Standardization in DiabetesPresented by: Dr. Emad HamedPracticing Physician, Naga- Hammady
Standardization in Diabetes In Prevention. In Screening for early detection. In Diagnosis. In Management In Routine Investigations In Management Protocols Life Style Modification Diet Physical Activity Medications Oral Hypoglycemic Drugs Insulin
Standardization in Diagnosis Plasma level / Blood level (Laboratory / Glucometers) The difference is that plasma numbers read about 10 - 12% higher than the older whole blood numbers. So if your fasting and pre-meal blood glucose target is 90 - 130 mg/dl plasma glucose, it would be 80 - 120 mg/dl if your meter reads whole blood.(Joslin Diabetes Center) Blood Pressure Measurement. Waist Circumference Measurement.
Standardization in Diagnosis Blood Pressure Measurement
Standardization in Diagnosis Waist Circumference MeasurementWhy is waist measurement important? A waist measurement of greater than 94cm for men or 80cm for women is an indicator of internal fat deposits, which can coat the heart, kidneys, liver and pancreas, and increase the risk of chronic disease. Waist circumference should only be used for adults to check the risk of developing a chronic disease. Measurements that indicate increased risks for children and teenagers have not been developed.
Standardization in Diagnosis Waist Circumference MeasurementMeasuring Waist Circumference The tape measure should be placed directly on your skin, or on no more than one layer of light clothing. The correct place to measure your waist is horizontally halfway between your lowest rib and the top of your hipbone. This is roughly in line with your belly button. Breathe out normally and take the measure. Make sure the tape is snug, without squeezing the skin.
Standardization in Management Oral Hypoglycemic Drugs Mode of Action & Dose of Oral Anti-Diabetic Drugs ( Accordinf to the British National Formulary BNF March 2010)Active Principle Mode of Action Dose Details Decreasing gluconeogenesis & increasing peripheral Adult and Child over 10 years 500 mg with breakfast > one week > 500 mg with Metformin utilization of glucose. Only if there is residual pancreatic breakfast & dinner > one week > 500 mg with 3 meals function Initially 5 rng daily with or immediately after break-fast, dose adjusted according toGlibenclamide response ; max. 15 mg daily Initially 30 mg daily with breakfast, adjusted according to response every 4 weeks ;Gliclazide(MR) max. 120 mg daily Augmentig Insulin secreation. During long term adminestration they have extrapanceatic action Initially 2.5—5 mg daily shortly before breakfast or lunch, adjusted according to Glipizide response; max. 20 mg daily.Up to 15 mg (Sigle dose), higher doses divided. Initially 1 mg daily, adjusted according to response at 1-2 week intervals; max. 4 mg Glimerpride daily taken shortly before or with first main meal > 18 years, initially 500 micrograms within 30 minutes before main meals ; up to 4 Repaglinide mg may be given as a single dose, max. 16 mg daily Stimulate insulin release. Both drugs have a rapid onset of action and short duration of activity > 18 years, initially 60 mg 3 times daily within 30 minutes before main meals, up to Natiglinide max. 180 mg 3 times daily > 18 years, initially 50 mg daily increased to 50 mg 3 times daily, max. 200 mg 3 times Inhibits intestinal glucosidase , delays the digestion & Acarbose absorption of starch & sucrose daily Tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food Reduce peripheral insulin resistance, leading to a reduction > 18 years, initially 15-30 mg once daily increased to 45 mg once daily according to Pioglitazone of blood-glucose concentration response >18 years, in combination with metformin or pioglitazone, 50 mg twice/D Vildagliptin Inhibits dipeptidylpeptidase-4 so increases insulin in combination with a sulfonylurea, 50 mg daily in the morning secreation and lowers glucagon secretion Sitagliptin > 18 years, 100 mg once daily
Standardization in Management Insulin Transporting Insulin. Cooling Insulin. Injecting Insulin. 100 U/ml / 40 U/ml. Sites of Injection. Technique (Flash Movies) If insulin leaks from the pen or from your skin after you remove the needle from the injection site, you may not be leaving the needle under the skin long enough. It is a good practice to count slowly to 10 before withdrawing the needle.