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Approach to a diabetic patient

My efforts for diabetes care & approach to diabetes patient

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Approach to a diabetic patient

  1. 1. APPROACH TO A DIABETIC PATIENT By Dr. Pushpendra Vyas. Guided by Dr. Rakesh Gupta sir.
  2. 2. DIABETES INITIAL MEDICAL EVALUATION 1. Classify diabetes 2. Detect complication 3. Review previous treatment & risk factor control in established case 4. Assist in formulating a management plan 5. Provide a basis for continuing care
  3. 3. COMPONENT OF MEDICAL EVALUATION  Medical history  Physical examination- Weight , Blood pressure, Foot examination .  Lab evaluation- FBG, HbA1c, Lipid profile, Renal function, Urinalysis, Microalbuminuria  Referrals- Retinopathy, Neuropathy, Nephropathy,
  4. 4. DIABETES MANAGEMENT WHAT IS OUR AIM :- 1. ACHIEVE HBA1C GOAL OR FBS OR OGTT OR PPG GOAL 2. PREVENT & DELAY LONGTERM MACRO & MICRO - VASCULAR COMPLICATION 3.INCREASE LIFE EXPECTANCY
  5. 5. TWO TYPE OF APPROACH 1. NON PHARMACOLOGICAL . 2. PHARMACOLOGICAL .
  6. 6. 1. NON-PHARMACOLOGICAL . It contain all action except drugs therapy 1. Diabetes patient education 2. Medical nutrition therapy 3. Exercise or workout 4. Reduce risk factors like smoking, obesity , alcohol ,sodium (2300mg/day)
  7. 7. DIABETES PATIENT EDUCATION  First demonstrated by miller & Goldstein in 1972  Objective is to make patient understand & handle acute & chronic complication which are 50-80% preventable . It Significantly reduce hypoglycemic event , ketoacidosis , leg amputation & improve diabetes control .  Impossible to manage diabetes without good awareness .  No diabetes educators in india .  At community level promotion  Teaching a teacher - In India even physicians doesn’t receive education program . There should be a curriculum to train teacher includes nutritional & physical advice , home based method of monitoring blood glucose , injection techniques, all acute & chronic complications .
  8. 8. MEDICAL NUTRITION THERAPY Basic principles are – 1. Decrease in saturated fat 2. Decrease in simple carbohydrates 3. Substitute with complex carb. 4. Increase in dietary fibers. 5. limiting alcohol consumption 6. 2 gm of protein/kg bw to minimize nitrogen loss 7. Consumption of high calorie snacks or sugar rich beverages should be discontinued . 8. Consumption of three main meals a day with 1 or 2 snacks .
  9. 9. BROCA’S INDEX & BMI  Ideal body weight of a pt may be assessed using broca’s index  Height in cms -100 = desirable body wt in kg . Maintaining wt at 90% of desirable wt may be preferred in pt with diabetes .  BMI = (wt in kgs )/(ht in mtr)^2
  10. 10. HOW WE DETERMINE DIET PRESCRIPTION
  11. 11. DETERMINE EXERCISE PRESCRIPTION  Normal prediabetic patient ADA recommond 150min/week aerobic or jogging activity  Diabetes with obesity more than 30 BMI recommondation of 300min/week aerobic with some vigorous exercises .
  12. 12. SMOKING CESSATION  One of the most cost effective interventions in pt with DM .  Ask history about duration, frequency & types of smoking & tobacco .  Regardless of patient’s willingness , offer advice & information about the effects & complications related to smoking .  Once pt prepare for quitting give them a favourable environment .
  13. 13. CONTROL OBESITY  BMI should be less than 23 kg/m2 in indians  Diet & food based therapy  Exercise  Behavioral therapy  Pharmacotherapy drugs like orlistat(decrease fat absorption),phenteremine (appetite suppressant) lorcaserin(satiety) ,naltrexone(reduce foodintake) ( USFDA approved ) others are metformin , glp-1 agonist , dpp-4 inhibitors .  Bariatric surgery
  14. 14. OTHERS INCLUDES :- Alcohol cessation Psychological assessment Immunization
  15. 15. 2. PHARMACOLOGICAL APPROACH  Type 1 DM  Type 2 DM
  16. 16. TYPE 1 DM PHARMACOTHERAPY 1. Insulin insulin & insulin . Insulin must be prescribed in basal bolus regimens There is no other drug use in type 1 dm 2. Pramlintide – USFDA approved delayed gastric emptying , blunt pancreatic secretion of glucagon & enhance satiety . Induce wt loss & lower insulin dose . Only indicated in adult .
  17. 17. TYPE 2 DM PHARMACOTHERAPY  These includes OHA in monotherapy or in combination with other OHA or INSULIN .

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