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DIABETES TREATMENT  AND  PREVENTION LAVANYA.K ROLL NO.39
Goals of therapy <ul><li>To eliminate the symptoms related to hyperglycemia </li></ul><ul><li>To reduce or eliminate the l...
Healthcare Team <ul><li>Members of the team include </li></ul><ul><li>Primary care provider </li></ul><ul><li>Endocrinolog...
Treatment Goals INDEX GOAL <ul><li>Glycemic control </li></ul><ul><li>A1C </li></ul><ul><li>Preprandial plasma glucose </l...
Diabetes education <ul><ul><li>Diabetes educator is healthcare professional (nurse, dietician or pharmacist) </li></ul></ul>
<ul><ul><li>Education topics  include  diet  </li></ul></ul><ul><ul><ul><li>Self monitoring of blood  </li></ul></ul></ul>...
EXERCISE <ul><li>Positive benefits </li></ul><ul><ul><li>Reduces cardiovascular risks, BP, body fat, weight  </li></ul></u...
<ul><li>Problems </li></ul><ul><ul><li>either hypo/ hyperglycemia </li></ul></ul><ul><li>Guidelines to avoid these problem...
Assesment of long term glycemic control <ul><li>Glycated Hb/ A1C </li></ul><ul><li>Fructose amine acid </li></ul><ul><li>1...
 
Treatment of type 1 Diabetes Preparation Onset (hr) Peak (hr) Eff.duration(hr) <ul><li>Short acting s.c. </li></ul><ul><li...
Insulin Combinations <ul><li>75 / 25 - Protamine lispro + Lispro </li></ul><ul><li>50 / 50  -  “ + “ </li></ul><ul><li>70 ...
INSULIN REGIMENS
INSULIN PREPARATIONS <ul><li>AVAILABLE AS U-40 & U-100 </li></ul><ul><li>REGULAR INSULIN U-500 </li></ul>
GUIDELINES FOR MIXING OF INSULIN <ul><li>Mix the different insulin formulations in the syringe immediately before injectio...
CALCULATION OF INSULIN DOSE <ul><li>Meal component </li></ul><ul><li>Based on insulin carbohydrate ratio </li></ul><ul><li...
<ul><li>Advantage of having long acting insulin before night meal </li></ul><ul><li>Dawn phenomenon </li></ul>
METHODS OF INSULIN DELIVEY <ul><li>Insulin syringe </li></ul><ul><li>insulin pen injectors </li></ul><ul><li>Insulin jet i...
INSULIN SYRINGE
ROTATION SITES
INULIN PEN <ul><li>Has cartridge for insulin-dial </li></ul><ul><li>Contains needle & plunger </li></ul><ul><li>More conve...
Insulin jet injectors <ul><li>Sprays insulin->directly passes through the skin </li></ul><ul><li>Costly </li></ul><ul><li>...
 
BLOOD GLUCOSE MONITORING <ul><li>Visually read test strips </li></ul><ul><li>ex.Betachek diabetes test strips </li></ul><u...
TREATMENT OF TYPE II DIABETES MANAGEMENT OF  TYPE II DIABETES <ul><li>GLYCEMIC CONTROL </li></ul><ul><li>Diet </li></ul><u...
 
Treatment of type 2 diabetes mellitus Oral Biguanides Metformin Alpha glucosidase inhibitors Acarbose ,  meglitol DPP 4 in...
Parenteral Insulin GLP1 agonist exenatide Amylin agonist pramlintide
 
 
drugs advantages Disadvantages biguanides Weight loss Lactic acidosis,GI dysfunctions Alpha glucosidase inhibitor Reduce p...
Glycaemic management of type 2 diabetes mellitus patient with type 2 diabetes medical, nutrition therapy,increased physica...
<ul><li>Fall in insulin requirements  </li></ul><ul><li>Dialysis associated complications </li></ul><ul><li>-hypotension,p...
<ul><li>Transplantation-combined pancreas and kidney </li></ul>
TREATMENT FOR DIABETIC NEUROPATHY <ul><li>Risk factors -> hypertension and hypertriglyceridemia </li></ul><ul><li>Avoidanc...
<ul><li>Chronic painful-antidepressants and anticonvulsants </li></ul><ul><li>Orthostatic hypotension-clonidine,fludrocort...
TREATMENT FOR GI DYSFUNCTION <ul><li>Smaller and more frequent meals(liquids) </li></ul><ul><li>Low in fat content </li></...
TREATMENT FOR GENITOURINARY DYSFUNCTION <ul><li>Diabetic cystopathy-timed voiding and self catheterisation </li></ul><ul><...
TREATMENT FOR CARDIOVASCULAR DYSFUNCTION <ul><li>Revascularisation procedures </li></ul><ul><li>PCI & CABG </li></ul><ul><...
New technologies in treatment of diabetes <ul><li>Islet cell transplantation </li></ul><ul><li>Gene therapy </li></ul><ul>...
 
<ul><li>PREVENTION </li></ul><ul><li>Primary prevention </li></ul><ul><li>population strategy </li></ul><ul><li>high risk ...
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Transcript of "Treatment & Prevention 6"

  1. 1. DIABETES TREATMENT AND PREVENTION LAVANYA.K ROLL NO.39
  2. 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. 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. 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><7 90-130 mg/dl <180 mg/dl Blood pressure <130/80 <ul><li>Lipids </li></ul><ul><li>LDL </li></ul><ul><li>HDL </li></ul><ul><li>Triglycerides </li></ul><100mg/dl >40mg/dl <150mg/dl
  5. 5. Diabetes education <ul><ul><li>Diabetes educator is healthcare professional (nurse, dietician or pharmacist) </li></ul></ul>
  6. 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 & skin care </li></ul></ul></ul><ul><ul><ul><li>Diabetes mgmt. before, during & after exercise </li></ul></ul></ul><ul><ul><ul><li>Risk factor modifying activities </li></ul></ul></ul>
  7. 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. 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 & after exercise </li></ul></ul><ul><ul><li>Delay exercise if bld. Glucose > 250 mg/ dl and Ketone bodies are present </li></ul></ul><ul><ul><li>If bld. Glucose< 100 mg/ dl , ingest carbohydrate before exercise </li></ul></ul>
  9. 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. 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><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><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
  11. 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>
  12. 13. INSULIN REGIMENS
  13. 14. INSULIN PREPARATIONS <ul><li>AVAILABLE AS U-40 & U-100 </li></ul><ul><li>REGULAR INSULIN U-500 </li></ul>
  14. 15. GUIDELINES FOR MIXING OF INSULIN <ul><li>Mix the different insulin formulations in the syringe immediately before injection &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>
  15. 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>
  16. 17. <ul><li>Advantage of having long acting insulin before night meal </li></ul><ul><li>Dawn phenomenon </li></ul>
  17. 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>
  18. 19. INSULIN SYRINGE
  19. 20. ROTATION SITES
  20. 21. INULIN PEN <ul><li>Has cartridge for insulin-dial </li></ul><ul><li>Contains needle & 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>
  21. 22. Insulin jet injectors <ul><li>Sprays insulin->directly passes through the skin </li></ul><ul><li>Costly </li></ul><ul><li>Bruishing->thin individuals </li></ul>
  22. 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>
  23. 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>
  24. 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
  25. 28. Parenteral Insulin GLP1 agonist exenatide Amylin agonist pramlintide
  26. 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
  27. 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
  28. 33. <ul><li>Fall in insulin requirements </li></ul><ul><li>Dialysis associated complications </li></ul><ul><li>-hypotension,progression of retinopathy,atherosclerosis & hyperlipidemia </li></ul>Treatment for diabetic nephropathy
  29. 34. <ul><li>Transplantation-combined pancreas and kidney </li></ul>
  30. 35. TREATMENT FOR DIABETIC NEUROPATHY <ul><li>Risk factors -> hypertension and hypertriglyceridemia </li></ul><ul><li>Avoidance of neurotoxins ->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 & take precaution </li></ul>
  31. 36. <ul><li>Chronic painful-antidepressants and anticonvulsants </li></ul><ul><li>Orthostatic hypotension-clonidine,fludrocortisone,ocreotide </li></ul>
  32. 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>
  33. 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 & estrogen replacement(systemic/local) </li></ul>
  34. 39. TREATMENT FOR CARDIOVASCULAR DYSFUNCTION <ul><li>Revascularisation procedures </li></ul><ul><li>PCI & 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>
  35. 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>
  36. 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>
  37. 43. Thank you
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