Treatment & Prevention 6
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Treatment & Prevention 6 Presentation Transcript

  • 1. DIABETES TREATMENT AND PREVENTION LAVANYA.K ROLL NO.39
  • 2. 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
  • 3. Healthcare Team
    • Members of the team include
    • Primary care provider
    • Endocrinologist/ Diabetologist
    • Certified diabetes educator
    • Nutritionist
    • Sub specialists
  • 4. 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
  • 5. Diabetes education
      • Diabetes educator is healthcare professional (nurse, dietician or pharmacist)
  • 6.
      • 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
  • 7. 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
  • 8.
    • 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
  • 9. Assesment of long term glycemic control
    • Glycated Hb/ A1C
    • Fructose amine acid
    • 1,5 anhydroglucitol
  • 10.  
  • 11. 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
  • 12. Insulin Combinations
    • 75 / 25 - Protamine lispro + Lispro
    • 50 / 50 - “ + “
    • 70 / 30 - Protamine aspart + Aspart
    • 70 / 30 - NPH + Reg. Insulin
    • 50 / 50 - “ + “
  • 13. INSULIN REGIMENS
  • 14. INSULIN PREPARATIONS
    • AVAILABLE AS U-40 & U-100
    • REGULAR INSULIN U-500
  • 15. 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
  • 16. 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
  • 17.
    • Advantage of having long acting insulin before night meal
    • Dawn phenomenon
  • 18. METHODS OF INSULIN DELIVEY
    • Insulin syringe
    • insulin pen injectors
    • Insulin jet injectors
    • Insulin pumps
    • Insulin inhalers
  • 19. INSULIN SYRINGE
  • 20. ROTATION SITES
  • 21. INULIN PEN
    • Has cartridge for insulin-dial
    • Contains needle & plunger
    • More convenient to use in
    • schools,public places or
    • at work
  • 22. Insulin jet injectors
    • Sprays insulin->directly passes through the skin
    • Costly
    • Bruishing->thin individuals
  • 23.  
  • 24. BLOOD GLUCOSE MONITORING
    • Visually read test strips
    • ex.Betachek diabetes test strips
    • pamphlet chemical test strips
  • 25. 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
  • 26.  
  • 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.  
  • 30.  
  • 31. 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
  • 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.
    • Fall in insulin requirements
    • Dialysis associated complications
    • -hypotension,progression of retinopathy,atherosclerosis & hyperlipidemia
    Treatment for diabetic nephropathy
  • 34.
    • Transplantation-combined pancreas and kidney
  • 35. 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
  • 36.
    • Chronic painful-antidepressants and anticonvulsants
    • Orthostatic hypotension-clonidine,fludrocortisone,ocreotide
  • 37. 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
  • 38. 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)
  • 39. 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
  • 40. New technologies in treatment of diabetes
    • Islet cell transplantation
    • Gene therapy
    • Vaccine-peptide
    • Foot ulcer-dermograft
    • Artificial pancreas
  • 41.  
  • 42.
    • PREVENTION
    • Primary prevention
    • population strategy
    • high risk strategy
    • Secondary prevention
    • glycosylated Hb
    • self care
    • home blood glucose
    • monitoring
    • Tertiary prevention
  • 43. Thank you