This document provides an update on diabetes mellitus, including its classification into four main subtypes, diagnostic criteria, screening recommendations, treatment goals, and management strategies. Type I diabetes is characterized by absolute insulin deficiency due to autoimmune destruction of beta cells. Type II diabetes accounts for 90-95% of cases and involves relative insulin deficiency and insulin resistance. Diagnosis is based on fasting plasma glucose, oral glucose tolerance testing, or HbA1c levels. The main goals of management are lifestyle modification, glycemic control, risk factor reduction, and prevention of complications through medical nutrition therapy, physical activity, pharmacotherapy including metformin and additional agents as needed.
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
This Presentation Give You A brief Information About DPP4 And New Recommendations .This Presentation Guide You How To Treat Patients With Safety.
For Further Contact:03354999496
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
This Presentation Give You A brief Information About DPP4 And New Recommendations .This Presentation Guide You How To Treat Patients With Safety.
For Further Contact:03354999496
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
Similar to AN UPDATE ON Diabetes Mellitus.pptx (20)
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. DIAGNOSIS
• Fasting plasma glucose (FPG)
• No caloric intake for at least 8 hours and for maximum of 12 hours.
• Two hour plasma glucose in 75g oral glucose tolerance test (OGTT)
• a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water.
• HbA1c
• does not require fasting
• Costly
• limited availability in resource poor settings.
• HbA1C must be measured using a validated assay standardized to the National
Glycohemoglobin Standardization Program-Diabetes Control and Complications Trial
reference
• HbA1C levels can vary with age, ethnicity, anaemia, haemoglobinopathies, haemolysis,
blood loss and severe hepatic and renal disease.
• Random blood sugar (RBS)
• can be used for diagnosis of diabetes in the presence of symptomatic hyperglycaemia.
6. How to confirm the Diagnosis ?
Classic symptoms of Hyperglycaemia or Hyperglycaemic crisis
Any single diagnostic test confirms the diagnosis
Additionally, RBS >= 200mg/dL (11.1 mmol/l) confirms the diagnosis
Asymptomatic individual
Requires TWO abnormal test results from the same sample OR in 2 separate test
samples
If using 2 separate samples, the second test may either be a repeat of the initial test
OR a different test
Repeat the test that has a result above the diagnostic cut-off point if a patient has
discordant results from 2 different tests
7. SCREENING FOR Type II DM
• Any adult >= 35Y of age
• Any adult < 35Y of age WITH any Risk factor
• Any adolescent with BMI > 85th centile ( >+ SD)
• Female of an eligible couple / female expecting a pregnancy
9. MANAGEMENT
• Main goals of management include,
1) Life style modification and patient education
2) Maintenance of good glycaemic control
3) Multiple risk factor management
4) Prevention of complications
10. Medical Nutrition Therapy
• Should be individualized.
• Weight loss is recommended (at least 5-10%) for all overweight or
obese individuals with a calorie restricted diet. All patients should
attempt to have near normal body weight
(BMI – 18.5 - 23kg/m2)
• Saturated fat and trans fat intake should be reduced.
• Salt intake should be limited to less than 2.4 g sodium (ex:- 1 tea spoon of salt)
11. Physical Activity
• Moderate intensity aerobic physical activity (e.g. walking, cycling, swimming) is
recommended.
• At least 150 min/week (e.g. brisk walk 30 minutes a day 5 days a week).
• For obese patients at least 60 minutes of exercise per a day.
• Resistance training (e.g. pushups, dumbbells) is recommended at least twice a
week.
• Encourage muscle-strengthening activities that involve all major muscle groups (2
or more days per week)
• Smoking and Alcohol
• All patients should be encouraged to quit smoking.
• Alcohol is best avoided. If taken it should be less than two units per day for men
and less than one unit per day for women.
13. Initiation of Pharmacotherapy
At initial diagnosis, monotherapy with Metformin (unless contraindicated) along with lifestyle interventions is
the preferred choice as most patients cannot achieve recommended targets on lifestyle interventions alone.
In the presence of moderate to severe hyperglycaemia at diagnosis, dual/ triple therapy or insulin may be
considered.
Insulin therapy may be required if there are severe symptoms or complications at presentation. Once the
hyperglycaemia is controlled, changing over to non-insulin therapies may be possible.
Consider timely initiation of combination therapy if monotherapy appears inadequate.
The combined regimen should aim for good glycaemic efficacy, low potential for hypoglycaemia as well as
weight neutrality or ideally weight loss in the obese and cost effectiveness.
Sulphonylurea is used as the second line treatment option or as the first choice in metformin intolerant/
contraindicated patients in local setting due to absence of robust data on superiority of other agents, low cost
and availability.
Nevertheless, any combination of anti hyperglycaemic agents such as sulfonylurea, thiazolidinedione, DPP-4
inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, or insulin can be considered for the combination therapy.
14. Life style modification
+
Metformin
Glycaemic target not achieved
in 3 months
Add a Second agent
Sulfonylurea (preferred)
DPP4i
GLP1
SGLT-2i
TZD
Basal Insulin
Glycaemic target not achieved
in 3 months
Add a Third agent
Sulfonylurea
DPP4i
GLP1
SGLT-2i
TZD
Basal Insulin
Glycaemic target not achieved
in 3 - 6 months
15. Non-Insulin therapies for Type II DM
CLASS ADVANTAGES DISADVANTAGES
REDUCTION OF
HbA1c
METFORMIN Extensive experience
No weight gain
No hypoglycaemia
Likely ↓ CVD events
GI side effects
(diarrhoea, abdominal cramps)
Lactic acidosis risk (extremely rare)
Vitamin B12 deficiency(rare)
Multiple contraindications:
CKD, acidosis, hypoxia, dehydration
1 – 2%
TOLBUTAMIDE
GLICLAZIDE
GLIPIZIDE
GLIBENCLAMIDE
GLIMIPERIDE
Extensive experience
↓ Microvascular risk
Hypoglycaemia
Weight gain
1 – 2%
ACARBOSE No hypoglycaemia
↓Postprandial glucose
excursions
Gastrointestinal side effects
(flatulence, diarrhoea)
Frequent dosing schedule
0.5 – 1%
SITAGLIPTIN
VILDAGLIPTIN
LINAGLIPTIN
No hypoglycaemia
Well tolerated
Weight neutral
CVD risk neutral
Generally modest HbA1c reduction
and efficacy
Urticaria/angioedema
1%
16. CLASS ADVANTAGES DISADVANTAGES
REDUCTION OF
HbA1c
GLP-1 Agonists
• EXENETIDE
• LIRAGLUTIDE
• SEMAGLUTIDE
No hypoglycaemia
Weight reduction
Cardiovascular benefits
Gastrointestinal side effects
(nausea/vomiting)
Injectables - Training requirements
1 – 1.5%
PIOGLITAZONE No hypoglycaemia
Durability
↑ HDL
↓ Triglycerides
↓CVD events
Weight gain
Oedema/heart failure
Fractures
? ↑ Bladder cancer risk
0.5 - 1%
SGLT2 Inhibitors
• DAPAGLIFLOZIN
• CANAGLIFLOZIN
• EMPAGLIFLOZIN
No hypoglycaemia
↓ Weight
↓ Blood pressure
↑HDL/↓ TG
Effective at all stages of
T2DM
Better cardiovascular
outcome
(Empagliflozin, Dapagliflozin)
Increased Genitourinary infections
Polyuria
Euglycaemic ketoacidosis
Volume depletion
Hypotension / Dizziness
0.5 – 1%
Editor's Notes
Type 1 may occur in adults
Type 2 may be seen in children