵĞĚŝĐĂŵĞŶƚŽ ƉĂƌĂ ĚŝĂďĞƚĞƐ ĐŽŵ Ă ĂĕĆŽ ŚŝƉŽŐůŝĐĞŵŝĂŶƚĞ ŵĂŝƐ ĞĨĞƟǀĂ Ğ ƉŽƌ ƉŽƐƐƵŝƌ Ă
ĐĂƉĂĐŝĚĂĚĞĚĞƌĞĚƵnjŝƌĂ,ĞŵŽŐůŽďŝŶĂ'ůŝĐĂĚĂĂŶşǀĞŝƐŶŽƌŵĂŝƐ͕ŝŶĚĞƉĞŶĚĞŶƚĞĚŽƐŶşǀĞŝƐĚŽŝŶşĐŝŽ
ĚŽƚƌĂƚĂŵĞŶƚŽ͕ĂŝŶƐƵůŝŶĂƚĞŵĂĐĂƉĂĐŝĚĂĚĞĚĞƉƌĞǀĞŶŝƌŽƐƵƌŐŝŵĞŶƚŽĚĞĐŽŵƉůŝĐĂĕƁĞƐĚĞĐŽƌƌĞŶƚĞƐ
ĚŽ ĚĞƐĐŽŶƚƌŽůĞ ŐůŝĐġŵŝĐŽ ƚĂŝƐ ĐŽŵŽ͗ ƉĞƌĚĂ ĚĂ ǀŝƐĆŽ͕ ĚŽĞŶĕĂƐ ĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ͕ ĚŽĞŶĕĂƐ ƌĞŶĂŝƐ͕
ĂŵƉƵƚĂĕƁĞƐĚĞŵĞŵďƌŽƐŝŶĨĞƌŝŽƌĞƐ͕ŝŵƉŽƚġŶĐŝĂƐĞdžƵĂů͘

ƐƚƵĚŽƐĐŝĞŶơĮĐŽƐƌĞĂůŝnjĂĚŽƐŶŽƐƷůƟŵŽƐϯϬĂŶŽƐĐŽŶĐůƵşƌĂŵƋƵĞŽĐŽŶƚƌŽůĞŝŶƚĞŶƐŝǀŽĚŽƐŶşǀĞŝƐ
ŐůŝĐġŵŝĐŽƐƉŽĚĞƌĞĚƵnjŝƌĞŵ͗

ͻϴϬйŽƌŝƐĐŽĚĞZĞƟŶŽƉĂƟĂ;ŽĞŶĕĂŽĐƵůĂƌƋƵĞĂĨĞƚĂĂƌĞƟŶĂ͕ƉŽĚĞŶĚŽůĞǀĂƌĂƉĞƌĚĂĚĂǀŝƐĆŽͿ

ͻϱϬйŽƌŝƐĐŽĚĞEĞĨƌŽƉĂƟĂ;ĚŽĞŶĕĂƋƵĞĂĨĞƚĂŽƐƌŝŶƐ͕ƉŽĚĞŶĚŽůĞǀĂƌĂŝŶƐƵĮĐŝġŶĐŝĂƌĞŶĂůͿ

ͻϲϬйŽƌŝƐĐŽĚĞEĞƵƌŽƉĂƟĂƐ;ĚŽĞŶĕĂƋƵĞĚĂŶŝĮĐĂŽƐŶĞƌǀŽƐͿͻϲϬйŽƌŝƐĐŽĚĞŝŶĨĂƌƚŽĨƵůŵŝŶĂŶƚĞ͕
ĚĞƌƌĂŵĞŽƵŵŽƌƚĞƉŽƌĐĂƵƐĂƉŽƌĚŽĞŶĕĂƐĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ͘

ŝŶƐƵůŝŶĂĠŽŵĞĚŝĐĂŵĞŶƚŽŵĂŝƐĂŶƟŐŽƉĂƌĂŽƚƌĂƚĂŵĞŶƚŽĚŽŝĂďĞƚĞƐ͕ĠŽƋƵĞĂƉƌĞƐĞŶƚĂŵĞŶŽƐ
ĞĨĞŝƚŽƐĐŽůĂƚĞƌĂŝƐ͕ƐĞŶĚŽŽŵĂŝƐĐŽŵƵŵĂ,ŝƉŽŐůŝĐĞŵŝĂ͘

ZĞĂĕĆŽůĠƌŐŝĐĂ͗

KƵƚƌŽĞĨĞŝƚŽĐŽůĂƚĞƌĂůƋƵĞƉŽĚĞŽĐŽƌƌĞƌĐŽŵŽƵƐŽĚĞŝŶƐƵůŝŶĂƐĆŽĂƐƌĞĂĕƁĞƐĂůĠƌŐŝĐĂƐ͘

ůĂƐ ƉŽĚĞŵ ƐĞƌ ĐĂƵƐĂĚĂƐ ƉĞůĂ ŵŽůĠĐƵůĂ ĚĂ ŝŶƐƵůŝŶĂ͕ ƉĞůŽƐ ĐŽŶƐĞƌǀĂŶƚĞƐ ĚĂ ƉƌĞƉĂƌĂĕĆŽ ŽƵ ƉĞůŽƐ
ĂŐĞŶƚĞƐƵƟůŝnjĂĚŽƐƉĂƌĂƌĞƚĂƌĚĂƌƐƵĂĂĕĆŽ͕ĐŽŵŽĞdžĞŵƉůŽŽŝŶĐŽ͘ƐƚĂƐƌĞĂĕƁĞƐĞƐƚĆŽĐĂĚĂĚŝĂŵĂŝƐ
ƌĂƌĂƐ͕ĚĞǀŝĚŽĂŽŐƌĂƵĚĞƉƵƌŝĮĐĂĕĆŽĚĂƐŝŶƐƵůŝŶĂƐĂƚƵĂůŵĞŶƚĞ͘

57 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ƐƌĞĂĕƁĞƐĂůĠƌŐŝĐĂƐĞƌĂŵŵƵŝƚŽŵĂŝƐĨƌĞƋƵĞŶƚĞƐƋƵĂŶĚŽƐĞƵƐĂǀĂŝŶƐƵůŝŶĂĚĞŽƌŝŐĞŵĂŶŝŵĂů͕ĐĞƌĐĂ
ĚĞ ϱϬй ĚĂƐ ƉĞƐƐŽĂƐ ĂƉƌĞƐĞŶƚĂǀĂŵ ĂůŐƵŵĂ ƌĞĂĕĆŽ Ă ŝŶƐƵůŝŶĂ ďŽǀŝŶĂ͕ ũĄ ƋƵĞ ƐƵĂ ŵŽůĠĐƵůĂ ƚĞŵ ϯ
ĂŵŝŶŽĄĐŝĚŽƐĚŝĨĞƌĞŶƚĞƐĞŵƌĞůĂĕĆŽăŝŶƐƵůŝŶĂŚƵŵĂŶĂϮϵ͘

Žŵ Ž ƵƐŽ ĚĂ ŝŶƐƵůŝŶĂ ƐƵşŶĂ͕ ĂƐ ƌĞĂĕƁĞƐ ĚŝŵŝŶƵşƌĂŵ͕ƉŽŝƐ͕ Ă ŵŽůĠĐƵůĂ ĚĞƐƚĂ ŝŶƐƵůŝŶĂ Ɛſ ĚŝĨĞƌĞ ĚĂ
ŝŶƐƵůŝŶĂŚƵŵĂŶĂĞŵϭĂŵŝŶŽĄĐŝĚŽ͘

Žŵ Ž ƵƐŽ ĚĂ ďŝŽƚĞĐŶŽůŽŐŝĂ͕ ĨŽŝ ƉŽƐƐşǀĞů Ž ĚĞƐĞŶǀŽůǀŝŵĞŶƚŽ ĚĂ /ŶƐƵůŝŶĂ ,ƵŵĂŶĂ ZĞĐŽŵďŝŶĂŶƚĞ͕
ĚŝŵŝŶƵŝŶĚŽŵƵŝƚŽĂƐƌĞĂĕƁĞƐĂůĠƌŐŝĐĂƐϯϬ͘

ƐƌĞĂĕƁĞƐĂůĠƌŐŝĐĂƐăŝŶƐƵůŝŶĂŵĂŝƐĐŽŵƵŶƐ͕ŶŽůŽĐĂůĚĂĂƉůŝĐĂĕĆŽƐĆŽ͗

• Coceira;
• Inchaço;
ͻsĞƌŵĞůŚŝĚĆŽ͖
• Prurido;

ƐƚĂƐƌĞĂĕƁĞƐƉŽĚĞŵƐĞĞƐƉĂůŚĂƌƉĞůŽĐŽƌƉŽŽƵŶĆŽ͘

KƋƵĞĚŝĨĞƌĞŶĐŝĂĂƐŝŶƐƵůŝŶĂƐ͍

ƐŝŶƐƵůŝŶĂƐĂůĠŵĚĞǀĂƌŝĂƌĞŵĚĞŶŽŵĞƐĞĂƉƌĞƐĞŶƚĂĕƁĞƐ͕ƚĂŵďĠŵƐĞĚŝĨĞƌĞŵƉĞůŽdĞŵƉŽĚĞ/ŶşĐŝŽ
ĚĂĕĆŽ͕WŝĐŽĚĂĕĆŽĞdĞŵƉŽĚĞƵƌĂĕĆŽĚĂĕĆŽ͘

58 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
KƐƟƉŽƐĚĞŝŶƐƵůŝŶĂƐĆŽ͗

ͻ ĞĂĕĆŽƵůƚƌĂƌƌĄƉŝĚĂ

ͻ ĞĂĕĆŽƌĄƉŝĚĂ

ͻ ĞĂĕĆŽ/ŶƚĞƌŵĞĚŝĄƌŝĂ

ͻ ĞĂĕĆŽ>ĞŶƚĂ

ͻ ĞĂĕĆŽhůƚƌĂůŽŶŐĂ

ͻ WƌĠͲŵŝƐƚƵƌĂƐ

ĚŽƐĞĚĞŝŶƐƵůŝŶĂĂƐĞƌĂƉůŝĐĂĚĂĠĐƌƵĐŝĂůĞĚĞƉĞŶĚĞĚĂƉĞƐƐŽĂƋƵĞŝƌĄĨĂnjĞƌƵƐŽʹĂĚƵůƚŽŽƵĐƌŝĂŶĕĂ͕
ƐŽďƌĞƉĞƐŽŽƵďĂŝdžŽƉĞƐŽ͕ĞƚĐ͘ʹĐĂĚĂƟƉŽĚĞƉĞƐƐŽĂƉƌĞĐŝƐĂĚĞƵŵĂĚŽƐĞĚŝĨĞƌĞŶƚĞ͕ŽƵƐĞũĂ͕ĂĚŽƐĞ
ĠŝŶĚŝǀŝĚƵĂůŝnjĂĚĂĞĚĞǀĞƐĞƌƉƌĞƐĐƌŝƚĂƉĞůŽŵĠĚŝĐŽ͘

ĚŽƐĞĚĞŝŶƐƵůŝŶĂĚĞĂĕĆŽƌĄƉŝĚĂŽƵƵůƚƌĂƌƌĄƉŝĚĂĚĞǀĞƐĞƌĂũƵƐƚĂĚĂĚĞĂĐŽƌĚŽĐŽŵĂĂůŝŵĞŶƚĂĕĆŽŽƵ
ĂŐůŝĐĞŵŝĂĚŽŵŽŵĞŶƚŽŽƵĐŽŵŽƟƉŽĚĞĂƟǀŝĚĂĚĞİƐŝĐĂƋƵĞƐĞĞƐƚĄĨĂnjĞŶĚŽ͕ƐĞŵƉƌĞƐĞŐƵŝŶĚŽĂƐ
ŽƌŝĞŶƚĂĕƁĞƐĚŽŵĠĚŝĐŽƉƌĞƐĐƌŝƚŽƌ͘

ƚƵĂůŵĞŶƚĞĞdžŝƐƚĞŵϴƟƉŽƐĚĞŝŶƐƵůŝŶĂƐƐĞŶĚŽĐŽŵĞƌĐŝĂůŝnjĂĚĂƐŶŽƌĂƐŝů͗EW,;EŽǀŽůŝŶE͕,ƵŵƵůŝŶ
E͕/ŶƐƵŶŽƌŵEͿ͕ZĞŐƵůĂƌ;EŽǀŽůŝŶZ͕,ƵŵƵůŝŶZ͕/ŶƐƵŶŽƌŵZͿ͕'ůĂƌŐŝŶĂ;>ĂŶƚƵƐͿ͕ĞƚĞŵŝƌ;>ĞǀĞŵŝƌͿ͕
ƐƉĂƌƚ ;EŽǀŽƌĂƉŝĚ͕ EŽǀŽŵŝdž ϯϬͿ͕ >ŝƐƉƌŽ ;,ƵŵĂůŽŐ͕ ,ƵŵĂůŽŐ Dŝdž Ϯϱ͕ ,ƵŵĂůŽŐ Dŝdž ϱϬͿ͕ 'ůƵůŝƐŝŶĂ
;ƉŝĚƌĂͿ͕ĞŐůƵĚĞĐĂ;dƌĞƐŝďĂͿĞ'ůĂƌŐŝŶĂϯϬϬh/;dŽƵũĞŽͿ͘WĂƌĂĞƐƚĂƷůƟŵĂĚĞǀĞŵŽƐĚĂƌƵŵĂĂƚĞŶĕĆŽ
ĞƐƉĞĐŝĂů͕ƉŽŝƐĞŶƚƌĞĂdŽƵũĞŽĞĂ>ĂŶƚƵƐ͕ŽƋƵĞĂƐĚŝĨĞƌĞŶĐŝĂĠĂĐŽŶĐĞŶƚƌĂĕĆŽĚĞŝŶƐƵůŝŶĂ'ůĂƌŐŝŶĂĞŵ
ĐĂĚĂƵŵĂĚĞůĂƐ;ϭϬϬĞϯϬϬh/Ϳ͕ŵĂƐŝƐƐŽũĄĠƐƵĮĐŝĞŶƚĞƉĂƌĂŐƌĂŶĚĞƐĚŝĨĞƌĞŶĕĂƐ͘

ƐƚĂƐŝŶƐƵůŝŶĂƐƐĆŽĐŽŵĞƌĐŝĂůŝnjĂĚĂƐĞŵϯƟƉŽƐĚĞĂƉƌĞƐĞŶƚĂĕƁĞƐĚŝĨĞƌĞŶƚĞƐ͗

ͻ &ƌĂƐĐŽƐĚĞϭϬŵů

ͻ &ƌĂƐĐŽZĞĮůĚĞϯŵůƉĂƌĂĐĂŶĞƚĂƌĞƵƟůŝnjĄǀĞů

ͻ ĂŶĞƚĂƉƌĠͲĐĂƌƌĞŐĂĚĂƋƵĞĠĚĞƐĐĂƌƚĄǀĞů

^ŽŵĞŶƚĞŽŵĠĚŝĐŽĞƐƚĂĂƉƚŽ͕ĂƉſƐĨĂnjĞƌƵŵĂĂǀĂůŝĂĕĆŽĚŽƉĂĐŝĞŶƚĞ͕ƉĂƌĂĚĞƚĞƌŵŝŶĂƌŽŵĞůŚŽƌƟƉŽ
ĚĞŝŶƐƵůŝŶĂƉĂƌĂĐĂĚĂƉĞƐƐŽĂ͘ĞĐŝĚŝƌƋƵĂůĞƐĐŽůŚĂĨĂnjĞƌ͕ǀĂŝĚĞƉĞŶĚĞƌĚĞŵƵŝƚŽƐĨĂƚŽƌĞƐ͕ŝŶĐůƵŝŶĚŽ͗

59 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ͻ ĂƌĞƐƉŽƐƚĂŝŶĚŝǀŝĚƵĂůŝnjĂĚĂăŝŶƐƵůŝŶĂ;ŽƚĞŵƉŽƋƵĞĂŝŶƐƵůŝŶĂůĞǀĂƉĂƌĂƐĞƌĂďƐŽƌǀŝĚĂƉĞůŽ
ŽƌŐĂŶŝƐŵŽĞƉĞƌŵĂŶĞĐĞĂƟǀĂŶŽĐŽƌƉŽǀĂƌŝĂůŝŐĞŝƌĂŵĞŶƚĞĚĞŝŶĚŝǀşĚƵŽƉĂƌĂŝŶĚŝǀşĚƵŽͿ͘

ͻ ƐƟůŽĚĞǀŝĚĂĚŽƉĂĐŝĞŶƚĞͲƉŽƌĞdžĞŵƉůŽ͕ĂůŝŵĞŶƚĂĕĆŽ͕ĐŽŶƐƵŵŽĚĞĄůĐŽŽů͕ŽƵƟƉŽĚĞĂƟǀŝĚĂĚĞ
İƐŝĐĂͲƐĆŽƚŽĚŽƐĨĂƚŽƌĞƐƋƵĞŝŶŇƵĞŶĐŝĂŵŽĐŽƌƉŽŶŽƉƌŽĐĞƐƐĂŵĞŶƚŽĚĂŝŶƐƵůŝŶĂ͘

ͻ YƵĂůĂƐƵĂĚŝƐƉŽƐŝĕĆŽĚŽƉĂĐŝĞŶƚĞĞŵĂĚĞƌŝƌŵƷůƟƉůĂƐĂƉůŝĐĂĕƁĞƐĚŝĄƌŝĂƐ͘

ͻ ŽŵƋƵĂůĨƌĞƋƵġŶĐŝĂŽƉĂĐŝĞŶƚĞƚĞŵĚŝƐƉŽŶŝďŝůŝĚĂĚĞƉĂƌĂǀĞƌŝĮĐĂƌĂŐůŝĐĞŵŝĂĐĂƉŝůĂƌ͘

ͻ /ĚĂĚĞĚŽƉĂĐŝĞŶƚĞ͘

ͻ YƵĂŝƐĂƐŵĞƚĂƐŐůŝĐĞŵŝĂĂƐĞƌĂůĐĂŶĕĂĚĂƐ͘

ͻ dŝƉŽĚĞŝĂďĞƚĞƐ͘

sĞũĂŶŽƋƵĂĚƌŽĂƐĞŐƵŝƌĂƐŝŶƐƵůŝŶĂƐĐŽŵĞƌĐŝĂůŝnjĂĚĂƐŶŽƌĂƐŝů
ĞƐƵĂƐĚŝĨĞƌĞŶĕĂƐ͗

60 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
61 O GUIA PARA O FARMACÊUTICO CLÍNICO NO
CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ŽŵŽ ŵŽƐƚƌĂĚŽ ŶŽ ƋƵĂĚƌŽ ĂŶƚĞƌŝŽƌ͕ >ĂŶƚƵƐ Ğ dŽƵũĞŽ ƉŽƐƐƵĞŵ Ž ŵĞƐŵŽ ƉƌŝŶĐşƉŝŽ ĂƟǀŽ ƋƵĞ Ġ Ă
'ůĂƌŐŝŶĂ͘ŐƌĂŶĚĞĚŝĨĞƌĞŶĕĂĚĞĐĂĚĂƵŵĂĚĞůĂƐĠŶĂĐŽŶĐĞŶƚƌĂĕĆŽĚĞŝŶƐƵůŝŶĂŐůĂƌŐŝŶĂĞŵĐĂĚĂƵŵĂ
ĚĂƐĂƉƌĞƐĞŶƚĂĕƁĞƐ͗

ͻ >ĂŶƚƵƐ;'ůĂƌŐŝŶĂϭϬϬh/ͿƉŽƐƐƵŝϭϬϬƵŶŝĚĂĚĞƐŝŶƚĞƌŶĂĐŝŽŶĂŝƐ;h/ͿĚĞŐůĂƌŐŝŶĂĞŵĐĂĚĂŵŝůŝůŝƚƌŽ
;ŵůͿ͘

ͻ dŽƵũĞŽ;'ůĂƌŐŝŶĂϯϬϬh/ͿƉŽƐƐƵŝϯϬϬƵŶŝĚĂĚĞƐŝŶƚĞƌŶĂĐŝŽŶĂŝƐ;h/ͿĚĞŐůĂƌŐŝŶĂĞŵĐĂĚĂŵŝůŝůŝƚƌŽ
;ŵůͿ͘

62 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ĞƐƚĂŵĂŶĞŝƌĂ͕dŽƵũĞŽƚĞŵĂŵĞƐŵĂƋƵĂŶƟĚĂĚĞĚĞƵŶŝĚĂĚĞƐĚĞ'ůĂƌŐŝŶĂƋƵĞ>ĂŶƚƵƐ͕ŵĂƐĞŵϭ඲ϯĚŽ
ǀŽůƵŵĞĚĞĂƉůŝĐĂĕĆŽĚĞ>ĂŶƚƵƐ͘

ŽŵĂƌĞĚƵĕĆŽĚĞǀŽůƵŵĞĚĞĂƉůŝĐĂĕĆŽ͕ƚĞŵŽƐƚĂŵďĠŵĂƌĞĚƵĕĆŽĚŽƚĂŵĂŶŚŽĚŽĚĞƉſƐŝƚŽƐƵďĐƵƚąŶĞŽ
ĨŽƌŵĂĚŽ͘ůŝďĞƌĂĕĆŽĚĞ'ůĂƌŐŝŶĂĚŽĚĞƉſƐŝƚŽĠĚŝƌĞƚĂŵĞŶƚĞƉƌŽƉŽƌĐŝŽŶĂůĂŽƚĂŵĂŶŚŽĚŽĚĞƉſƐŝƚŽ
ĨŽƌŵĂĚŽ͘KĚĞƉſƐŝƚŽĨŽƌŵĂĚŽƉŽƌdŽƵũĞŽĠϱϬйŵĞŶŽƌƋƵĞŽĨŽƌŵĂĚŽƉŽƌ>ĂŶƚƵƐ͕ĐŽŵĂŵĞƐŵĂ
ƋƵĂŶƟĚĂĚĞĚĞƵŶŝĚĂĚĞƐ͕ƉƌŽƉŽƌĐŝŽŶĂŶĚŽĂƐƐŝŵƵŵĂůŝďĞƌĂĕĆŽĚĞŐůĂƌŐŝŶĂŵĂŝƐůĞŶƚĂĞĐŽŶƐƚĂŶƚĞ͘

KŶŽǀŽƉĞƌĮůĨĂƌŵĂĐŽĐŝŶĠƟĐŽĚĞƚĞƌŵŝŶĂĚŽƉŽƌĞƐƚĂůŝďĞƌĂĕĆŽŵĂŝƐůĞŶƚĂĚŽĚĞƉſƐŝƚŽĚĞŐůĂƌŐŝŶĂ
ƉƌŽŵŽǀĞƵƚĂŵďĠŵƵŵŶŽǀŽƉĞƌĮůĚĞĂĕĆŽ͘

dŽƵũĞŽ Ġ ƵŵĂ ŶŽǀĂ ĂƉƌĞƐĞŶƚĂĕĆŽ ĚĞ ŝŶƐƵůŝŶĂ ŐůĂƌŐŝŶĂ͕ ĐŽŵ Ƶŵ ŶŽǀŽ ƉĞƌĮů ĨĂƌŵĂĐŽĐŝŶĠƟĐŽ Ğ
ĨĂƌŵĂĐŽĚŝŶąŵŝĐŽ͕ƉŽƌƚĂŶƚŽĠƵŵƉƌŽĚƵƚŽŶŽǀŽ͘dŽƵũĞŽƐſƉŽĚĞƐĞƌƵƐĂĚŽĞŵƐƵďƐƟƚƵŝĕĆŽĚĂ>ĂŶƚƵƐ
ĐŽŵŽƌŝĞŶƚĂĕĆŽŵĠĚŝĐĂ͘

Considerações
Finais
^ĞŐƵŶĚŽ Ž /& ʹ /ŶƚĞŶĂƟŽŶĂů ŝĂďĞƚĞƐ &ĞĚĞƌĂƟŽŶ͕ ϭϮй ĚŽ ŽƌĕĂŵĞŶƚŽ ŐůŽďĂů Ğŵ ƐĂƷĚĞ Ġ ŐĂƐƚŽ
ĐŽŵĚŝĂďĞƚĞƐ͘^ĆŽĐĞƌĐĂĚĞϲϳϯďŝůŚƁĞƐĚĞĚſůĂƌĞƐŐĂƐƚŽƐϭ͘ƐƚĞĐƵƐƚŽƉŽĚĞƌŝĂƐĞƌŵŝŶŝŵŝnjĂĚŽĐŽŵ
ĂƚƵĂĕƁĞƐĞĚƵĐĂĐŝŽŶĂŝƐŵĂŝƐƉƌſdžŝŵĂƐĚĂƉŽƉƵůĂĕĆŽ͘

WĞƐƋƵŝƐĂƐŝŶĚŝĐĂŵƋƵĞŽƐďĞŶĞİĐŝŽƐĂƐƐŽĐŝĂĚŽƐĐŽŵĂĞĚƵĐĂĕĆŽƐŽďƌĞĂƵƚŽͲŐĞƐƚĆŽĞŵŽĚŝĮĐĂĕĆŽ
ĚŽĞƐƟůŽĚĞǀŝĚĂƉĂƌĂƉĞƐƐŽĂƐĐŽŵĚŝĂďĞƚĞƐƐĆŽƉŽƐŝƟǀŽƐĞƐƵƉĞƌĂŵŽƐĐƵƐƚŽƐĂƐƐŽĐŝĂĚŽƐĐŽŵĂ
ŝŶƚĞƌǀĞŶĕĆŽϯϭ͘

dƌŝƐŚĂƵŶŶŝŶŐĞŶŶĞĞůƚŽŶ͕ƉƌĞƐŝĚĞŶƚĞĞǀŝĐĞͲƉƌĞƐŝĚĞŶƚĞĚŽ/&ĐŽŵĞŶƚĂŵƋƵĞ͞ĐŽŵŽĂƉŽŝŽĚĞ
ƵŵŶƷŵĞƌŽƐƵĮĐŝĞŶƚĞŵĞŶƚĞŐƌĂŶĚĞĚĞƉƌŽĮƐƐŝŽŶĂŝƐĚĞƐĂƷĚĞĐĂƉĂĐŝƚĂĚŽƐĞĐŽŶƐĐŝĞŶƚĞƐĚŽĚŝĂďĞƚĞƐ͕
ƐĞƌĞŵŽƐĐĂƉĂnjĞƐĚĞĞŶĨƌĞŶƚĂƌĂƐĚĞŵĂŶĚĂƐĚĂĞƉŝĚĞŵŝĂŐůŽďĂůĚĞĚŝĂďĞƚĞƐ͟ϭ͘

K/&ĞƐƟŵĂƋƵĞĞŵϮϬϰϬŶĂŵĠƌŝĐĂĚŽ^ƵůĞĞŶƚƌĂůŚĂǀĞƌĄƵŵĂƵŵĞŶƚŽĚĞϲϱйŶŽŶƷŵĞƌŽĚĞ
ĐĂƐŽƐĚĞĚŝĂďĞƚĞƐ͘DĄŐĞƐƚĆŽĚŽŝĂďĞƚĞƐ>ĞǀĂĂ^ĠƌŝĂƐŽŵƉůŝĐĂĕƁĞƐĞDŽƌƚĞWƌĞŵĂƚƵƌĂ͘ŽŵƵŵĂ
ďŽĂĂƵƚŽͲŐĞƐƚĆŽĞ^ƵƉŽƌƚĞĚĞƵŵƉƌŽĮƐƐŝŽŶĂůĚĞ^ĂƷĚĞ͕ƉĞƐƐŽĂƐĐŽŵŝĂďĞƚĞƐƉŽĚĞŵƚĞƌƵŵĂǀŝĚĂ
ůŽŶŐĂĞ^ĂƵĚĄǀĞůϭ͘

63 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
YƵĂŶĚŽƐĞĞƐĐŽůŚĞƵŵĂƉƌŽĮƐƐĆŽŶĂĄƌĞĂĚĞƐĂƷĚĞ͕ĞƐĐŽůŚĞŵŽƐĐƵŝĚĂƌĚĞĂůŐƵĠŵ͘EſƐĨĂƌŵĂĐġƵƟĐŽƐ
ƵƐĂŵŽƐǀĄƌŝŽƐƌĞĐƵƌƐŽƐƉĂƌĂĚĞĚŝĐĂƌĂĞƐƚĞĐƵŝĚĂĚŽ͕ŵĞƐŵŽƋƵĂŶĚŽŶĆŽĞƐƚĂŵŽƐĞŵĐŽŶƚĂƚŽĚŝƌĞƚŽ
ĐŽŵŽƉĂĐŝĞŶƚĞ͕ĐŽŵŽƉŽƌĞdžĞŵƉůŽ͕ƋƵĂŶĚŽĂƚƵĂŵŽƐŶĂŝŶĚƷƐƚƌŝĂ͕ŽƵĞŵůĂďŽƌĂƚſƌŝŽƐĚĞĂŶĄůŝƐĞƐ
ĐůşŶŝĐĂƐ͘
ĨĂƌŵĄĐŝĂĠŽůŽĐĂůŽŶĚĞƚĞŵŽƐĂŵĂŝŽƌƉŽƐƐŝďŝůŝĚĂĚĞƉĂƌĂƉƌŽŵŽĕĆŽĚĞƐĂƷĚĞ͕ƉŽĚĞŵŽƐƚƌĂŶƐĨŽƌŵĂƌ
ĂǀŝĚĂĚĞƋƵĞŵƚĞŵĚŝĂďĞƚĞƐĞŵƵŵĂǀŝĚĂƐĂƵĚĄǀĞůĞĚĞƋƵĂůŝĚĂĚĞ͘

KD^ʹKƌŐĂŶŝnjĂĕĆŽDƵŶĚŝĂůĚĞ^ĂƷĚĞ͕ĚĞĮŶĞƐĂƷĚĞĐŽŵŽ͗

“O completo estado de bem-estar físico, mental

e social, e não simplesmente a ausência de
enfermidade”
EĆŽƉŽĚĞŵŽƐŶŽƐĞƐƋƵĞĐĞƌƋƵĞŵĞƐŵŽŽƉĂĐŝĞŶƚĞƚĞŶĚŽƌĞĐƵƌƐŽƐƉĂƌĂĂĚƋƵŝƌŝƌŽƋƵĞŚĄĚĞŵĞůŚŽƌ
ĞŵĂŝƐŵŽĚĞƌŶŽƉĂƌĂŽƚƌĂƚĂŵĞŶƚŽĚŽĚŝĂďĞƚĞƐ͕ƐĞĞůĞŶĆŽĨŽƌďĞŵŽƌŝĞŶƚĂĚŽ͕ĞůĞŶĆŽǀĂŝĐŽŶƐĞŐƵŝƌ
ĂůĐĂŶĕĂƌĂƐŵĞƚĂƐŐůŝĐġŵŝĐĂƐŝĚĞĂŝƐ͘^ĞƌŝĂŽŵĞƐŵŽƋƵĞĐŽŵƉƌĂƌƵŵĂ&ĞƌƌĂƌŝ͕ŵĂƐŶĆŽĂƉƌĞŶĚĞƌĂ
ƵƐĂƌ͘

Referências:
ϭ͘ /&/d^d>^Ͳϳd,/d/KEͲ΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϬϮͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉ͗ͬͬ
ǁǁǁ͘ĚŝĂďĞƚĞƐĂƚůĂƐ͘ŽƌŐͬ

Ϯ͘ ŵ:,ĞĂůƚŚ^LJƐƚWŚĂƌŵ͘ϮϬϬϮĞĐϭ͖ϱϵ^ƵƉƉůϵ͗^ϭϴͲϮϭ͘ZŽůĞŽĨƚŚĞƉŚĂƌŵĂĐŝƐƚŝŶĚŝĂďĞƚĞƐ
ŵĂŶĂŐĞŵĞŶƚ͘ĂŵƉďĞůůZ<͘

ϯ͘ ŚƩƉ͗ͬͬǁǁǁ͘ƉůĂŶĂůƚŽ͘ŐŽǀ͘ďƌͬĐĐŝǀŝůͺϬϯͬͺƚŽϮϬϭϭͲϮϬϭϰͬϮϬϭϰͬ>Ğŝͬ>ϭϯϬϮϭ͘Śƚŵů

ϰ͘ ŚƩƉ͗ͬͬǁǁǁ͘Đī͘ŽƌŐ͘ďƌͬƵƐĞƌĮůĞƐͬĮůĞͬƌĞƐŽůƵĐŽĞƐͬϱϴϱ͘ƉĚĨ

ϱ͘ ŚƩƉ͗ͬͬǁǁǁ͘Đī͘ŽƌŐ͘ďƌͬƵƐĞƌĮůĞƐͬĮůĞͬƌĞƐŽůƵĐŽĞƐͬϱϴϲ͘ƉĚĨ

ϲ͘ WʹŵĞƌŝĐĂŶŽůůĞŐĞŽĨůŝŶŝĐĂůWŚĂƌŵĂĐLJͲ΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϬϮͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞů
Ğŵ͗ŚƩƉ͗ͬͬǁǁǁ͘ĂĐĐƉ͘ĐŽŵ

ϳ͘ :ůŝŶWŚĂƌŵĂĐŽů͘ϭϵϴϭƉƌ͖Ϯϭ;ϰͿ͗ϭϵϱͲϳ͘,ŝƐƚŽƌLJŽĨĐůŝŶŝĐĂůƉŚĂƌŵĂĐLJĂŶĚĐůŝŶŝĐĂůƉŚĂƌŵĂĐŽůŽŐLJ͘
DŝůůĞƌZZ͘

64 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
ϴ͘ ŚƚƚƉ͗ͬͬŐϭ͘ŐůŽďŽ͘ĐŽŵͬďĞŵĞƐƚĂƌͬŶŽƚŝĐŝĂͬĐŽŶƐƵůƚŽƌŝŽƐͲĨĂƌŵĂĐĞƵƚŝĐŽƐͲĞŶƚĞŶĚĂͲĐŽŵŽͲĞͲ
ĂƚĞŶĚŝŵĞŶƚŽͲƋƵĞͲǀĞŵͲƐĞŶĚŽͲŽĨĞƌĞĐŝĚŽͲƉŽƌͲĨĂƌŵĂĐŝĂƐ͘ŐŚƚŵů΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϭϱͬϬϯͬϮϬϭϳ΁͗
ϵ͘ ƐƟŵĂƚĞĚ ŽƐƚͲīĞĐƟǀĞŶĞƐƐ͕ ŽƐƚ ĞŶĞĮƚ͕ ĂŶĚ ZŝƐŬ ZĞĚƵĐƟŽŶ ƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ĂŶ
ŶĚŽĐƌŝŶŽůŽŐŝƐƚͲWŚĂƌŵĂĐŝƐƚ ŝĂďĞƚĞƐ /ŶƚĞŶƐĞ DĞĚŝĐĂů DĂŶĂŐĞŵĞŶƚ ͞dƵŶĞͲhƉ͟ ůŝŶŝĐ DŝƌŝĂŵ 
dƵĐŬĞƌͲ:DĂŶĂŐĂƌĞ^ƉĞĐWŚĂƌŵ͕ϮϬϭϳDĂƌ͖Ϯϯ;ϯͿ͗ϯϭϴͲϯϮϲ͘

ϭϬ͘ dŚĞĂǁŶWŚĞŶŽŵĞŶŽŶͶŽŵŵŽŶKĐĐƵƌƌĞŶĐĞŝŶŽƚŚEŽŶͲ/ŶƐƵůŝŶͲĞƉĞŶĚĞŶƚĂŶĚ/ŶƐƵůŝŶͲ
ĞƉĞŶĚĞŶƚŝĂďĞƚĞƐDĞůůŝƚƵƐͲ'ĞƌĞŵŝĂ͘Žůůŝ͕D͕͘͘ĂŶĚ:ŽŚŶ͘'ĞƌŝĐŚ͕D͘͘ͲEŶŐů:DĞĚϭϵϴϰ͖
ϯϭϬ͗ϳϰϲͲϳϱϬDĂƌĐŚϮϮ͕ϭϵϴϰ

ϭϭ͘ /Ŷ^ĞĂƌĐŚKĨdŚĞ^ŽŵŽŐLJŝīĞĐƚͲ͘͘D͘'ĂůĞ͕͘͘͘<Ƶƌƚnj͕͘Z͘͘dĂƩĞƌƐĂůů͘ͲdŚĞ>ĂŶĐĞƚsŽůƵŵĞ
ϯϭϲ͕/ƐƐƵĞϴϭϴϵ͕ϵƵŐƵƐƚϭϵϴϬ͕WĂŐĞƐϮϳϵͲϮϴϮ

ϭϮ͘ WĞƐƋƵŝƐĂŝĂďĞƚĞƐƐĞŵŽŵƉůŝĐĂĕƁĞƐʹ^Ͳ΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϭϵͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞů
Ğŵ͗ŚƩƉ͗ͬͬĚŝĂďĞƚĞƐƐĞŵĐŽŵƉůŝĐĂĐŽĞƐ͘ĐŽŵ͘ďƌͬ

ϭϯ͘ WŽƌƚĂůƌĂƐŝůʹDŝŶŝƐƚĠƌŝŽĚĂ^ĂƷĚĞ͘΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϭϵͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉ͗ͬͬ
ǁǁǁ͘ďƌĂƐŝů͘ŐŽǀ͘ďƌͬ

ϭϰ͘ E,E^///ʹͲ΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϭϵͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉƐ͗ͬͬǁǁǁ͘ĐĚĐ͘ŐŽǀͬ
ŶĐŚƐͬŶŚĂŶĞƐͬŶŚĂŶĞƐϯ͘Śƚŵů

ϭϱ͘ ĞŽŽŬϮ͘ϬŝĂďĞƚĞƐŶĂWƌĄƟĐĂůşŶŝĐĂͲ^΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϭϵͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗
ŚƩƉ͗ͬͬǁǁǁ͘ĚŝĂďĞƚĞƐ͘ŽƌŐ͘ďƌͬĞŬͬŵĂŝŶͲƉĂŐĞ

ϭϲ͘ WŽƌƚĂůŝĞŶơĮĐŽ^ʹ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞĂƌĚŝŽůŽŐŝĂ͘΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϭϵͬϬϯͬϮϬϭϳ΁
ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉ͗ͬͬǁǁǁ͘ĐĂƌĚŝŽů͘ďƌͬĐŽŶŚĞĐĂͬĚĞƉĂƌƚĂŵĞŶƚŽ͘ĂƐƉ

ϭϳ͘ ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞEĞĨƌŽůŽŐŝĂ͘΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϮϬͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗ǁǁǁ͘
ƐďŶ͘ŽƌŐ͘ďƌ

ϭϴ͘ ŽŶƐĞůŚŽƌĂƐŝůĞŝƌŽĚĞKŌĂůŵŽůŽŐŝĂ΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϮϬͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉ͗ͬͬ
ǁǁǁ͘ĐďŽ͘ŶĞƚ͘ďƌ

ϭϵ͘ ĞĮŶŝƟŽŶĂŶĚĚŝĂŐŶŽƐŝƐŽĨĚŝĂďĞƚĞƐŵĞůůŝƚƵƐĂŶĚŝŶƚĞƌŵĞĚŝĂƚĞŚLJƉĞƌŐůLJĐĂĞŵŝĂͲZĞƉŽƌƚŽĨĂ
t,Kͬ/&ĐŽŶƐƵůƚĂƟŽŶͲϮϬϬϲ΀/ŶƚĞƌŶĞƚ΁͘΀ĐĞƐƐŽĞŵϮϬͬϬϯͬϮϬϭϳ΁ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉ͗ͬͬǁǁǁ͘ǁŚŽ͘
ŝŶƚͬĚŝĂďĞƚĞƐͬƉƵďůŝĐĂƟŽŶƐͬĚŝĂŐŶŽƐŝƐͺĚŝĂďĞƚĞƐϮϬϬϲͬĞŶͬ

ϮϬ͘ 'ĞƐƚĂĕĆŽĚĞůƚŽZŝƐĐŽͲDĂŶƵĂůdĠĐŶŝĐŽʹϱǐĚŝĕĆŽʹϮϬϭϬʹDŝŶŝƐƚĠƌŝŽĚĂ^ĂƷĚĞͲŚƩƉ͗ͬͬ
ďǀƐŵƐ͘ƐĂƵĚĞ͘ŐŽǀ͘ďƌͬďǀƐͬƉƵďůŝĐĂĐŽĞƐͬŐĞƐƚĂĐĂŽͺĂůƚŽͺƌŝƐĐŽ͘ƉĚĨ

65 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO
Ϯϭ͘ ZŽůĞ ŽĨ ƚŚĞ ŝĂďĞƚĞƐ ĚƵĐĂƚŽƌ ŝŶ /ŶƉĂƟĞŶƚ ŝĂďĞƚĞƐ DĂŶĂŐĞŵĞŶƚ ʹ  ʹ ƵŐƵƐƚ ϮϬϭϲ Ͳ
ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĚŝĂďĞƚĞƐĞĚƵĐĂƚŽƌ͘ŽƌŐͬĚŽĐƐͬĚĞĨĂƵůƚͲƐŽƵƌĐĞͬĚĞĨĂƵůƚͲĚŽĐƵŵĞŶƚͲůŝďƌĂƌLJͬƌŽůĞͲŽĨͲƚŚĞͲ
ĚŝĂďĞƚĞƐͲĞĚƵĐĂƚŽƌͲŝŶͲŝŶƉĂƟĞŶƚͲĚŝĂďĞƚĞƐͲŵĂŶĂŐĞŵĞŶƚ͘ƉĚĨ͍ƐĨǀƌƐŶсϬ

ϮϮ͘ ĂƌĞŽĨŚŝůĚƌĞŶĂŶĚĚŽůĞƐĐĞŶƚƐtŝƚŚdLJƉĞϭŝĂďĞƚĞƐʹŝĂďĞƚĞƐĂƌĞϮϬϬϱ:ĂŶ͖Ϯϴ;ϭͿ͗ϭϴϲͲ
ϮϭϮ͘ŚƩƉƐ͗ͬͬĚŽŝ͘ŽƌŐͬϭϬ͘ϮϯϯϳͬĚŝĂĐĂƌĞ͘Ϯϴ͘ϭ͘ϭϴϲ

Ϯϯ͘ ŝĂďĞƚĞƐŝŶKůĚĞƌĚƵůƚƐͲŝĂďĞƚĞƐĂƌĞϮϬϭϮĞĐ͖ϯϱ;ϭϮͿ͗ϮϲϱϬͲϮϲϲϰ͘ŚƩƉƐ͗ͬͬĚŽŝ͘ŽƌŐͬϭϬ͘Ϯϯϯϳͬ
ĚĐϭϮͲϭϴϬϭ

Ϯϰ͘ sŝŐŽƌŽƵƐ /ŶƚĞŶƐŝƚLJ džĞƌĐŝƐĞ ĨŽƌ 'ůLJĐĞŵŝĐ ŽŶƚƌŽů ŝŶ WĂƟĞŶƚƐ ǁŝƚŚ dLJƉĞ ϭ ŝĂďĞƚĞƐ ʹ : Ͳ
ĞĐĞŵďĞƌϮϬϭϯsŽůƵŵĞϯϳ͕/ƐƐƵĞϲ͕WĂŐĞƐϰϮϳʹϰϯϮͲŚƩƉ͗ͬͬĚdž͘ĚŽŝ͘ŽƌŐͬϭϬ͘ϭϬϭϲͬũ͘ũĐũĚ͘ϮϬϭϯ͘Ϭϴ͘Ϯϲϵ

Ϯϱ͘ EƵƚƌŝƟŽŶdŚĞƌĂƉLJZĞĐŽŵŵĞŶĚĂƟŽŶƐĨŽƌƚŚĞDĂŶĂŐĞŵĞŶƚŽĨĚƵůƚƐtŝƚŚŝĂďĞƚĞƐͲŝĂďĞƚĞƐ
ĂƌĞϮϬϭϰ:ĂŶ͖ϯϳ;^ƵƉƉůĞŵĞŶƚϭͿ͗^ϭϮϬͲ^ϭϰϯ͘ŚƩƉƐ͗ͬͬĚŽŝ͘ŽƌŐͬϭϬ͘ϮϯϯϳͬĚĐϭϰͲ^ϭϮϬ

Ϯϲ͘ ^ŽĐŝĞĚĂĚĞƌĂƐŝůĞŝƌĂĚĞŝĂďĞƚĞƐ͘ŝƌĞƚƌŝnjĞƐ^ϮϬϭϱ

Ϯϳ͘ /& ůŝŶŝĐĂů 'ƵŝĚĞůŝŶĞƐ dĂƐŬĨŽƌĐĞ ͬ ^D' /ŶƚĞƌŶĂƟŽŶĂů tŽƌŬŝŶŐ 'ƌŽƵƉ͘ 'ƵŝĚĞůŝŶĞ͗ ^ĞůĨͲ
DŽŶŝƚŽƌŝŶŐ ŽĨ ůŽŽĚ 'ůƵĐŽƐĞ ŝŶ EŽŶͲ/ŶƐƵůŝŶ dƌĞĂƚĞĚ dLJƉĞ Ϯ ŝĂďĞƚĞƐ͘ /ŶƚĞƌŶĂƟŽŶĂů ŝĂďĞƚĞƐ
&ĞĚĞƌĂƟŽŶ͕ϮϬϬϵ͘

Ϯϴ͘ ŝĂďĞƚĞƐĂƌĞ͘ϭϵϵϯĞĐ͖ϭϲ^ƵƉƉůϯ͗ϭϱϱͲϲϱ͘/ŵŵƵŶŽŐĞŶŝĐŝƚLJĂŶĚĂůůĞƌŐĞŶŝĐƉŽƚĞŶƟĂůŽĨĂŶŝŵĂů
ĂŶĚŚƵŵĂŶŝŶƐƵůŝŶƐ͘^ĐŚĞƌŶƚŚĂŶĞƌ'͘

Ϯϵ͘ ƌĐŚ /ŵŵƵŶŽů dŚĞƌ džƉ ;tĂƌƐnjͿ͘ ϮϬϭϮ KĐƚ͖ϲϬ;ϱͿ͗ϯϯϭͲϰϰ͘ ĚŽŝ͗ ϭϬ͘ϭϬϬϳͬƐϬϬϬϬϱͲϬϭϮͲϬϭϴϵͲϳ͘
ƉƵďϮϬϭϮƵŐ

ϯϬ͘ /ŵŵƵŶŽŐĞŶŝĐŝƚLJƚŽďŝŽůŽŐŝĐƐ͗ŵĞĐŚĂŶŝƐŵƐ͕ƉƌĞĚŝĐƟŽŶĂŶĚƌĞĚƵĐƟŽŶ͘^ĞƚŚƵ^͕'ŽǀŝŶĚĂƉƉĂ<͕
ůŚĂŝĚĂƌŝD͕WŝƌŵŽŚĂŵĞĚD͕WĂƌŬ<͕^ĂƚŚŝƐŚ:͘ͲƌĐŚ/ŵŵƵŶŽůdŚĞƌdžƉ;tĂƌƐnjͿ͘ϮϬϭϮKĐƚ͖ϲϬ;ϱͿ͗ϯϯϭͲ
ϰϰ͘ĚŽŝ͗ϭϬ͘ϭϬϬϳͬƐϬϬϬϬϱͲϬϭϮͲϬϭϴϵͲϳ͘ƉƵďϮϬϭϮƵŐϮϵ͘

ϯϭ͘ ŽƐƚƐ ĂŶĚ ďĞŶĞĮƚƐ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ĚŝĂďĞƚĞƐ ĞĚƵĐĂƟŽŶ͗ Ă ƌĞǀŝĞǁ ŽĨ ƚŚĞ ůŝƚĞƌĂƚƵƌĞ͘ Ͳ
ŽƌĞŶ ^͕ &ŝƚnjŶĞƌ <͕ WĂŶŚĂůŬĂƌ W^͕ ^ƉĞĐŬĞƌ : Ͳ ŝĂďĞƚĞƐ ĚƵĐ͘ ϮϬϬϵ :ĂŶͲ&Ğď͖ϯϱ;ϭͿ͗ϳϮͲϵϲ͘ ĚŽŝ͗
ϭϬ͘ϭϭϳϳͬϬϭϰϱϳϮϭϳϬϴϯϮϲϳϳϰ͘

66 O GUIA PARA O FARMACÊUTICO CLÍNICO NO

CONTROLE GLICÊMICO DO PACIENTE DIABÉTICO