Your SlideShare is downloading. ×
0
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Treatment & Prevention 6
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Treatment & Prevention 6

5,576

Published on

0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
5,576
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
464
Comments
0
Likes
7
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. DIABETES TREATMENT AND PREVENTION LAVANYA.K ROLL NO.39
  • 2. Goals of therapy <ul><li>To eliminate the symptoms related to hyperglycemia </li></ul><ul><li>To reduce or eliminate the long term microvascular and macrovascular complications </li></ul><ul><li>To allow the patient to achieve as normal a lifestyle as </li></ul><ul><li>possible </li></ul>
  • 3. Healthcare Team <ul><li>Members of the team include </li></ul><ul><li>Primary care provider </li></ul><ul><li>Endocrinologist/ Diabetologist </li></ul><ul><li>Certified diabetes educator </li></ul><ul><li>Nutritionist </li></ul><ul><li>Sub specialists </li></ul>
  • 4. Treatment Goals INDEX GOAL <ul><li>Glycemic control </li></ul><ul><li>A1C </li></ul><ul><li>Preprandial plasma glucose </li></ul><ul><li>Peak post prandial plasma glucose </li></ul>&lt;7 90-130 mg/dl &lt;180 mg/dl Blood pressure &lt;130/80 <ul><li>Lipids </li></ul><ul><li>LDL </li></ul><ul><li>HDL </li></ul><ul><li>Triglycerides </li></ul>&lt;100mg/dl &gt;40mg/dl &lt;150mg/dl
  • 5. Diabetes education <ul><ul><li>Diabetes educator is healthcare professional (nurse, dietician or pharmacist) </li></ul></ul>
  • 6. <ul><ul><li>Education topics include diet </li></ul></ul><ul><ul><ul><li>Self monitoring of blood </li></ul></ul></ul><ul><ul><ul><li>glucose </li></ul></ul></ul><ul><ul><ul><li>Urine sugar monitoring </li></ul></ul></ul><ul><ul><ul><li>diet </li></ul></ul></ul><ul><ul><ul><li>Insulin administration </li></ul></ul></ul><ul><ul><ul><li>Management of hypoglycemia </li></ul></ul></ul><ul><ul><ul><li>Foot &amp; skin care </li></ul></ul></ul><ul><ul><ul><li>Diabetes mgmt. before, during &amp; after exercise </li></ul></ul></ul><ul><ul><ul><li>Risk factor modifying activities </li></ul></ul></ul>
  • 7. EXERCISE <ul><li>Positive benefits </li></ul><ul><ul><li>Reduces cardiovascular risks, BP, body fat, weight </li></ul></ul><ul><ul><li>Maintenance of muscle mass </li></ul></ul><ul><ul><li>Lowers blood glucose </li></ul></ul><ul><ul><li>Increases insulin sensitivity </li></ul></ul><ul><li>Time </li></ul><ul><ul><li>150 min per week ( 3 days) </li></ul></ul><ul><ul><li>In type 2 DM, resistance training </li></ul></ul>
  • 8. <ul><li>Problems </li></ul><ul><ul><li>either hypo/ hyperglycemia </li></ul></ul><ul><li>Guidelines to avoid these problems </li></ul><ul><ul><li>Monitor blood glucose before, during &amp; after exercise </li></ul></ul><ul><ul><li>Delay exercise if bld. Glucose &gt; 250 mg/ dl and Ketone bodies are present </li></ul></ul><ul><ul><li>If bld. Glucose&lt; 100 mg/ dl , ingest carbohydrate before exercise </li></ul></ul>
  • 9. Assesment of long term glycemic control <ul><li>Glycated Hb/ A1C </li></ul><ul><li>Fructose amine acid </li></ul><ul><li>1,5 anhydroglucitol </li></ul>
  • 10. &nbsp;
  • 11. Treatment of type 1 Diabetes Preparation Onset (hr) Peak (hr) Eff.duration(hr) <ul><li>Short acting s.c. </li></ul><ul><li>Lispro </li></ul><ul><li>Aspart </li></ul><ul><li>Glulisine </li></ul><ul><li>Regular </li></ul>&lt;0.25 “ “ 0.5- 1.0 0.5- 1.5 “ “ 2-3 3-4 “ “ 4-6 <ul><li>Short acting-inhaled </li></ul><ul><li>Regular </li></ul>&lt;0.25 0.5-1.5 4-6 <ul><li>Long acting </li></ul><ul><li>NPH </li></ul><ul><li>Detemir </li></ul><ul><li>Glargine </li></ul>1-4 “ “ 6-10 Dual peak Dual peak 10-16 12-20 24
  • 12. Insulin Combinations <ul><li>75 / 25 - Protamine lispro + Lispro </li></ul><ul><li>50 / 50 - “ + “ </li></ul><ul><li>70 / 30 - Protamine aspart + Aspart </li></ul><ul><li>70 / 30 - NPH + Reg. Insulin </li></ul><ul><li>50 / 50 - “ + “ </li></ul>
  • 13. INSULIN REGIMENS
  • 14. INSULIN PREPARATIONS <ul><li>AVAILABLE AS U-40 &amp; U-100 </li></ul><ul><li>REGULAR INSULIN U-500 </li></ul>
  • 15. GUIDELINES FOR MIXING OF INSULIN <ul><li>Mix the different insulin formulations in the syringe immediately before injection &amp;inject within 2 min after mixing </li></ul><ul><li>Do not store insulin as mixture </li></ul><ul><li>Standardize the response </li></ul><ul><li>Do not mix insulin glargine or detemir with other insulins </li></ul>
  • 16. CALCULATION OF INSULIN DOSE <ul><li>Meal component </li></ul><ul><li>Based on insulin carbohydrate ratio </li></ul><ul><li>1 to 1.5 U/10gm of carbohydrate </li></ul><ul><li>Pre prandial blood glucose level </li></ul><ul><li>- 1 U of insulin for every 50 mg/dl </li></ul><ul><li>- (Body weight in kg) × (blood glucose-desired glucose)/1500 </li></ul>
  • 17. <ul><li>Advantage of having long acting insulin before night meal </li></ul><ul><li>Dawn phenomenon </li></ul>
  • 18. METHODS OF INSULIN DELIVEY <ul><li>Insulin syringe </li></ul><ul><li>insulin pen injectors </li></ul><ul><li>Insulin jet injectors </li></ul><ul><li>Insulin pumps </li></ul><ul><li>Insulin inhalers </li></ul>
  • 19. INSULIN SYRINGE
  • 20. ROTATION SITES
  • 21. INULIN PEN <ul><li>Has cartridge for insulin-dial </li></ul><ul><li>Contains needle &amp; plunger </li></ul><ul><li>More convenient to use in </li></ul><ul><li>schools,public places or </li></ul><ul><li>at work </li></ul>
  • 22. Insulin jet injectors <ul><li>Sprays insulin-&gt;directly passes through the skin </li></ul><ul><li>Costly </li></ul><ul><li>Bruishing-&gt;thin individuals </li></ul>
  • 23. &nbsp;
  • 24. BLOOD GLUCOSE MONITORING <ul><li>Visually read test strips </li></ul><ul><li>ex.Betachek diabetes test strips </li></ul><ul><li>pamphlet chemical test strips </li></ul>
  • 25. TREATMENT OF TYPE II DIABETES MANAGEMENT OF TYPE II DIABETES <ul><li>GLYCEMIC CONTROL </li></ul><ul><li>Diet </li></ul><ul><li>Exercise </li></ul><ul><li>Medication </li></ul><ul><li>ASSOCIATED CONDITIONS </li></ul><ul><li>Dyslipidemia </li></ul><ul><li>Hypertension </li></ul><ul><li>Obesity </li></ul><ul><li>CHD </li></ul><ul><li>SCREENING </li></ul><ul><li>Retinopathy </li></ul><ul><li>Cardiovascular disease </li></ul><ul><li>Nephropathy </li></ul><ul><li>Neuropathy </li></ul>
  • 26. &nbsp;
  • 27. Treatment of type 2 diabetes mellitus Oral Biguanides Metformin Alpha glucosidase inhibitors Acarbose , meglitol DPP 4 inhibtors sitagliptin Insulin secretagogues sulfonyl ureas first generation chlorpropamide,tolbutamide second generation Glimepiride , glipizide non sulfonyl ureas Repaglinide , nateglinide – Thiazolidinedidones roseglitazone, pioglitazone
  • 28. Parenteral Insulin GLP1 agonist exenatide Amylin agonist pramlintide
  • 29. &nbsp;
  • 30. &nbsp;
  • 31. drugs advantages Disadvantages biguanides Weight loss Lactic acidosis,GI dysfunctions Alpha glucosidase inhibitor Reduce postprandial glycaemia Liver &amp; GI dysfunctions DPP4 inhibitors No hypoglcaemia --- sulfonylureas Lowers fasting blood glucose Weight gain,hypoglyacemia Nonsulfonylureas thiazolidinediones Shorter onset of action Lowers postprandial glycaemia Lowera insulin requirements Hypoglycaemia CHF,weight gain ,fractures
  • 32. Glycaemic management of type 2 diabetes mellitus patient with type 2 diabetes medical, nutrition therapy,increased physical Activity and weight loss + metformin Reasses A1C Combination therapy metformin+second agent Reasses A1C Combination therapy metformin+2 agents metformin +insuln
  • 33. <ul><li>Fall in insulin requirements </li></ul><ul><li>Dialysis associated complications </li></ul><ul><li>-hypotension,progression of retinopathy,atherosclerosis &amp; hyperlipidemia </li></ul>Treatment for diabetic nephropathy
  • 34. <ul><li>Transplantation-combined pancreas and kidney </li></ul>
  • 35. TREATMENT FOR DIABETIC NEUROPATHY <ul><li>Risk factors -&gt; hypertension and hypertriglyceridemia </li></ul><ul><li>Avoidance of neurotoxins -&gt;alcohol,smoking </li></ul><ul><li>Vit.supp(B12,folate) </li></ul><ul><li>Symptomatic treatment </li></ul><ul><li>Should check their feet </li></ul><ul><li>daily &amp; take precaution </li></ul>
  • 36. <ul><li>Chronic painful-antidepressants and anticonvulsants </li></ul><ul><li>Orthostatic hypotension-clonidine,fludrocortisone,ocreotide </li></ul>
  • 37. TREATMENT FOR GI DYSFUNCTION <ul><li>Smaller and more frequent meals(liquids) </li></ul><ul><li>Low in fat content </li></ul><ul><li>Drugs </li></ul><ul><li>metoclopramide 5-10 mg </li></ul><ul><li>domperidone 10-20 mg </li></ul><ul><li>Diabetic diarrhoea </li></ul><ul><li>loperamide or ocreotide(50-70 µg TDS) </li></ul><ul><li>Antibiotics </li></ul>
  • 38. TREATMENT FOR GENITOURINARY DYSFUNCTION <ul><li>Diabetic cystopathy-timed voiding and self catheterisation </li></ul><ul><li>Erectile dysfunction-type 5 PDE inhibitors </li></ul><ul><li>Women-lubricants,treatment of infections &amp; estrogen replacement(systemic/local) </li></ul>
  • 39. TREATMENT FOR CARDIOVASCULAR DYSFUNCTION <ul><li>Revascularisation procedures </li></ul><ul><li>PCI &amp; CABG </li></ul><ul><li>Problem-restenosis </li></ul><ul><li>Improved outcomes-stents/ GP 2b 3a platelet inhibitors </li></ul><ul><li>Drugs </li></ul><ul><li>- ß blockers,ACE inh/ARBs </li></ul><ul><li>Secondary prevention-Aspirin </li></ul>
  • 40. New technologies in treatment of diabetes <ul><li>Islet cell transplantation </li></ul><ul><li>Gene therapy </li></ul><ul><li>Vaccine-peptide </li></ul><ul><li>Foot ulcer-dermograft </li></ul><ul><li>Artificial pancreas </li></ul>
  • 41. &nbsp;
  • 42. <ul><li>PREVENTION </li></ul><ul><li>Primary prevention </li></ul><ul><li>population strategy </li></ul><ul><li>high risk strategy </li></ul><ul><li>Secondary prevention </li></ul><ul><li>glycosylated Hb </li></ul><ul><li>self care </li></ul><ul><li>home blood glucose </li></ul><ul><li>monitoring </li></ul><ul><li>Tertiary prevention </li></ul>
  • 43. Thank you

×