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Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
Management of diabetic mellitus
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Management of diabetic mellitus

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  • 1. Bharatha Ambadasu
  • 2. What is Diabetes? • Body cannot properly store/use food for fuel • Insulin • hormone • Produced by beta cells in the pancreas • Allows glucose to move from blood stream into muscles to be used in energy production • In diabetes, insulin is produced in insufficient amounts, or it is produced but cannot be used properly
  • 3. Diabetes mellitus (DM) • 5-8% of the population • Large number of individuals are asymptomatic Classified into: Type 1 (IDDM) –autoimmune (10%) • Juvenile onset DM Type 2 (NIDDM) –genetic (90%) • Adult onset DM, often obese Type 3 (MODY) –genetic (1-5%) • • Occurs before 25 years of age No insulin resistance, not obese Type 4 (gestational) • Glucose intolerance
  • 4. Complications Diabetes: Complications Macrovascular Stroke Microvascular Diabetic eye disease (retinopathy and cataracts) Heart disease and hypertension 2-4 X increased risk Renal disease Peripheral vascular disease Erectile Dysfunction Peripheral Neuropathy Foot problems
  • 5. Treatment Unfortunately, THERE IS NO CURE!
  • 6. Aims of the treatment • To alleviate symptomatic hyperglycemia • Reduce overall blood glucose & minimise fluctuations • To reduce insulin resistance, hyperglycemia dislipidemias • Avoid hypoglycemia • (insuln & sulfonylureas) • Avoid weight gain • (insulin, sulfonylureas, thiozolidinediones) • Cardiovascular risk factors should be corrected &
  • 7. Treatment • PATIENT EDUCATION, participation is vital understanding, and
  • 8. Treatment Physical Activity • Regular physical activity helps your body lower blood glucose levels, promotes weight loss, reduces stress and enhances overall fitness.
  • 9. Treatment Diet • What, when and how much you eat
  • 10. Treatment Weight Management • Maintaining a healthy weight is especially important in the management of type 2 diabetes.
  • 11. Treatment Lifestyle Management • Learning to reduce stress levels in day-to-day life can help people with diabetes better manage their disease.
  • 12. Treatment Blood Pressure • High blood pressure can lead to eye disease, heart disease, stroke and kidney disease, so people with diabetes should try to maintain a blood pressure at or below 130/80. • To do this, you may need to change your eating and physical activity habits and/or take medication.
  • 13. Treatment Medication • Type 1 diabetes is always treated with insulin. Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to assist your body in making or using insulin more effectively.
  • 14. Treatment: Type 1 • Diet + Insulin Insulin requirement • Increased during: • Infections, severe illness, trauma, surgery, thyrotoxicosis, hyperparathyroid ism, acromegaly, hypokalemia and pregnancy • Decreased during: • Dieting, weight loss, exercise, hypothyroidism, renal insufficiency and old age
  • 15. Treatment: Type 1 Diabetes Cont… Insulin regimens: • Choice of regimen depends on the desired degree of glycemic control, the patients life style & his/her ability to adjust the insulin dose
  • 16. Treatment: Type 1 Diabetes i. Cont… Three doses of soluble insulin (before the main meals) plus an intermediate acting insulin at bedtime ii. A biphasic or intermediate acting insulin twice a day before morning and evening meals iii. A single morning dose of a biphasic or intermediate acting insulin before breakfast
  • 17. Treatment: Type 2 Diabetes • 80% are obese • 10% non-obese • 10% unstable: may look more like a Type 1 Diabetic
  • 18. Treatment: Type 2 Diabetes • Diet and weight reduction (mild diabetics) • Diet plus an oral antidiabetic agent • Insulin (suboptimal doses) with oral antidiabetics • Insulin Cont…
  • 19. Weight maintenance diet Non obese <40yrs Most Type I Insulin Insulin Obese Low energy diet Weight maintenance diet Non obese Sulfonylureas Obese Metformin >40yrs Most Type II Low energy diet Excersise Diet Monotherapy Sulfonylurea + Insulin Metformin Or add Glitazones Alpha glucosidase Inhibitor PGR Bedtime isophane insulin Combined therpy
  • 20. Low calorie sweetener • Replace sugar with low calorie sweetener Aspartame (1 tab of 18mg =sweetness of 1 ts sugar, gives 2 calories) • Sucralose
  • 21. Management of MODY • Any child persistent, or young asymptomatic adult who hyperglycemia had without progression to diabetic ketosis or ketoacidosis • MODY is often referred to as "monogenic diabetes“ • MODY 1 - 6 • Defects are mutations of transcription factor genes • Changes in diet, physical exercise, oral hypoglycemic agents, and insulin injections
  • 22. Management of Gestational diabetes • Most common medical complication of Pregnancy • affects 2-3% of pregnancies • Gestational DM 90% • Preexisting DM 10% • To avoid fetal loss at all stages, and in the first trimester to reduce fetal malformations
  • 23. Management of Gestational diabetes Cont… • Human Placental Lactogen (HPL) –”Anti-insulin” • Estrogen and Progesterone • Insulinase (Minor role) • Typically controlled with INSULIN but oral hypoglycemic agents like glyburide are also showing promise.
  • 24. Diabetic Ketoacidosis
  • 25. Treatment for DKA • Correct fluid volume deficit 1. 1 liter of isotonic saline over 1 hour 2. 1 liter of hypotonic saline over 6 to 8 hrs 3. 1 liter of hypertonic solution (D5/2NS) over 8 to 12 hrs.
  • 26. Drug therapy for DKA • Cont… Insulin therapy: lower BG by 75-150mg/dl/hr 1. Regular insulin IV bolus dose of 0.1 - 0.2 U/kg followed by IV drip of 0.1 U/kg/hr. • Electrolyte replacement 1. Potassium 2. Bicarbonate
  • 27. Answer these questions 1. A 50year old women has just been diagnosed as a Type 2 diabetic and given a prescription for Metformin. Which one of the following statements is characteristic of this medication? A. B. C. D. E. Hypoglycemia Undergoes metabolism to an active compound Many Drug –Drug interactions Increases peripheral glucose uptake & utilisation Pt often gains weight
  • 28. Answer these questions 2. A 64yr old women with a history of Type 2 diabetes is diagnosed with heart failure. Which one of the following drugs would be a poor choice in controlling her diabetes? A. B. C. D. Exenatide Glyburide Glipizide Pioglitazone
  • 29. Answer these questions 3. A 75 ys diabetic female on an oral hypoglycemic agent becomes light headed and profuse sweating. Blood glucose is below normal. Which of the following agents are responsible for this? A. B. C. D. Pioglitazone Glipizide Acarbose Metformin
  • 30. Answer these questions 4. A 60yr old diabetic male on an oral diabetic agent develops abnormal LFT. Which one of the following agent agent can cause this finding? A. B. C. D. Glyburide Metformin Troglitazone Acarbose
  • 31. THE END!!!!

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