Dr. Zeenat Hussain Foundation is working to create awareness against diseases like diabetes among the common people of Pakistan. This lecture is part of their campaign. The lecture discusses diabetes, including the different types of diabetes, symptoms, complications, diagnosis, management through lifestyle changes and medications, and prevention. Feedback from attendees is appreciated to help improve awareness efforts.
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
Learning objectives:
Understand the definition, causes, symptoms, risk factors of type 1 Diabetes.
Understand the definition, causes, symptoms, risk factors of type 2 Diabetes.
Understand the definition, causes, symptoms of Gestational Diabetes.
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes mellitus -INTRODUCTION,TYPES OF DIABETES MELLITUSvarinder kumar
INTRODUCTION
TYPES OF DIABETES MELLITUS
DIAGNOSE TEST FOR DIABETES MELLITUS
MECHANISM OF ACTION OF INSULIN (IDDM)
HERBAL DRUG TREATMENT FOR DIABETES
LIFESTYLE FOR TYPE 1 AND TYPE 2 DM
NEW ANTI DIABETIC DRUGS
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
These slides content the explanation of what happen in Diabetes Melitus exactly. By learn how it could happen, may it be beneficial and help people in preventing the disease.
Learning objectives:
Understand the definition, causes, symptoms, risk factors of type 1 Diabetes.
Understand the definition, causes, symptoms, risk factors of type 2 Diabetes.
Understand the definition, causes, symptoms of Gestational Diabetes.
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Diabetes Mellitus type 1 major comorbidity now days.
Insulin injection being the major treatment Diabetes Mellitus.
Some other drugs used to treat the Diabetes Mellitus are Tablet Metformin 500 mg and other hypoglycemic drugs.
Diabetes Mellitus and Hypertension how they are interlinked.
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.
With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.
Diabetes mellitus is a disease caused by deficiency or diminished effectiveness of endogenous insulin. It is characterised by hyperglycaemia, deranged metabolism and sequelae predominantly affecting the vasculature.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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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.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Diabetes mellitus
1. Dr. Zeenat Hussain
Foundation
“The ultimate value of life depends upon
awareness and the power of contemplation
rather than upon mere survival.”
Aristotle
Dr. Zeenat Hussain Foundation is working to create
awareness against the diseases among the common people
of Pakistan. This lecture is also a part of this campaign. Your
cooperation and feed back shall be highly appreciated .
3.
Diabetes Mellitus is combination of two latin words
◦ Diabetes means “to flow through”
◦ Mellitus means “honey like”
Diabetes mellitus (DM) is a group of diseases
characterized by high levels of blood glucose resulting from
defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder
of
multiple
aetiology
characterized
by
chronic
hyperglycaemia with disturbances of carbohydrate, fat and
protein metabolism resulting from defects in insulin
secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage,
dysfunction and failure of various organs.
4.
Diabetes mellitus may present with characteristic
symptoms such as thirst, polyuria, blurring of vision, and
weight loss.
In its most severe forms, ketoacidosis or a non–ketotic
hyperosmolar state may develop and lead to stupor, coma
and, in absence of effective treatment, death.
Often symptoms are not severe, or may be absent, and
consequently hyperglycaemia sufficient to cause
pathological and functional changes may be present for a
long time before the diagnosis is made.
5.
The long–term effects of diabetes mellitus include
progressive development of the specific complications
of retinopathy with potential blindness, nephropathy
that may lead to renal failure, and/or neuropathy with
risk of foot ulcers, amputation, Charcot joints, and
features of autonomic dysfunction, including sexual
dysfunction.
People with diabetes are at increased risk of
cardiovascular,
peripheral
vascular
and
cerebrovascular disease.
6.
The development of diabetes is projected to reach pandemic
proportions over the next10-20 years.
International Diabetes Federation (IDF) data indicate that by the
year 2025, the number of people affected will reach 333 million –
90% of these people will have Type 2 diabetes.
In most Western societies, the overall prevalence has reached 46%, and is as high as 10-12% among 60-70-year-old people.
The annual health costs caused by diabetes and its complications
account for around 6-12% of all health-care expenditure.
8. Type
1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes
Other types:
LADA (Latent Autoimmune Diabetes in Adults)
MODY (Maturity-onset diabetes of youth)
Secondary Diabetes Mellitus
9.
Was previously called insulin-dependent diabetes mellitus
(IDDM) or juvenile-onset diabetes.
Type 1 diabetes develops when the body’s immune system
destroys pancreatic beta cells, the only cells in the body that
make the hormone insulin that regulates blood glucose.
This form of diabetes usually strikes children and young adults,
although disease onset can occur at any age.
Type 1 diabetes may account for 5% to 10% of all diagnosed
cases of diabetes.
Risk factors for type 1 diabetes may include autoimmune,
genetic, and environmental factors.
10.
Was previously called non-insulin-dependent diabetes mellitus (NIDDM)
or adult-onset diabetes.
Type 2 diabetes may account for about 90% to 95% of all diagnosed
cases of diabetes.
It usually begins as insulin resistance, a disorder in which the cells do
not use insulin properly. As the need for insulin rises, the pancreas
gradually loses its ability to produce insulin.
Type 2 diabetes is associated with older age, obesity, family history of
diabetes, history of gestational diabetes, impaired glucose metabolism,
physical inactivity, and race/ethnicity.
African Americans, Hispanic/Latino Americans, American Indians, and
some Asian Americans and Native Hawaiians or Other Pacific Islanders
are at particularly high risk for type 2 diabetes.
Type 2 diabetes is increasingly being diagnosed in children and
adolescents.
11.
12.
13.
A form of glucose intolerance that is diagnosed in some women
during pregnancy.
Gestational diabetes occurs more frequently among African
Americans, Hispanic/Latino Americans, and American Indians. It
is also more common among obese women and women with a
family history of diabetes.
During pregnancy, gestational diabetes requires treatment to
normalize maternal blood glucose levels to avoid complications
in the infant.
After pregnancy, 5% to 10% of women with gestational diabetes
are found to have type 2 diabetes.
Women who have had gestational diabetes have a 20% to 50%
chance of developing diabetes in the next 5-10 years.
14.
Other specific types of diabetes result from
specific genetic conditions (such as maturity-onset
diabetes of youth), surgery, drugs, malnutrition,
infections, and other illnesses.
Such types of diabetes may account for 1% to 5%
of all diagnosed cases of diabetes.
15.
Latent Autoimmune Diabetes in Adults (LADA) is a form
of autoimmune (type 1 diabetes ) which is
diagnosed in individuals who are older than the usual
age of onset of type 1 diabetes.
Alternate terms that have been used for "LADA" include
Late-onset Autoimmune Diabetes of Adulthood, "Slow
Onset Type 1" diabetes, and sometimes also "Type 1.5
Often, patients with LADA are mistakenly thought to
have type 2 diabetes , based on their age at the time
of diagnosis.
16.
17.
MODY – Maturity Onset Diabetes of the Young
MODY is a monogenic form of diabetes with an autosomal
dominant mode of inheritance:
◦ Mutations in any one of several transcription factors or in the enzyme
glucokinase lead to insufficient insulin release from pancreatic ß-cells,
causing MODY.
◦ Different subtypes of MODY are identified based on the mutated gene.
Originally, diagnosis of MODY was based on presence of nonketotic hyperglycemia in adolescents or young adults in
conjunction with a family history of diabetes.
However, genetic testing has shown that MODY can occur at
any age and that a family history of diabetes is not always
obvious.
18.
19.
Within MODY, the different subtypes can essentially
be divided into 2 distinct groups: glucokinase MODY
and transcription factor MODY, distinguished by
characteristic phenotypic features and pattern on oral
glucose tolerance testing.
Glucokinase MODY requires no treatment, while
transcription factor MODY (i.e. Hepatocyte nuclear
factor -1alpha) requires low-dose sulfonylurea therapy
and PNDM (caused by Kir6.2 mutation) requires highdose sulfonylurea therapy.
20. Secondary causes of Diabetes mellitus include:
Acromegaly,
Cushing syndrome,
Thyrotoxicosis,
Pheochromocytoma
Chronic pancreatitis,
Cancer
Drug induced hyperglycemia:
◦ Atypical Antipsychotics - Alter receptor binding characteristics, leading to increased insulin
resistance.
◦ Beta-blockers - Inhibit insulin secretion.
◦ Calcium Channel Blockers - Inhibits secretion of insulin by interfering with cytosolic calcium
release.
◦ Corticosteroids - Cause peripheral insulin resistance and gluconeogensis.
◦ Fluoroquinolones - Inhibits insulin secretion by blocking ATP sensitive potassium channels.
◦ Naicin - They cause increased insulin resistance due to increased free fatty acid mobilization.
◦ Phenothiazines - Inhibit insulin secretion.
◦ Protease Inhibitors - Inhibit the conversion of proinsulin to insulin.
◦ Thiazide Diuretics - Inhibit insulin secretion due to hypokalemia. They also cause increased
insulin resistance due to increased free fatty acid mobilization.
21.
Prediabetes is a term used to distinguish people who are at
increased risk of developing diabetes. People with
prediabetes have impaired fasting glucose (IFG) or
impaired glucose tolerance (IGT). Some people may have
both IFG and IGT.
IFG is a condition in which the fasting blood sugar level is
elevated (100 to 125 milligrams per decilitre or mg/dL) after
an overnight fast but is not high enough to be classified as
diabetes.
IGT is a condition in which the blood sugar level is elevated
(140 to 199 mg/dL after a 2-hour oral glucose tolerance
test), but is not high enough to be classified as diabetes.
22.
Progression to diabetes among those with prediabetes is
not inevitable. Studies suggest that weight loss and
increased physical activity among people with
prediabetes prevent or delay diabetes and may return
blood glucose levels to normal.
People with prediabetes are already at increased risk for
other adverse health outcomes such as heart disease
and stroke.
23.
24. Diagnosing Diabetes
Fasting morning venous glucose is the best initial test for
diagnosing diabetes.
An oral glucose tolerance test is reserved for people with
equivocal fasting glucose results.
Patients with impaired glucose tolerance or impaired
fasting glucose benefit from lifestyle intervention and
annual review.
HbA1C is the best test of glycaemic control in diabetes.
Patients with diabetes benefit from aggressive monitoring
and management of all cardiovascular risk factors.
Contents
25.
26. KEY TESTS
TEST OR EXAM
FREQUENCY
Glycated Hb
2x per year
Fundoscopy
1x per year
Foot exam
Quaterly
Lipid profile
1-2 yearly
S-createnine
Yearly
Microalbuminuria
Yearly
Blood pressure
Daily
BMI
Quarterly
ECG
2x per year
27.
Research studies have found that lifestyle changes can
prevent or delay the onset of type 2 diabetes among highrisk adults.
These studies included people with IGT and other high-risk
characteristics for developing diabetes.
Lifestyle interventions included diet and moderate-intensity
physical activity (such as walking for 3 hours each week).
In the Diabetes Prevention Program, a large prevention
study of people at high risk for diabetes, the development
of diabetes was reduced 58% over 3 years.
28.
Studies have shown that medications have been successful in
preventing diabetes in some population groups.
In the Diabetes Prevention Program, people treated with the drug
metformin reduced their risk of developing diabetes by 31% over 3
years.
Treatment with metformin was most effective among younger, heavier
people (those 25-40 years of age who were 50 to 80 pounds
overweight) and less effective among older people and people who
were not as overweight.
Similarly, in the STOP-NIDDM Trial, treatment of people with IGT with
the drug acarbose reduced the risk of developing diabetes by 25% over
3 years.
Other medication studies are ongoing. In addition to preventing
progression from IGT to diabetes, both lifestyle changes and medication
have also been shown to increase the probability of reverting from IGT
to normal glucose tolerance.
31.
Diet is a basic part of management in every case.
Treatment cannot be effective unless adequate
attention is given to ensuring appropriate nutrition.
Dietary treatment should aim at:
◦ ensuring weight control
◦ providing nutritional requirements
◦ allowing good glycaemic control with blood glucose
levels as close to normal as possible
◦ correcting any associated blood lipid abnormalities
32. The following principles are recommended as dietary
guidelines for people with diabetes:
Dietary fat should provide 25-35% of total intake of calories but
saturated fat intake should not exceed 10% of total energy. Cholesterol
consumption should be restricted and limited to 300 mg or less daily.
Protein intake can range between 10-15% total energy (0.8-1 g/kg of
desirable body weight). Requirements increase for children and during
pregnancy. Protein should be derived from both animal and vegetable
sources.
Carbohydrates provide 50-60% of total caloric content of the diet.
Carbohydrates should be complex and high in fibre.
Excessive salt intake is to be avoided. It should be particularly restricted
in people with hypertension and those with nephropathy.
33.
Physical activity promotes weight reduction and
improves insulin sensitivity, thus lowering blood
glucose levels.
Together with dietary treatment, a programme of
regular physical activity and exercise should be
considered for each person. Such a programme must
be tailored to the individual’s health status and fitness.
People should, however, be educated about the
potential risk of hypoglycaemia and how to avoid it.
34.
There are currently four classes of oral antidiabetic agents:
i. Biguanides
ii. Insulin Secretagogues – Sulphonylureas
iii. Insulin Secretagogues – Non-sulphonylureas
iv. α-glucosidase inhibitors
v. Thiazolidinediones (TZDs)
35.
If glycaemic control is not achieved (HbA1c > 6.5%
and/or; FPG > 7.0 mmol/L or; RPG >11.0mmol/L) with
lifestyle modification within 1 –3 months, ORAL ANTIDIABETIC AGENT should be initiated.
In the presence of marked hyperglycaemia in newly
diagnosed symptomatic type 2 diabetes (HbA1c > 8%,
FPG > 11.1 mmol/L, or RPG > 14 mmol/L), oral antidiabetic agents can be considered at the outset
together with lifestyle modification.
36. As first line therapy:
Obese type 2 patients, consider use of metformin, acarbose or TZD.
Non-obese type 2 patients, consider the use of metformin or insulin
secretagogues
Metformin is the drug of choice in overweight/obese patients. TZDs and
acarbose are acceptable alternatives in those who are intolerant to
metformin.
If monotherapy fails, a combination of TZDs, acarbose and metformin is
recommended. If targets are still not achieved, insulin secretagogues
may be added
37. Combination oral agents is indicated in:
Newly diagnosed
HbA1c >10
symptomatic
patients
with
Patients who are not reaching targets after 3
months on monotherapy
38.
If targets have not been reached after optimal dose of combination
therapy for 3 months, consider adding intermediate-acting/long-acting
insulin (BIDS).
Combination of insulin+ oral anti-diabetic agents (BIDS) has been
shown to improve glycaemic control in those not achieving target
despite maximal combination oral anti-diabetic agents.
Combining insulin and the following oral anti-diabetic agents has been
shown to be effective in people with type 2 diabetes:
◦ Biguanide (metformin)
◦ Insulin secretagogues (sulphonylureas)
◦ Insulin sensitizers (TZDs)(the combination of a TZD plus insulin is not an approved
indication)
◦ α-glucosidase inhibitor (acarbose)
Insulin dose can be increased until target FPG is achieved.
41.
In elderly non-obese patients, short acting insulin secretagogues can be
started but long acting Sulphonylureas are to be avoided. Renal function
should be monitored.
Oral anti-diabetic agent s are not recommended for diabetes in pregnancy.
Oral anti-diabetic agents are usually not the first line therapy in diabetes
diagnosed during stress, such as infections. Insulin therapy is
recommended for both the above.
Targets for control are applicable for all age groups. However, in patients
with co-morbidities, targets are individualized.
When indicated, start with a minimal dose of oral anti-diabetic agent, while
reemphasizing diet and physical activity. An appropriate duration of time (216 weeks depending on agents used) between increments should be given
to allow achievement of steady state blood glucose control.
42. Short-term use:
Acute illness, surgery, stress and emergencies
Pregnancy
Breast-feeding
Insulin may be used as initial therapy in type 2 diabetes
in marked hyperglycaemia
Severe metabolic decompensation (diabetic ketoacidosis, hyperosmolar
nonketotic coma, lactic acidosis, severe hypertriglyceridaemia)
Long-term use:
If targets have not been reached after optimal dose of combination
therapy or BIDS, consider change to multi-dose insulin therapy. When
initiating this,insulin secretagogues should be stopped and insulin
sensitisers e.g. Metformin or TZDs, can be continued.
43.
The majority of patients will require more than one daily injection if
good glycaemic control is to be achieved. However, a once-daily
injection of an intermediate acting preparation may be effectively
used in some patients.
Twice-daily mixtures of short- and intermediate-acting insulin is a
commonly used regimen.
In some cases, a mixture of short- and intermediate-acting
insulin may be given in the morning. Further doses of short-acting
insulin are given before lunch and the evening meal and an evening
dose of intermediate-acting insulin is given at bedtime.
Other regimens based on the same principles may be used.
A regimen of multiple injections of short-acting insulin before the main
meals, with an appropriate dose of an intermediate-acting insulin given
at bedtime, may be used, particularly when strict glycaemic control is
mandatory.
44.
45.
46.
Patients should be educated to practice self-care. This
allows the patient to assume responsibility and control
of his / her own diabetes management. Self-care
should include:
◦
◦
◦
◦
◦
◦
◦
Blood glucose monitoring
Body weight monitoring
Foot-care
Personal hygiene
Healthy lifestyle/diet or physical activity
Identify targets for control
Stopping smoking
47.
National Diabetes Fact Sheet 2003, DEPARTMENT OF HEALTH
AND HUMAN SERVICES Centres for Disease Control and Prevention
World Health Organization . Definition, Diagnosis and Classification of
Diabetes Mellitus and its Complications. Report of WHO. Department of
Non-communicable Disease Surveillance. Geneva 1999
Academy of Medicine. Clinical Practice Guidelines. Management of type 2
diabetes mellitus. MOH/P/PAK/87.04(GU), 2004
NHS. Diabetes - insulin initiation - University Hospitals of
Leicester NHS Trust Working in partnership with PCTs across
Leicestershire and Rutland, May 2008.