Obesity as presented by cheruiyot sambu clinical nutritionist at kapkatet cou...cheruiyot sambu
obesity is currently a global concern. in developing countries like kenya, we have a double burden of both under-nutrition and over-nutrition. health care providers too are not spared by over-nutrition. my best advice is for everyone to see nutritionist for nutrition advice. in kapkatet hospital we are starting weight management plan for health professionals; you can join us.
Obesity is characterized by excess body fat accumulation and increased disease risk. It is assessed using body mass index (BMI) and other measures. Obesity is correlated with increased risks of conditions like type 2 diabetes, heart disease, and some cancers. Treatment involves lifestyle modifications like calorie reduction and exercise, as well as potential pharmacologic or surgical options. Bariatric surgery is recommended for severe, morbid obesity and provides significant, sustained weight loss that can improve related health issues.
Obesity is a medical condition where excess body fat has accumulated to the point it can negatively impact health, reducing life expectancy and increasing health problems. It is defined as a body mass index over 30 kg/m2. Signs include excess body fat, large waistline, difficulty sleeping, sweating, lack of energy, joint/muscle pain and rashes. Obesity is also associated with oral diseases like periodontal disease and may be related to cardiovascular disease. It has multiple contributing factors like genetics, lifestyle, behavior and health conditions.
This powerpoint covers the following subtopics:
What is obesity?
Pathogenesis
Burden
Epidemiology of obesity
Assessment of obesity
Consequences of obesity
Prevention and Control
Obesity is a complex disease with various contributing factors. It is defined as excessive fat accumulation that may impair health. According to WHO, over 1.6 billion adults are overweight globally, with 400 million being obese. Obesity rates have sharply increased worldwide and are projected to affect over 2.3 billion adults by 2020. Unani medicine attributes obesity to disturbances in digestion and metabolism, temperament, and lifestyle factors. Treatment focuses on diet modification, exercise, pharmacotherapy using herbs to aid weight loss, and lifestyle changes like adequate sleep and stress management.
Underweight people at elevated risk of heart diseasesAllyson James
Underweight individuals are at greater risk of heart disease than those at a normal weight. A study in Bali found that underweight people are 3.6 times more likely to experience heart disease compared to normal weight individuals. Low levels of hemoglobin, abdominal fat accumulation, unhealthy eating habits, lack of physical activity, and congenital heart disease can all increase the risk of cardiovascular disease for underweight people. Maintaining a balanced diet, engaging in regular physical activity, and consulting a doctor are important for heart health, regardless of body weight.
This seminar presentation discusses the threat of childhood obesity to health. It defines childhood obesity and outlines its causes such as poor diet, lack of exercise, and genetic factors. The presentation notes that childhood obesity rates have increased dramatically in developed and developing countries alike. Left uncontrolled, childhood obesity can lead to serious health complications and affect academic and social development. Prevention requires a focus on healthy diet, exercise, limiting screen time, and parental involvement.
Obesity is defined as excess body fat that negatively impacts health, reducing life expectancy and increasing health risks. It is caused by poor nutrition and lack of physical activity. Obesity raises the likelihood of heart disease, diabetes, breathing issues, certain cancers, and arthritis. Exercising for at least 60 minutes daily and eating a healthy diet low in junk food and high in water can help treat obesity.
Obesity as presented by cheruiyot sambu clinical nutritionist at kapkatet cou...cheruiyot sambu
obesity is currently a global concern. in developing countries like kenya, we have a double burden of both under-nutrition and over-nutrition. health care providers too are not spared by over-nutrition. my best advice is for everyone to see nutritionist for nutrition advice. in kapkatet hospital we are starting weight management plan for health professionals; you can join us.
Obesity is characterized by excess body fat accumulation and increased disease risk. It is assessed using body mass index (BMI) and other measures. Obesity is correlated with increased risks of conditions like type 2 diabetes, heart disease, and some cancers. Treatment involves lifestyle modifications like calorie reduction and exercise, as well as potential pharmacologic or surgical options. Bariatric surgery is recommended for severe, morbid obesity and provides significant, sustained weight loss that can improve related health issues.
Obesity is a medical condition where excess body fat has accumulated to the point it can negatively impact health, reducing life expectancy and increasing health problems. It is defined as a body mass index over 30 kg/m2. Signs include excess body fat, large waistline, difficulty sleeping, sweating, lack of energy, joint/muscle pain and rashes. Obesity is also associated with oral diseases like periodontal disease and may be related to cardiovascular disease. It has multiple contributing factors like genetics, lifestyle, behavior and health conditions.
This powerpoint covers the following subtopics:
What is obesity?
Pathogenesis
Burden
Epidemiology of obesity
Assessment of obesity
Consequences of obesity
Prevention and Control
Obesity is a complex disease with various contributing factors. It is defined as excessive fat accumulation that may impair health. According to WHO, over 1.6 billion adults are overweight globally, with 400 million being obese. Obesity rates have sharply increased worldwide and are projected to affect over 2.3 billion adults by 2020. Unani medicine attributes obesity to disturbances in digestion and metabolism, temperament, and lifestyle factors. Treatment focuses on diet modification, exercise, pharmacotherapy using herbs to aid weight loss, and lifestyle changes like adequate sleep and stress management.
Underweight people at elevated risk of heart diseasesAllyson James
Underweight individuals are at greater risk of heart disease than those at a normal weight. A study in Bali found that underweight people are 3.6 times more likely to experience heart disease compared to normal weight individuals. Low levels of hemoglobin, abdominal fat accumulation, unhealthy eating habits, lack of physical activity, and congenital heart disease can all increase the risk of cardiovascular disease for underweight people. Maintaining a balanced diet, engaging in regular physical activity, and consulting a doctor are important for heart health, regardless of body weight.
This seminar presentation discusses the threat of childhood obesity to health. It defines childhood obesity and outlines its causes such as poor diet, lack of exercise, and genetic factors. The presentation notes that childhood obesity rates have increased dramatically in developed and developing countries alike. Left uncontrolled, childhood obesity can lead to serious health complications and affect academic and social development. Prevention requires a focus on healthy diet, exercise, limiting screen time, and parental involvement.
Obesity is defined as excess body fat that negatively impacts health, reducing life expectancy and increasing health risks. It is caused by poor nutrition and lack of physical activity. Obesity raises the likelihood of heart disease, diabetes, breathing issues, certain cancers, and arthritis. Exercising for at least 60 minutes daily and eating a healthy diet low in junk food and high in water can help treat obesity.
Obesity is defined as excessive accumulation of body fat that occurs when caloric intake exceeds physiological needs. It can be caused by genetic, behavioral, social, and medical factors. Obesity is assessed by measuring body mass index (BMI), body fat percentage, and skin fold thickness. A BMI over 30 indicates obesity and is associated with increased risk of health complications like hypertension, diabetes, heart disease, and stroke. Obesity management involves dietary changes like reducing carbohydrate and fat intake while increasing protein and fiber, regular exercise, psychological counseling, medication, and sometimes surgery.
Obesity in children is on the rise and is caused by multiple factors including unhealthy eating habits, lack of physical activity, and genetic predispositions. Children who consume lots of fast food and junk food high in sugars and fats are at risk, as are those with family histories of obesity. A sedentary lifestyle focused on video games and technology rather than exercise also contributes to weight gain. Obesity can lead to serious health issues for children like diabetes, heart disease, and breathing problems. Parents are encouraged to help kids develop healthy diets and be more physically active through activities the whole family can enjoy.
Obesity is defined as an excessive accumulation of body fat that can damage health. It is caused by an imbalance between calorie intake and expenditure, influenced by a worldwide shift to diets high in fats and sugars but low in nutrients, and more sedentary lifestyles due to jobs and transportation changes. Obesity increases the risk of cardiovascular disease, diabetes, osteoarthritis and some cancers. Childhood obesity is a serious condition where a child is well above the normal weight for their age and height, and can lead to health issues like diabetes and depression. Improving the diet and exercise habits of the whole family is a key strategy to reduce childhood obesity.
this presentation is based on the basic overview of obesity.
in this presentation overview of obesity causes, treatment, prevention is described precisely. this presentation may help in making your assignment and you can also get idea realted to sub headings mention in this presentation related to obesity.
The document discusses obesity and defines it as having too much body fat compared to what is considered healthy. It provides information on body mass index (BMI) and how BMI is used to classify weight categories from underweight to obese. It lists several health risks associated with obesity like diabetes, heart disease, and some cancers. The document gives tips for prevention of obesity like exercising, eating healthy foods, limiting screen time, and reducing stress. It also provides treatment options for obesity including lifestyle changes, medicines, and surgical procedures like gastric bypass.
Belly Fat invites various fatal diseases. So its imp to know why belly fat happened and how can you reduce belly fat effortlessly. See PPT & know whole about the belly fat.
The document summarizes a seminar on obesity in children and adolescents. It discusses definitions of obesity and overweight, prevalence and trends, causes including exogenous factors like poor diet and lack of exercise as well as endogenous genetic and endocrine factors. Complications of childhood obesity discussed include psychological issues, sleep apnea, non-alcoholic fatty liver disease, diabetes, and cardiovascular risks. Screening and normal values for tests to evaluate complications are also presented.
This document discusses obesity, including its definition, classification, causes, health risks, diagnosis, and management. Obesity is defined as excess body fat accumulation that negatively impacts health, and is classified using body mass index (BMI), waist circumference, and waist-to-hip ratio. Causes include genetic, environmental, and behavioral factors. Health risks associated with obesity include increased risk of diabetes, cardiovascular disease, respiratory issues, cancers, and mental health conditions. Treatment involves lifestyle modifications focusing on diet and exercise, as well as potential medication options to help with weight loss.
The document discusses obesity, defining it as excessive body fat over 35% for women and 25% for men. It outlines the health risks of obesity like heart disease, diabetes, and certain cancers. Factors that contribute to obesity are discussed, like overeating high calorie foods, sedentary lifestyles, genetics, and certain medical conditions. Regional fat distribution is important, with abdominal fat posing more risks than lower body fat. The document provides guidelines for measuring obesity through BMI and outlines treatments like diet, exercise and medication or surgery in severe cases.
obesity in children , causes of obesity, approach to children obesity, complication of obesity, obesity definition, how to manage obesity, guidelines in pediatric obesity
The document summarizes information about childhood obesity, including:
- Data from a study showing 644 children categorized as non-obese (85%), overweight (9.1%) or obese (5.9%)
- Definitions of obesity, overweight and BMI measurements
- Factors contributing to rising childhood obesity rates like changes in food environment, lifestyle, and genetics
- Potential endocrine and genetic causes of obesity
- Health risks and recommended tests, diets, and lifestyle interventions to treat obesity
- Obesity rates have tripled globally since 1980 due to increased consumption of energy-dense, processed foods and reduced physical activity. Every fourth person worldwide is now considered overweight or obese.
- Obesity is caused by a complex interplay of genetic, environmental, and behavioral factors. Key contributors include excessive calorie intake, lack of exercise, fast food consumption, and genetic predispositions.
- Maintaining a physically active lifestyle is important for preventing weight gain and fat accumulation over time as metabolism naturally slows with age. Both diet and exercise are needed to effectively treat and prevent obesity on a long-term basis.
This document discusses obesity prevention in infants, children, adolescents, and adults. It provides tips for preventing overweight and obesity at different life stages. For infants, breastfeeding reduces the risk of later obesity. For children and adolescents, encouraging physical activity, limiting screen time, and making healthy foods available helps prevent obesity. For adults, eating more fruits and vegetables, watching portion sizes, balancing calorie intake and output, and making time for physical activity each day can help maintain a healthy weight. The best way to address obesity is through prevention by making lifestyle changes.
This document is a project submitted by Prathik to Rajiv Gandhi University of Health Sciences in partial fulfillment of a Bachelor of Physiotherapy degree. The project is titled "Effects of Diet and Physical Exercise in Obesity" and was conducted under the guidance of Dr. N. Mageswaran. It includes sections on the introduction to obesity, categories and types of obesity, pathophysiology of obesity, diet and exercise effects and guidelines, and a review of literature on the topic.
Worldwide, obesity nearly tripled since 1975, with over 650 million adults and 340 million children classified as obese in 2016. Obesity is defined as abnormal fat accumulation that impairs health, measured as a BMI over 30 for adults and over 2 or 3 standard deviations for children depending on age. The fundamental causes of obesity are an energy imbalance from increased intake of unhealthy foods and decreased physical activity due to sedentary lifestyles. Obesity raises the risk of diseases like heart disease, diabetes, and certain cancers. Reducing obesity involves limiting unhealthy foods, increasing physical activity, and for some, bariatric surgery.
This document discusses obesity and related topics. It defines obesity as abnormal or excessive fat accumulation that presents health risks. It provides BMI classifications for different regions including South East Asia. Key points are that globally obesity rates are rising, and factors influencing obesity are complex, involving genes, environment, behavior, and their interactions. Measuring obesity includes BMI, waist circumference, body fat percentage, and fat distribution. The regulation of energy balance and factors influencing obesity risk are multifaceted.
Obesity is one of the most serious life
threatening health problems of the 21st century
which affects nearly 300 million people
worldwide that in turn would trigger additional
pathologies such as cardiorespiratory
dysfunctions, cancer, gastrointestinal
disturbances, and type2 diabetes mellitus.
Obesity has a multifactorial nature resulting
from genetic, physiological, behavioural, and
environmental factors that lead to an imbalance
between energy intake and expenditure.
However, the key to success in tackling this
problem lies in prevention and this in itself
mandates a rigorous understanding of the
physiology of weight control and the
pathogenesis of obesity. Conventional therapies
such as lifestyle modification (diet and exercise)
recommended as the cornerstone of obesity
management.
1) DPP-4 inhibitors are a class of oral anti-diabetic drugs that work by inhibiting the DPP-4 enzyme and increasing incretin levels.
2) A recent study showed DPP-4 inhibitors provide effective glycemic control with a low risk of hypoglycemia in elderly patients with diabetes.
3) Linagliptin has a unique non-renal elimination pathway and does not require dose adjustment in patients with renal or hepatic impairment.
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
Obesity is defined as excessive accumulation of body fat that occurs when caloric intake exceeds physiological needs. It can be caused by genetic, behavioral, social, and medical factors. Obesity is assessed by measuring body mass index (BMI), body fat percentage, and skin fold thickness. A BMI over 30 indicates obesity and is associated with increased risk of health complications like hypertension, diabetes, heart disease, and stroke. Obesity management involves dietary changes like reducing carbohydrate and fat intake while increasing protein and fiber, regular exercise, psychological counseling, medication, and sometimes surgery.
Obesity in children is on the rise and is caused by multiple factors including unhealthy eating habits, lack of physical activity, and genetic predispositions. Children who consume lots of fast food and junk food high in sugars and fats are at risk, as are those with family histories of obesity. A sedentary lifestyle focused on video games and technology rather than exercise also contributes to weight gain. Obesity can lead to serious health issues for children like diabetes, heart disease, and breathing problems. Parents are encouraged to help kids develop healthy diets and be more physically active through activities the whole family can enjoy.
Obesity is defined as an excessive accumulation of body fat that can damage health. It is caused by an imbalance between calorie intake and expenditure, influenced by a worldwide shift to diets high in fats and sugars but low in nutrients, and more sedentary lifestyles due to jobs and transportation changes. Obesity increases the risk of cardiovascular disease, diabetes, osteoarthritis and some cancers. Childhood obesity is a serious condition where a child is well above the normal weight for their age and height, and can lead to health issues like diabetes and depression. Improving the diet and exercise habits of the whole family is a key strategy to reduce childhood obesity.
this presentation is based on the basic overview of obesity.
in this presentation overview of obesity causes, treatment, prevention is described precisely. this presentation may help in making your assignment and you can also get idea realted to sub headings mention in this presentation related to obesity.
The document discusses obesity and defines it as having too much body fat compared to what is considered healthy. It provides information on body mass index (BMI) and how BMI is used to classify weight categories from underweight to obese. It lists several health risks associated with obesity like diabetes, heart disease, and some cancers. The document gives tips for prevention of obesity like exercising, eating healthy foods, limiting screen time, and reducing stress. It also provides treatment options for obesity including lifestyle changes, medicines, and surgical procedures like gastric bypass.
Belly Fat invites various fatal diseases. So its imp to know why belly fat happened and how can you reduce belly fat effortlessly. See PPT & know whole about the belly fat.
The document summarizes a seminar on obesity in children and adolescents. It discusses definitions of obesity and overweight, prevalence and trends, causes including exogenous factors like poor diet and lack of exercise as well as endogenous genetic and endocrine factors. Complications of childhood obesity discussed include psychological issues, sleep apnea, non-alcoholic fatty liver disease, diabetes, and cardiovascular risks. Screening and normal values for tests to evaluate complications are also presented.
This document discusses obesity, including its definition, classification, causes, health risks, diagnosis, and management. Obesity is defined as excess body fat accumulation that negatively impacts health, and is classified using body mass index (BMI), waist circumference, and waist-to-hip ratio. Causes include genetic, environmental, and behavioral factors. Health risks associated with obesity include increased risk of diabetes, cardiovascular disease, respiratory issues, cancers, and mental health conditions. Treatment involves lifestyle modifications focusing on diet and exercise, as well as potential medication options to help with weight loss.
The document discusses obesity, defining it as excessive body fat over 35% for women and 25% for men. It outlines the health risks of obesity like heart disease, diabetes, and certain cancers. Factors that contribute to obesity are discussed, like overeating high calorie foods, sedentary lifestyles, genetics, and certain medical conditions. Regional fat distribution is important, with abdominal fat posing more risks than lower body fat. The document provides guidelines for measuring obesity through BMI and outlines treatments like diet, exercise and medication or surgery in severe cases.
obesity in children , causes of obesity, approach to children obesity, complication of obesity, obesity definition, how to manage obesity, guidelines in pediatric obesity
The document summarizes information about childhood obesity, including:
- Data from a study showing 644 children categorized as non-obese (85%), overweight (9.1%) or obese (5.9%)
- Definitions of obesity, overweight and BMI measurements
- Factors contributing to rising childhood obesity rates like changes in food environment, lifestyle, and genetics
- Potential endocrine and genetic causes of obesity
- Health risks and recommended tests, diets, and lifestyle interventions to treat obesity
- Obesity rates have tripled globally since 1980 due to increased consumption of energy-dense, processed foods and reduced physical activity. Every fourth person worldwide is now considered overweight or obese.
- Obesity is caused by a complex interplay of genetic, environmental, and behavioral factors. Key contributors include excessive calorie intake, lack of exercise, fast food consumption, and genetic predispositions.
- Maintaining a physically active lifestyle is important for preventing weight gain and fat accumulation over time as metabolism naturally slows with age. Both diet and exercise are needed to effectively treat and prevent obesity on a long-term basis.
This document discusses obesity prevention in infants, children, adolescents, and adults. It provides tips for preventing overweight and obesity at different life stages. For infants, breastfeeding reduces the risk of later obesity. For children and adolescents, encouraging physical activity, limiting screen time, and making healthy foods available helps prevent obesity. For adults, eating more fruits and vegetables, watching portion sizes, balancing calorie intake and output, and making time for physical activity each day can help maintain a healthy weight. The best way to address obesity is through prevention by making lifestyle changes.
This document is a project submitted by Prathik to Rajiv Gandhi University of Health Sciences in partial fulfillment of a Bachelor of Physiotherapy degree. The project is titled "Effects of Diet and Physical Exercise in Obesity" and was conducted under the guidance of Dr. N. Mageswaran. It includes sections on the introduction to obesity, categories and types of obesity, pathophysiology of obesity, diet and exercise effects and guidelines, and a review of literature on the topic.
Worldwide, obesity nearly tripled since 1975, with over 650 million adults and 340 million children classified as obese in 2016. Obesity is defined as abnormal fat accumulation that impairs health, measured as a BMI over 30 for adults and over 2 or 3 standard deviations for children depending on age. The fundamental causes of obesity are an energy imbalance from increased intake of unhealthy foods and decreased physical activity due to sedentary lifestyles. Obesity raises the risk of diseases like heart disease, diabetes, and certain cancers. Reducing obesity involves limiting unhealthy foods, increasing physical activity, and for some, bariatric surgery.
This document discusses obesity and related topics. It defines obesity as abnormal or excessive fat accumulation that presents health risks. It provides BMI classifications for different regions including South East Asia. Key points are that globally obesity rates are rising, and factors influencing obesity are complex, involving genes, environment, behavior, and their interactions. Measuring obesity includes BMI, waist circumference, body fat percentage, and fat distribution. The regulation of energy balance and factors influencing obesity risk are multifaceted.
Obesity is one of the most serious life
threatening health problems of the 21st century
which affects nearly 300 million people
worldwide that in turn would trigger additional
pathologies such as cardiorespiratory
dysfunctions, cancer, gastrointestinal
disturbances, and type2 diabetes mellitus.
Obesity has a multifactorial nature resulting
from genetic, physiological, behavioural, and
environmental factors that lead to an imbalance
between energy intake and expenditure.
However, the key to success in tackling this
problem lies in prevention and this in itself
mandates a rigorous understanding of the
physiology of weight control and the
pathogenesis of obesity. Conventional therapies
such as lifestyle modification (diet and exercise)
recommended as the cornerstone of obesity
management.
1) DPP-4 inhibitors are a class of oral anti-diabetic drugs that work by inhibiting the DPP-4 enzyme and increasing incretin levels.
2) A recent study showed DPP-4 inhibitors provide effective glycemic control with a low risk of hypoglycemia in elderly patients with diabetes.
3) Linagliptin has a unique non-renal elimination pathway and does not require dose adjustment in patients with renal or hepatic impairment.
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
This document summarizes the classification, diagnosis, and pharmacological treatment of diabetes mellitus. It discusses the following key points in 3 sentences:
Type 1 diabetes results from autoimmune destruction of beta cells leading to insulin deficiency. Type 2 diabetes involves progressive loss of insulin secretion against a background of insulin resistance. Gestational diabetes involves any degree of glucose intolerance with onset or first recognition during pregnancy. The document also discusses glycemic targets, criteria for diagnosing diabetes and prediabetes, screening for gestational diabetes, and the pharmacological approaches including metformin, sulfonylureas, GLP-1 receptor agonists, and DPP-4 inhibitors.
This document provides an overview of diabetes mellitus, including its classification, pathogenesis, clinical presentation, complications, diagnosis, management, and acute emergencies. It defines diabetes as a metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion or action. The main types are type 1, type 2, gestational diabetes, and other specific types. Management involves lifestyle modifications including nutrition, physical activity, and medication such as oral hypoglycemic drugs and insulin. Acute emergencies of diabetes that can be life-threatening include diabetic ketoacidosis, hyperglycemic hyperosmolar state, and hypoglycemia.
Impact of patient counseling on diabetes mellitus patients in the territory c...SriramNagarajan17
This study assessed the impact of patient counseling on 80 diabetes patients in Erode district, India over 6 months. After counseling on diet, exercise, medications and lifestyle changes, patients showed improved fasting blood glucose levels, blood pressure, and body mass index. Specifically, fasting blood glucose decreased from 148.40 mg/dl to 128.40 mg/dl. Body mass index and blood pressure also slightly decreased. The results suggest that patient counseling is effective for improving health outcomes for diabetes patients by helping them better manage their condition.
Oral hypoglycemic agents with complicationschotatalha
The document summarizes information about diabetes mellitus and oral hypoglycemic agents. It defines diabetes as a chronic metabolic disease characterized by high blood glucose levels according to WHO. It then provides global facts about the rising prevalence of diabetes. It describes the main types of diabetes - type 1, type 2 and gestational diabetes - and their causes. It discusses the signs, complications and diagnostic criteria for diabetes. Finally, it describes various classes of oral hypoglycemic agents used to treat diabetes, including their mechanisms of action, efficacy, adverse effects and contraindications.
This document provides an overview of diabetes mellitus (DM), including its epidemiology, classification, etiology, clinical features, complications, oral manifestations, diagnostic criteria, investigations, management, and differences between type 1 and type 2 DM. DM is characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It is classified into type 1, type 2, gestational DM, and other types. Clinical features and complications are discussed, along with oral manifestations like periodontal disease and increased risk of infection. Diagnostic testing and treatment focus on glycemic control to prevent microvascular and macrovascular complications.
Firoz ahmad m.sc.bio chemistry ppt daibetic nephropathy copyFirozAhmad30
The document describes a study that induced type 1 diabetes in rats using streptozotocin injections to study the progression of diabetic nephropathy. Rats were divided into normal, diabetic, and diabetic fed a high-fat diet groups. Over 8 weeks, the diabetic and diabetic high-fat diet rats displayed increased blood glucose, water intake, urine output and glomerular mesangial expansion compared to normal rats, indicating the onset and progression of diabetic nephropathy. Streptozotocin successfully induced diabetes in rats and the addition of a high-fat diet exacerbated nephropathy severity.
This document provides an overview of diabetes mellitus (DM), including its anatomy, physiology, epidemiology, classification, diagnosis, complications, and treatment. It discusses the two main types of DM - type 1 caused by beta cell destruction leading to insulin deficiency, and type 2 caused by insulin resistance and impaired insulin secretion. Key facts include that DM affects over 382 million people worldwide, is classified based on etiology, and can be diagnosed through blood glucose and A1C levels. Treatment involves lifestyle changes, glucose-lowering medications like insulin and sulfonylureas, and managing complications to control blood sugar levels.
This document discusses diabetes mellitus and its management. It provides information on:
1) The classification and prevalence of diabetes in Saudi Arabia, finding an overall prevalence of 23.7% with higher rates in males.
2) The diagnostic criteria and thresholds for diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests. Screening is recommended for those over 45 or with risk factors.
3) Treatment involves lifestyle modifications, metformin as first line therapy, and additional oral medications or insulin as needed to achieve glycemic targets. Managing associated cardiovascular risk factors is also emphasized.
diabetes in pregnancy definition and types .pptxVigneshT64
Diabetes in pregnancy can be gestational diabetes or pregestational diabetes. Gestational diabetes is carbohydrate intolerance that begins during pregnancy. Pregestational diabetes includes type 1 and type 2 diabetes that occurs prior to pregnancy. Screening and management of diabetes in pregnancy aims to reduce complications for both mother and baby such as premature delivery, malformations, and growth problems. Treatment involves medical nutrition therapy, blood glucose monitoring, and possibly insulin therapy. After delivery, women with gestational diabetes receive follow-up testing to determine if diabetes persists.
The document presents guidelines from the ADA and EASD on managing hyperglycemia in type 2 diabetes, recommending a patient-centered approach focusing on individualized glycemic targets and treatment options including lifestyle changes, oral medications, and insulin to reduce risks of complications while avoiding hypoglycemia. The pathogenesis of type 2 diabetes involves insulin resistance and defects in insulin secretion, incretin effect, and glucagon secretion leading to hyperglycemia.
This document discusses gestational diabetes mellitus (GDM). It defines GDM as carbohydrate intolerance that begins during pregnancy. Risk factors include obesity, family history of diabetes, and previous GDM. The pathophysiology involves increased insulin resistance due to placental hormones. Left untreated, GDM can lead to complications for both mother and baby, such as preeclampsia and macrosomia. Diagnosis involves glucose screening tests. Treatment focuses on medical nutrition therapy, exercise, and possibly insulin to control blood glucose levels and minimize risks. Close monitoring of mother and baby is important during and after pregnancy.
This document provides information about diabetes mellitus, including its definition, classification, risk factors, diagnostic criteria, clinical presentation, management, complications, and special patient populations. Diabetes is a chronic condition characterized by hyperglycemia due to insulin deficiency or insulin resistance. It is classified into type 1, type 2, and gestational diabetes. Lifestyle modifications including diet and exercise are the primary management approach. Oral medications and insulin therapy may also be used. Complications can include hypoglycemia, retinopathy, nephropathy, neuropathy, and foot ulcers if not properly managed.
The use of vildagliptin in patients with type 2 diabetes with renal impairmentUsama Ragab
The use of vildagliptin in patients with type 2 diabetes with renal impairment
By Dr. Usama Ragab Youssif
Agenda
----------
Case presentation
Diabetes and CKD: What is the problem
Drug treatment in patient with CKD: choice of treatment
Vildagliptin in mild renal impairment
Vildagliptin in moderate and severe renal impairment
Vildagliptin in ESRD (patients on HD)
Vildagliptin in kidney transplant patients with NODAT
Final bottom-line
The document discusses diabetes mellitus (DM), including its classification into types 1 and 2, gestational diabetes, and other types. It covers the anatomy and functions of the pancreas, which produces insulin and digestive enzymes. Diagnostic criteria for DM include hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests. Complications of uncontrolled DM are also mentioned. Treatment involves lifestyle changes, insulin therapy, and managing comorbidities.
This document provides information on a presentation about diabetes mellitus given by Songoma John. It discusses the different types of diabetes, including type 1 diabetes where the body does not produce insulin; type 2 diabetes where cells are resistant to insulin; and gestational diabetes during pregnancy. It describes diabetes symptoms and complications, as well as methods for diagnosing and treating diabetes through diet, exercise, insulin, and oral medications. The goal of treatment is to control blood glucose levels and prevent serious long-term complications.
1) The document discusses the perioperative management of diabetes mellitus, noting the rising global incidence and importance of glycemic control in surgical patients.
2) It provides an overview of the pathophysiology and complications of both type 1 and type 2 diabetes and emphasizes the need for thorough preoperative assessment and optimization of diabetic patients' management.
3) The key goals for perioperative management are to minimize blood glucose fluctuations and avoid both hyperglycemia and hypoglycemia through appropriate insulin and glucose administration via continuous intravenous infusions or other regimens depending on the type, extent, and timing of surgery.
The document discusses diabetes mellitus and insulin secretion and function. It provides details on the classification of diabetes, including type 1, type 2, and gestational diabetes. It also discusses the diagnosis, management through diet, exercise, medication and insulin, and complications of diabetes. Key tests discussed are fasting blood glucose, oral glucose tolerance test, and A1C.
This document discusses asthma and COPD, including key differences and updates. It provides an overview of asthma, describing it as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, and coughing. It also provides an overview of COPD, describing it as a common lung disease associated with exposure to noxious particles or gases. The document reviews epidemiology, pathophysiology, diagnosis, management, and updates from the GINA and GOLD guidelines for both conditions.
Power Point Presentation on Chest X-Ray by Dr Md Main Uddin (MBBS, FCPS), Assistant Professor (Medicine), Cox’s Bazar Medical College, Bangladesh
email -- jawadaug2006@gmail.com
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
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This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
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Diabetes Mellitus
1. DIABETES MELLITUS
Dr Md Main Uddin
MBBS, FCPS
Assistant Professor (Medicine)
Cox’s Bazar Medical College
9/14/2018
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
1
2. DIABETES MELLITUS
• Definition
• Etiopathogenesis
• Presenting problems in DM(C/F)
a) Newly discovered hyperglycemia
b) Long term supervision
c) Acute complication
d) Long term complication
e) DM in special situation
• Investigation
• Treatment
• Follow up
9/14/2018 2
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
3. • Diabetes mellitus is a clinical syndrome
characterised by hyperglycaemia caused by
absolute or relative deficiency of insulin.
• Hyperglycaemia -- microvascular disease, and
in particular diabetic retinopathy.
• Impaired glucose tolerance -- large vessel
disease (e.g. atheroma leading to myocardial
infarction) and with a greater risk of
developing diabetes in future.
9/14/2018 3
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
4. Aetiological classification
Type 1 diabetes
• Immune-mediated
• Idiopathic
Type 2 diabetes
Other specific types
• Genetic defects of β-cell function
• Pancreatic disease (e.g. pancreatitis, fibrocalculous pancreatopathy)
• Excess endogenous production of hormonal antagonists to insulin
• Drug-induced (e.g. corticosteroids)
• Viral infections (e.g. congenital rubella, mumps, Coxsackie virus B)
• Gestational diabetes
9/14/2018 4
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
5. Type 2 diabetes
• Insulin resistance -- Intra-abdominal 'central'
adipose tissue , physical inactivity
• Pancreatic β-cell failure -- deposition of
amyloid
• Genetic predisposition -- Genome-wide
association studies have identified over 65
genes or gene regions that are associated with
type 2 diabetes
9/14/2018 5
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
6. • Environmental and other risk factors
1) Diet and obesity -- overeating, especially
when combined with obesity and
underactivity
2) Age -- middle-aged and elderly
3) Pregnancy -- The term 'gestational diabetes'
refers to hyperglycaemia occurring for the first
time during pregnancy
9/14/2018 6
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
7. Insulin resistance
(metabolic) syndrome
• Hyperinsulinaemia
• Type 2 diabetes or impaired glucose tolerance
• Hypertension
• Low HDL cholesterol; elevated triglycerides
• Central (visceral) obesity
• Microalbuminuria
• Increased fibrinogen
• Increased plasminogen activator inhibitor-1
• Increased C-reactive protein (CRP)
• Elevated plasma uric acid
9/14/2018 7
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
8. Type 1 diabetes
• T cell-mediated autoimmune disease involving
destruction of the insulin-secreting β cells in
the pancreatic islets which takes place over
many years
• Type 1 diabetes is associated with other
autoimmune disorders , including thyroid
disease , coeliac disease , Addison's disease ,
pernicious anaemia and vitiligo.
9/14/2018 8
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
9. • Genetic predisposition -- The HLA haplotypes
DR3 and/or DR4 are associated with increased
susceptibility to type 1 diabetes
• Environmental factors -- reduced exposure to
microorganisms, viral infection
9/14/2018 9
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
10. Investigations
• Blood – Glucose, HbA1C
• Others – When a diagnosis of diabetes is
confirmed, other investigations should include
plasma urea, creatinine and electrolytes,
lipids, liver and thyroid function tests, and
urine testing for ketones, glucose, albumin.
9/14/2018 10
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
11. • Glucose - variation in renal threshold
for glucose, common during pregnancy
and in young people; drugs (such as β-lactam
antibiotics, levodopa and salicylates) may interfere
with urine glucose tests.
• Ketones - fasting or exercising strenuously
for long periods, who have been vomiting repeatedly,
or who have been eating a diet high in fat and low in
carbohydrate
• Albumine - Standard dipstick testing for albumin
detects urinary albumin at concentrations above 300
mg/L
9/14/2018 11
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
12. • The World Health Organization (WHO)
guidelines (2011) introduced the use of HbA1c
for diagnosis of diabetes, with an IFCC HbA1c
of more than 48 mmol/mol also being
diagnostic.
9/14/2018 12
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
13. Newly discovered hyperglycaemia
• Routine biochemical analysis of asymptomatic
patients, during severe illness ('stress
hyperglycaemia'), chronic symptoms, present
as an emergency with acute metabolic
decompensation.
• The key goals are to establish whether the
patient has diabetes, what type of diabetes it
is and how it should be treated.
9/14/2018 13
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
14. Diagnosis of diabetes
Patient complaints of symptoms suggesting diabetes
• Test urine for glucose and ketones
• Measure random or fasting venous blood glucose.
Diagnosis confirmed by:
– Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL)
– Random plasma glucose ≥ 11.1 mmol/L (200 mg/dL)
Indications for oral glucose tolerance test
• Fasting plasma glucose 6.1-7.0 mmol/L (110-126
mg/dL)
• Random plasma glucose 7.8-11.0 mmol/L (140-198
mg/dL)
In asymptomatic patients two samples are required to
confirm diabetes.
9/14/2018 14
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
15. OGTT
Preparation before the test
• Unrestricted carbohydrate diet for 3 days
• Fasted overnight for at least 8 hrs
• Rest for 30 mins
• Remain seated for the duration of the test,
with no smoking
Sampling
• Plasma glucose is measured before and 2 hrs
after a 75 g oral glucose drink
9/14/2018 15
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
16. Fasting 2 hrs after
glucose load
Fasting
hyperglycaemia
6.1-6.9 mmol/L
(110-125 mg/dL)
< 7.8 mmol/L
(< 140 mg/dL)
Impaired glucose
tolerance
< 7.0 mmol/L
(< 126 mg/dL)
7.8-11.0 mmol/L
(140-199 mg/dL)
Diabetes ≥ 7.0 mmol/L
(≥ 126 mg/dL)
≥ 11.1 mmol/L
(≥ 200 mg/dL)
Interpretation (venous plasma glucose)
9/14/2018 16
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
17. Symptoms of hyperglycaemia
• Thirst, dry mouth
• Polyuria
• Nocturia
• Tiredness, fatigue, lethargy
• Noticeable change in weight (usually weight loss)
• Blurring of vision
• Pruritus vulvae, balanitis (genital candidiasis)
• Nausea; headache
• Hyperphagia; predilection for sweet foods
• Mood change, irritability, difficulty in concentrating,
apathy
9/14/2018 17
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
18. • The classical symptoms are prominent in type
1 diabetes, but are often absent in patients
with type 2 diabetes.
• increased susceptibility to infection -- skin
sepsis (boils) or genital candidiasis
Type 2 diabetes
• Central (truncal or abdominal) obesity
• Hypertension is present in at least 50% of
patients with type 2 diabetes.
• Dyslipidaemia
• Non-alcoholic fatty liver disease
9/14/2018 18
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
19. Comparative features of type 1 and
type 2 diabetes
Type 1 Type 2
Typical age at onset < 40 yrs > 50 yrs
Duration of symptoms Weeks Months to years
Body weight Normal or low Obese
Ketonuria Yes No
Rapid death without
treatment with insulin
Yes No
Autoantibodies Yes No
Diabetic complications at
diagnosis
No 25%
Family history of diabetes Uncommon Common
Other autoimmune disease Common Uncommon
9/14/2018 19
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
20. MANAGEMENT OF DIABETES
Diet and lifestyle
• Composition of the diet (diet chart)
• Weight management
• Exercise -- walking, gardening, swimming or
cycling, for approximately 30 minutes daily.
• Alcohol
9/14/2018 20
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
21. Anti-diabetic drugs
OHA
• Biguanides -- Metformin
• Sulphonylureas – Tolbutamide, Chlorpropamide (first-
generation)
Second-generation -- gliclazide and glipizide
• Meglitinides – Repaglinide, Nateglinide
• Alpha-glucosidase inhibitors -- Acarbose
• Thiazolidinediones -- Pioglitazone
• Incretin-based therapies -- sitagliptin, vildagliptin and
saxagliptin
9/14/2018 21
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
22. • Metformin – given with
food, irrespective of body
weight, 1-3 gm/day, 2-3
devided doses.
A/E – GI upset, lactic
acidosis.
• Gliclazide, glimepiride –
nonobese; differences
among these are potency,
duration of action and
cost
9/14/2018 22
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
23. • It should not be used in CKD (GFR below of 30
mL/min).
• Its use is also contraindicated in patients with
impaired hepatic function and in those who drink
alcohol in excess, in whom the risk of lactic acidosis
is significantly increased.
• It should be discontinued, at least temporarily, if any
other serious medical condition develops, especially
one causing severe shock or hypoxia.
Metformin
9/14/2018 23
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
24. Insulin
• Type 1 DM
• Type 2 DM
Severe weight loss
Renal or hepatic disease
In individuals who are hospitalized or acutely ill; e.g.
acute stroke, AMI, septicemia
During major surgery
9/14/2018 24
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
25. • There is little consensus regarding the optimal
insulin regimen in type 2 diabetes, but an
intermediate insulin given at night with
metformin during the day is initially as
effective as multidose insulin regimens in
controlling glucose levels, and is less likely to
promote weight gain.
9/14/2018 25
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
26. • Insulin is usually initiated in a single dose of
long-acting insulin (0.3–0.4 U/kg per day),
given either before breakfast and in the
evening (NPH) or just before bedtime (NPH,
glargine, detemir).
• Metformin is a useful adjunct to insulin in
those able to tolerate it. A second morning
dose of insulin may become necessary to
control postprandial hyperglycaemia.
9/14/2018 26
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
27. • Twice-daily injections of premixed soluble and
isophane insulins (i.e. biphasic isophane
insulin) are widely used and reasonably
effective
• Once-daily insulin glargine showed good
control of blood glucose in one study. More
aggressive treatment, with multiple injections
or continuous infusion pumps, is increasingly
being used in younger patients with type 2
diabetes.
9/14/2018 27
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
28. Insulin
Side-effects of insulin therapy
• Hypoglycaemia
• Weight gain
• Peripheral oedema (insulin treatment causes
salt and water retention in the short term)
• Lipodystrophy at injection sites
9/14/2018 28
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
29. Choice of Initial Glucose-Lowering
Agent
• The level of hyper-glycemia should influence
the initial choice of therapy.
• Assuming maximal benefit of MNT and
increased physical activity has been realized,
patients with mild to moderate hyperglycemia
[FPG <11.1–13.9 mmol/L (200–250 mg/dL)]
often respond well to a single, oral glucose-
lowering agent.
9/14/2018 29
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
30. • Patients with more severe hyperglycemia [FPG
>13.9 mmol/L (250 mg/dL)], a stepwise approach
that starts with a single agent and adds a second
agent to achieve the glycemic target can be used
• Insulin can be used as initial therapy in individuals
with severe hyperglycemia [FPG >13.9–16.7
mmol/L (250–300 mg/dL)] or in those who are
symptomatic from the hyperglycemia.
• Rapid glycemic control with insulin will reduce
"glucose toxicity" to the islet cells, improve
endogenous insulin secretion
9/14/2018 30
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
31. 9/14/2018 31
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
32. 9/14/2018 32
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
33. Long term supervision of DM
How to review a patient in the diabetes clinic
Smoking, Exercise, Alcohol
Body weight and BMI
Blood pressure (130-140/70-
80 mmHg)
Eye examination
• Visual acuities
• Fundoscopy or digital
photography
Lower limbs and feet
• Peripheral pulses
• Tendon reflexes
• Perception of vibration
sensation, light touch
and proprioception
• Ulceration
9/14/2018 33
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
34. Hypoglycaemic episodes
• Number and cause of severe (requiring
assistance for treatment) events and
frequency of mild (self-treated) episodes
• Time of day when 'hypos' are experienced
• Nature and intensity of symptoms
• Ability to identify onset (awareness)
9/14/2018 34
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
35. Urinalysis
• Analyse fasting specimen for glucose, ketones,
albumin
Biochemistry
• Lipid profile and renal, liver and thyroid function
Glycaemic control
• F, 2ABF
• Glycated haemoglobin (HbA1c) (Target 48-58
mmol/mol)
• Inspection of home blood glucose monitoring
record
9/14/2018 35
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
36. Acute complication
• Diabetic ketoacidosis
• Hyperglycaemic hyperosmolar state
• Hypoglycaemia
9/14/2018 36
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
37. • Mortality in DKA is most commonly caused in adults by
hypokalaemia, acute respiratory distress syndrome and
comorbid conditions such as acute myocardial
infarction, sepsis or pneumonia.
• The cardinal biochemical features are:
hyperketonaemia (≥ 3 mmol/L) and ketonuria
(more than 2+ on standard urine sticks)
hyperglycaemia (blood glucose ≥ 11 mmol/L (~200
mg/dL))
metabolic acidosis (venous bicarbonate < 15 mmol/L
and/or venous pH < 7.3).
9/14/2018 37
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
38. Potassium loss
• Osmotic diuresis
• Secondary hyperaldosteronism as a result of
reduced renal perfusion.
• Metabolic acidosis
9/14/2018 38
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
39. Investigations
• Venous blood:
for urea and
electrolytes,
glucose and
bicarbonate
• Urine or blood
analysis for
ketones
• ECG
• Infection screen: full blood count, blood and urine
culture, C-reactive protein, chest X-ray
9/14/2018 39
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
40. 9/14/2018 40
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
41. Hyperglycaemic hyperosmolar state
• Plasma osmolarity =
2[Na+] + [glucose] +
[urea]
• The normal value is
280–290 mmol/L and
consciousness is
impaired when it is
high (> 340 mmol/L),
as commonly occurs in
HHS.
9/14/2018 41
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
42. Hypoglycaemia
• Hypoglycaemia (blood glucose < 3.5 mmol/L
(63 mg/ dL)) in diabetes results in most
circumstances from insulin therapy
• When hypoglycaemia develops in non-diabetic
people, it is called ‘spontaneous’
hypoglycaemia
• Hypoglycaemia is defined as ‘severe’ while
requiring assistance for recovery.
9/14/2018 42
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
43. Hypoglycaemia in
diabetes
Common causes
• Missed, delayed or
inadequate meal
• Unexpected or unusual
exercise
• Alcohol
• Errors in oral anti-diabetic
agent(s) or insulin
dose/schedule/administra
tion
Risk factors for severe hypoglycaemia
• Strict glycaemic control • Impaired awareness of
• Age (very young and elderly) hypoglycaemia
• Long duration of diabetes
9/14/2018 43
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
44. • If the patient fails to
regain consciousness
after blood glucose is
restored to normal,
then cerebral oedema
and other causes of
impaired consciousness
– such as alcohol
intoxication, a post-ictal
state or cerebral
haemorrhage should be
considered.
Cerebral oedema has a high mortality and morbidity, and
requires urgent treatment with mannitol and oxygen.
9/14/2018 44
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
45. 9/14/2018 45
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
Long
term
46. 9/14/2018 46
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
47. Preventing diabetes complications
• Glycaemic control -- No single factor other than
glycaemic control had a significant effect on
outcome.
• Low target HbA1c is appropriate in younger
patients with earlier diabetes who do not have
underlying cardiovascular disease
• Aggressive glucose-lowering is not beneficial in
older patients with long duration of diabetes and
multiple comorbidities.
• Control of other risk factors – ACE inhibitors,
statins
9/14/2018 47
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
48. Diabetic retinopathy
• Diabetic retinopathy (DR) is one of the most
common causes of blindness in adults
between 30 and 65 years of age in developed
countries.
9/14/2018 48
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
49. 9/14/2018 49
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
50. Screening
Management
• Good glycaemic (HbA1c around 7%) control
and an appropriate blood pressure (< 130/80
mmHg) should be maintained to prevent
onset and delay progression of diabetic eye
disease.
• Retinal photocoagulation (laser treatment)
• Monoclonal antibody -- ranibizumab
9/14/2018 50
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
51. Nephropathy
• Microalbuminuria -- ACE or ARB
Neuropathy
• Peripheral nervous system
• Classification
• Management
9/14/2018 51
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
52. Diabetes in pregnancy
• Gestational diabetes is
defined as diabetes
with first onset or
recognition during
pregnancy.
• Women at high risk for
gestational diabetes
should have an oral
glucose tolerance test
at 24–28 weeks
9/14/2018 52
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
53. • Aiming for pre-meal blood glucose levels of less
than 5.5 mmol/L or postmeal blood glucose levels
of less than 7.0 mmol/L
• Metformin or glibenclamide is considered safe to
use in pregnancy.
• Insulin may be required, especially in the later
stages of pregnancy
• Woman should be tested at least 6 weeks post-
partum with an oral glucose tolerance test.
9/14/2018 53
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
54. • A woman with diabetes should, if possible, be
helped to achieve excellent glycaemic control
before becoming pregnant.
• In addition, high-dose folic acid (5 mg, rather
than the usual 400 μg, daily) should be
initiated before conception to reduce the risk
of neural tube defects.
9/14/2018 54
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
55. 9/14/2018 55
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
56. 9/14/2018 56
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
57. • Once a patient’s usual treatment has been
reinstated, care must be taken to continue to
control the blood glucose, ideally between 4
and 10 mmol/L (70–180 mg/dL), in order to
optimise wound healing and recovery.
9/14/2018 57
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College
58. 9/14/2018 58
Dr Md Main Uddin, Assistant Professor
(Medicine), Cox's Bazar Medical College