Type 2 DIABETES MELLITUS

Type 2 DiabetesMellitus http://crisbertcualteros.page.tl

Etiology• Insulin resistance: – decrease peripheral utilization of glucose elevated PPG - Increase liver glucose output -> elevatedFBS• Beta cell dysfunction• Alpha cell dysfunction – lack suppression of glucagon secrection

Pathophysiology of Diabetes FBS 2Hr PP Insulin Insulin Treatment Resistance SecretionPhase 1 Normal Normal increased increased none OGTTPhase 2 Normal or increased Markedly increased Diet, a- increased increased glucosidase, metforminPhase 3 increased increased increased increased OHA, insulin

diagnosis• Any of: (ADA, 2008)Symptoms of DM + RBS >200FBS > 126 (normal: <100) IFG: 100 – 12575 gm OGTT a) 2hr Plasma glucose: > 200  DM normal: <140 b) 2hr Plasma Glucose: 140 – 199  IGT

Goals of treatmentHBA1C: <7Preprandial plasma glucose: 90 – 130Peak post-prandial plasma glucose: < 180Hospitalized patient: – Critically ill: kept as close to 110; gen. <140; insulin needed – Non-critical: FBS <126; RBS<180

Goals of treatmentBP: <130/80LDL: <100Triglycerides: <150HDL: >140

DM Management• All DM with HPN ACEI or ARB• Annual influenza vaccine• Atleast 1 lieftime pneumococcal vaccine• >40yo: give statin to achieve LDL reduction of 30-40%• <40yo: medical tx if diet modification is failed• Aspirin tx

DM ManagementMonotx: for FBS<140; 2PPBS<1801st line:1. metformin: dec liver glucose output2. Sulfonylurea: inc insulin secretion3. TZD: inc insulin sensitivity

Alternative tx:1. Non-SU insulin secretagogue: inc insulin secretion2. Glucosidase inhibitor: delays GI absortion of carbohydrates

Combination TX: if FBS>140; 2PPBS>1801. If on SU: add metfomin or TZD2. If on metformin: add SU or TZD3. If on TZD: add SU or metforminInsulin TX: if blood sugar is not controlled

http://crisbertcualteros.page.tl

http://crisbertcualteros.page.tl	30
http://familymedicine.page.tl	7
http://www.crisbertcualteros.page.tl	4
http://medicalpowerpointdownload.blogspot.com	1

Type 2 DIABETES MELLITUS

by DJ CrissCross

Accessibility

Categories

Upload Details

Usage Rights

4 Embeds 42

Statistics

Type 2 DIABETES MELLITUS Presentation Transcript