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Treatment & Prevention 6
 

Treatment & Prevention 6

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    Treatment & Prevention 6 Treatment & Prevention 6 Presentation Transcript

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