This document provides an overview of the approach to treating diabetic patients. It discusses the initial medical evaluation, which includes classifying diabetes, detecting complications, reviewing previous treatment, and creating a management plan. It also describes the components of the medical evaluation such as medical history, physical exam, and lab tests. The document outlines the goals of diabetes management and the two types of treatment approaches - non-pharmacological including education, nutrition, exercise, and risk factor control, and pharmacological including medications for type 1 and type 2 diabetes.

1. APPROACH TO A
DIABETIC PATIENT
By Dr. Pushpendra Vyas.
Guided by Dr. Rakesh Gupta sir.

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. 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. 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. TWO TYPE OF APPROACH
1. NON PHARMACOLOGICAL .
2. PHARMACOLOGICAL .

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. 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. 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. 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. HOW WE DETERMINE DIET PRESCRIPTION

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. 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. 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. OTHERS INCLUDES :-
Alcohol cessation
Psychological assessment
Immunization

15. 2. PHARMACOLOGICAL APPROACH
 Type 1 DM
 Type 2 DM

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. TYPE 2 DM PHARMACOTHERAPY
 These includes OHA in monotherapy or in
combination with other OHA or INSULIN .