Diabetes Mellitus 6.10.07

1,970 views

Published on

Published in: Education, Health & Medicine

Diabetes Mellitus 6.10.07

  1. 1. Diabetes Mellitus DR SHABEEL’S PRESENTATIONS
  2. 2. Definition <ul><li>DM is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin </li></ul>
  3. 3. Classification <ul><li>Type 1 DM </li></ul><ul><li>Type 2 DM </li></ul><ul><li>Gestational diabetes </li></ul><ul><li>Other specific types </li></ul>
  4. 4. Pathophysiology & clinical features
  5. 5. Lack of insulin Decreased peripheral Uptake of glucose Hyperglycemia Osmotic diuresis Glycosuria Na, H2O depletion
  6. 6. Lack of insulin Decreased peripheral Uptake of glucose Hyperglycemia Osmotic diuresis Glycosuria Na, H2O depletion Polyuria Polydipsia Fatigue Vulvitis Balanitis Tachycardia Hypotension
  7. 7. Lack of insulin Decreased peripheral Uptake of glucose Hyperglycemia Osmotic diuresis Glycosuria Na, H2O depletion Increased breakdown of glycogen & lipid Ketone bodies Acidosis
  8. 8. Lack of insulin Decreased peripheral Uptake of glucose Hyperglycemia Osmotic diuresis Glycosuria Na, H2O depletion Increased breakdown of glycogen & lipid Ketone bodies Acidosis Wasting & loss of weight Hyperventilation Peripheral vasodilatation Hypotension Hypothermia
  9. 9. Investigations <ul><li>Urine – sugar / Ketones / protein </li></ul><ul><li>Blood – glucose / HbA1c / RFT / lipids </li></ul>
  10. 10. Diagnosis <ul><li>FBS > 126mg% OR </li></ul><ul><li>RBS > 200mg% </li></ul><ul><li>+ </li></ul><ul><li>Symptoms of diabetes </li></ul>
  11. 11. Complications of diabetes <ul><li>Keto acidosis </li></ul><ul><li>Non ketotic hyperosmolar diabetic coma </li></ul><ul><li>Retinopathy / cataract </li></ul><ul><li>Nephropathy </li></ul><ul><li>DPN / autonomic neuropathy </li></ul><ul><li>Diabetic foot </li></ul><ul><li>Myocardial ischaemia / infarction </li></ul><ul><li>TIA / stroke </li></ul><ul><li>Claudication </li></ul>
  12. 12. Management of diabetes <ul><li>Diet & exercise </li></ul><ul><li>OHA </li></ul><ul><li>Insulin </li></ul><ul><li>Insulin + OHA </li></ul>
  13. 13. Oral Hypo- glycaemic Agents <ul><li>Sulphonyluria </li></ul><ul><ul><li>Secretagogue </li></ul></ul><ul><ul><li>Used in non-obese </li></ul></ul><ul><ul><li>Glibenclamide / glipizide / glyclazide / glimiperide </li></ul></ul>
  14. 14. OHA Contd………. <ul><li>Biguanides </li></ul><ul><ul><li>Metformin </li></ul></ul><ul><ul><li>Increases insulin sensitivity </li></ul></ul><ul><ul><li>Increase peripheral glucose uptake </li></ul></ul><ul><ul><li>Impairs glucose absorption from the gut </li></ul></ul><ul><ul><li>Decrease hepatic gluconeogenesis </li></ul></ul><ul><ul><li>Used in obese </li></ul></ul>
  15. 15. OHA contd…….. <ul><li>Alpha glucosidase inhibitors </li></ul><ul><ul><li>Acarbose / miglitol / voglibose </li></ul></ul><ul><ul><li>Delay carbohydrate absorption </li></ul></ul><ul><ul><li>PPBS control </li></ul></ul><ul><li>Thiazolidinediones </li></ul><ul><ul><li>Pioglitazone / Rosiglitazone </li></ul></ul><ul><ul><li>Insulin sensitizer </li></ul></ul>
  16. 16. OHA contd……. <ul><li>Meglitinides </li></ul><ul><ul><li>Repaglenide </li></ul></ul><ul><ul><li>Stimulates endogenous insulin secretion </li></ul></ul>
  17. 17. Insulin <ul><li>Bovine </li></ul><ul><li>Porcine </li></ul><ul><li>Human </li></ul>
  18. 18. Insulin <ul><li>Rapid acting (lispro/ aspart ) </li></ul><ul><li>Short acting (regular / soluble ) </li></ul><ul><li>Intermediate acting ( lente / isophane ) </li></ul><ul><li>Long acting (ultra lente / insulin analogues- glargine / detemir) </li></ul>
  19. 19. Insulin delivery devices <ul><li>Syringe </li></ul><ul><li>Pen device </li></ul><ul><li>Insulin pumps </li></ul>
  20. 20. Diabetic ketoacidosis
  21. 21. Pathophysiology Marked hyperglycaemia Osmotic diuresis Dehydration & electrolyte imbalance
  22. 22. Clinical features <ul><li>Infection precipitates </li></ul><ul><li>Symptoms </li></ul><ul><ul><li>Polyuria / Polydipsia / Weakness </li></ul></ul><ul><ul><li>Nausea / vomiting / abd pain </li></ul></ul><ul><ul><li>Leg cramps </li></ul></ul><ul><ul><li>Blurred vision </li></ul></ul>
  23. 23. Clinical features signs <ul><li>Dehydration / Hypotension / Tachycardia </li></ul><ul><li>Smell of acetone </li></ul><ul><li>Kussmaul’s breathing ( air hunger ) </li></ul><ul><li>Hypothermia </li></ul><ul><li>Confusion / drowsiness / coma </li></ul>
  24. 24. Investigations <ul><li>RBS </li></ul><ul><li>Urea / creat </li></ul><ul><li>Electrolytes </li></ul><ul><li>Ketones </li></ul><ul><li>ABG </li></ul><ul><li>Blood / urine C/S </li></ul><ul><li>CXR </li></ul>
  25. 25. Management <ul><li>IV insulin infusion @ 5u / hr </li></ul><ul><li>IVF NS 1L - 30mts </li></ul><ul><li>½ L - 30mts </li></ul><ul><li>½ L - 60mts </li></ul><ul><li>½ L - 120mts </li></ul><ul><li>KCL 20mmol/L of infused fluid if S.K+ is 3.5-5.5mmols/L </li></ul><ul><li>If < 3.5mmols/L 40mmols of KCL / L </li></ul>
  26. 26. Contd…….. <ul><li>Antibiotic coverage </li></ul><ul><li>If hypernatraemia , ½ NS </li></ul><ul><li>When RBS is <250mg% , reduce the rate of insulin infusion & change to 5%Dextrose </li></ul><ul><li>Sodabicarb if severely acidotic </li></ul>
  27. 27. Complications of DKA <ul><li>Cerebral oedema </li></ul><ul><li>ARDS </li></ul><ul><li>Thrombo-embolism </li></ul><ul><li>DIC </li></ul><ul><li>Acute circulatory failure </li></ul>
  28. 28. Hypoglycemia
  29. 29. Hypoglycemia <ul><li>Seen in patients treated with insulin / OHA </li></ul>
  30. 30. Causes <ul><li>Missed / delayed / inadequate meal </li></ul><ul><li>Unusual exercise </li></ul><ul><li>Alcohol </li></ul><ul><li>Inappropriate dosage </li></ul><ul><li>Gastro paresis due to autonomic neuropathy </li></ul><ul><li>Malabsorption syndrome </li></ul><ul><li>Dumping syndrome </li></ul><ul><li>Factitious </li></ul>
  31. 31. <ul><li>Hypoglycemia is countered by secretion of glucagon & adrenaline </li></ul>
  32. 32. Clinical features <ul><li>Non-specific </li></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>headache </li></ul></ul><ul><ul><li>tiredness </li></ul></ul><ul><li>Autonomic </li></ul><ul><ul><li>Sweating / tremor / palpitation </li></ul></ul><ul><ul><li>hunger / anxiety </li></ul></ul>
  33. 33. Contd…… <ul><li>Neuroglycopenic </li></ul><ul><ul><li>Inability to concentrate </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>In co-ordination </li></ul></ul><ul><ul><li>Drowsiness </li></ul></ul><ul><ul><li>Difficulty in speech </li></ul></ul><ul><ul><li>Coma </li></ul></ul>
  34. 34. Management <ul><li>Oral carbohydrates / sugar </li></ul><ul><li>25-50% dextrose 100/50ml </li></ul><ul><li>Followed by 5-10% IV infusion till the patient can take orally </li></ul><ul><li>Glucagon 1mg IM </li></ul><ul><li>Watch for recurrence </li></ul>

×