This document discusses diabetes mellitus, including its increasing prevalence worldwide driven by obesity and reduced activity. It covers the classification, pathogenesis, symptoms, diagnosis and management of both type 1 and type 2 diabetes. Key points include the roles of insulin and insulin resistance in the different types of diabetes, long-term complications involving microvascular and macrovascular damage, and treatment involving lifestyle modifications and medications like metformin, insulin, and other anti-diabetic drugs. Hypoglycemia, ketoacidosis, and other acute complications are also summarized.
Type 2 diabetes results from insulin resistance and beta cell dysfunction. It progresses from normal blood sugar levels to prediabetes to diabetes as insulin resistance and secretion abilities decline. Diagnosis is based on symptoms and elevated fasting blood sugar, oral glucose tolerance tests, or random blood sugar. Treatment goals include an A1C below 7, managing blood pressure and cholesterol, and initially using metformin, sulfonylureas, or TZDs alone or in combination. Later stages may require insulin. Strict control can prevent diabetes complications.
This document provides guidance on the diagnosis, treatment, and management of type 1 diabetes mellitus. It discusses diagnostic criteria including A1C levels and oral glucose tolerance tests. The goals of treatment are outlined as maintaining tight glucose control while avoiding hypoglycemia. Insulin therapy is described as the primary treatment involving multiple daily injections or continuous infusion. Target blood glucose ranges and total daily insulin doses are provided for different age groups. Guidance is also given on managing diabetic ketoacidosis, including precipitating factors, treatment approach involving fluid resuscitation and insulin therapy, and electrolyte monitoring and replacement.
This document discusses types of diabetes, methods for diagnosing diabetes, goals and treatment for diabetes, carbohydrate counting, medication options, dawn phenomenon and Somogyi effect, complications of uncontrolled diabetes, types of insulin and their onsets and durations. It describes type 1 diabetes as insulin deficient, type 2 as insulin resistance, and gestational diabetes criteria. It also lists common high, medium, and low glycemic index foods and provides examples of portions for various food groups in carbohydrate counting.
The document discusses modern methods for treating diabetes mellitus, including the alphabet strategy, management of type 2 diabetes, and nutritional/physical activity principles. It outlines the plan of lecture topics which include the alphabet strategy, type 2 DM management, nutritional care, phytotherapy, physical activity, oral hypoglycemic agents, insulin therapy, insulin pump therapy, and complications of insulin therapy. A clinical case study is also presented of a patient with type 2 diabetes that may require starting an oral antidiabetic agent.
Diabetes mellitus definition,classification,clinical features ,investigationFarrukh Masood
This document defines diabetes mellitus and discusses its classification and clinical features. It begins by defining diabetes as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. It then classifies diabetes into four main types: type 1, type 2, gestational diabetes, and other specific types. The document goes on to describe the clinical features of diabetes and various investigations used to diagnose and monitor the disease, including urine testing, blood glucose levels, glycated hemoglobin, and renal function tests.
Diabetes Mellitus(Past,Present and Future)Vikas Reddy
This is an integrated and evidence based presentation on Diabetes Mellitus covering all the aspects of its pathology,clinical features,classification,complications,diagnosis,treatment and recent advances.
LAB DIAGNOSIS N INVESTIGATION OF DIABETES MELLITUS.madhursejwal
The document outlines the diagnostic criteria for diabetes mellitus, including having a fasting plasma glucose level of 126 mg/dL or higher, symptoms of hyperglycemia with a casual plasma glucose of 200 mg/dL or higher, or a 2 hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also lists the WHO criteria for diagnosing metabolic syndrome which includes having any two of the following: diabetes, high blood pressure, high triglycerides or low HDL cholesterol, central obesity, or insulin resistance. The document notes that microalbuminuria, lipid profiles, electrolytes, lactate, C-peptide levels, and evaluating complications are also important for diagnosis.
This document discusses gestational diabetes, including:
1) Gestational diabetes affects 6-7% of pregnancies and is more common in certain ethnic groups who are also at higher risk of developing type 2 diabetes.
2) It results from insulin resistance and sometimes insulin deficiency during pregnancy and can lead to complications for both mother and baby if not well-controlled.
3) Diagnosis is made through a 3 hour glucose tolerance test showing two abnormal glucose values, with two competing diagnostic criteria currently in use.
4) Treatment focuses on tight glucose control through diet, glucose monitoring, and sometimes insulin to prevent issues like fetal macrosomia and birth complications.
Type 2 diabetes results from insulin resistance and beta cell dysfunction. It progresses from normal blood sugar levels to prediabetes to diabetes as insulin resistance and secretion abilities decline. Diagnosis is based on symptoms and elevated fasting blood sugar, oral glucose tolerance tests, or random blood sugar. Treatment goals include an A1C below 7, managing blood pressure and cholesterol, and initially using metformin, sulfonylureas, or TZDs alone or in combination. Later stages may require insulin. Strict control can prevent diabetes complications.
This document provides guidance on the diagnosis, treatment, and management of type 1 diabetes mellitus. It discusses diagnostic criteria including A1C levels and oral glucose tolerance tests. The goals of treatment are outlined as maintaining tight glucose control while avoiding hypoglycemia. Insulin therapy is described as the primary treatment involving multiple daily injections or continuous infusion. Target blood glucose ranges and total daily insulin doses are provided for different age groups. Guidance is also given on managing diabetic ketoacidosis, including precipitating factors, treatment approach involving fluid resuscitation and insulin therapy, and electrolyte monitoring and replacement.
This document discusses types of diabetes, methods for diagnosing diabetes, goals and treatment for diabetes, carbohydrate counting, medication options, dawn phenomenon and Somogyi effect, complications of uncontrolled diabetes, types of insulin and their onsets and durations. It describes type 1 diabetes as insulin deficient, type 2 as insulin resistance, and gestational diabetes criteria. It also lists common high, medium, and low glycemic index foods and provides examples of portions for various food groups in carbohydrate counting.
The document discusses modern methods for treating diabetes mellitus, including the alphabet strategy, management of type 2 diabetes, and nutritional/physical activity principles. It outlines the plan of lecture topics which include the alphabet strategy, type 2 DM management, nutritional care, phytotherapy, physical activity, oral hypoglycemic agents, insulin therapy, insulin pump therapy, and complications of insulin therapy. A clinical case study is also presented of a patient with type 2 diabetes that may require starting an oral antidiabetic agent.
Diabetes mellitus definition,classification,clinical features ,investigationFarrukh Masood
This document defines diabetes mellitus and discusses its classification and clinical features. It begins by defining diabetes as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or action. It then classifies diabetes into four main types: type 1, type 2, gestational diabetes, and other specific types. The document goes on to describe the clinical features of diabetes and various investigations used to diagnose and monitor the disease, including urine testing, blood glucose levels, glycated hemoglobin, and renal function tests.
Diabetes Mellitus(Past,Present and Future)Vikas Reddy
This is an integrated and evidence based presentation on Diabetes Mellitus covering all the aspects of its pathology,clinical features,classification,complications,diagnosis,treatment and recent advances.
LAB DIAGNOSIS N INVESTIGATION OF DIABETES MELLITUS.madhursejwal
The document outlines the diagnostic criteria for diabetes mellitus, including having a fasting plasma glucose level of 126 mg/dL or higher, symptoms of hyperglycemia with a casual plasma glucose of 200 mg/dL or higher, or a 2 hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also lists the WHO criteria for diagnosing metabolic syndrome which includes having any two of the following: diabetes, high blood pressure, high triglycerides or low HDL cholesterol, central obesity, or insulin resistance. The document notes that microalbuminuria, lipid profiles, electrolytes, lactate, C-peptide levels, and evaluating complications are also important for diagnosis.
This document discusses gestational diabetes, including:
1) Gestational diabetes affects 6-7% of pregnancies and is more common in certain ethnic groups who are also at higher risk of developing type 2 diabetes.
2) It results from insulin resistance and sometimes insulin deficiency during pregnancy and can lead to complications for both mother and baby if not well-controlled.
3) Diagnosis is made through a 3 hour glucose tolerance test showing two abnormal glucose values, with two competing diagnostic criteria currently in use.
4) Treatment focuses on tight glucose control through diet, glucose monitoring, and sometimes insulin to prevent issues like fetal macrosomia and birth complications.
The document discusses the pancreas and its role in producing both digestive enzymes and peptide hormones like insulin, glucagon, and somatostatin. It focuses on the different types of diabetes, their causes and classifications. Type 1 diabetes results from beta cell destruction leading to absolute insulin deficiency. Type 2 diabetes involves insulin resistance and relative insulin deficiency. Gestational diabetes occurs during pregnancy. The roles and mechanisms of insulin and other hormones in regulating blood glucose levels are described.
This document summarizes the pharmacotherapy of diabetes mellitus. It discusses the classification, diagnosis, and pathophysiology of diabetes. It also describes the types of insulin preparations including human insulin, insulin analogs, and their mechanisms of action and indications. The document provides examples of insulin dosing regimens for type 1 diabetes, including an example case of calculating the initial daily insulin dose for a 14-year-old patient presenting with polydipsia, polyuria, and weight loss.
Type 2 diabetes results from insulin resistance and inadequate insulin secretion. It is characterized by hyperglycemia and increases the risk of microvascular and macrovascular complications if poorly controlled. Treatment involves lifestyle modifications and medications to control blood glucose levels and prevent complications. The goals are to eliminate symptoms, prevent complications, and achieve an A1C under 7%. First line treatment is often metformin, while additional drugs may be added if goals are not met.
This document provides an overview of diabetes mellitus (DM), including its pathogenesis, signs and symptoms, diagnostic criteria, complications, and management. It discusses the two main types of DM (type 1 and type 2), their distinguishing characteristics, and the role of insulin in the body. The document outlines microvascular and macrovascular complications of long-term hyperglycemia, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. It also covers diabetic ketoacidosis, risk factors for type 2 DM, and the increased risk of coronary heart disease in diabetic patients.
Update on diabetes treatment strategies 2017Indhu Reddy
This document discusses strategies for treating type 2 diabetes, including lifestyle changes and medication options. It provides guidelines on initiating treatment at diagnosis, individualizing treatment based on patient characteristics, and adjusting therapy over time to achieve glycemic targets. Intensive control is recommended to reduce microvascular and macrovascular complications, though treatment needs to be tailored based on each patient's situation to minimize risks like hypoglycemia. Both oral medications and insulin therapy are covered, along with considerations for renal function.
This document discusses diabetes mellitus (DM), including the different types of DM, symptoms, causes, long-term effects, risk factors, and management strategies. It defines DM as a metabolic disorder characterized by high blood glucose levels due to defects in insulin production or action. The three main types of DM are type 1, type 2, and gestational diabetes. Management involves lifestyle changes like diet and exercise, oral medications, and sometimes insulin therapy, with the goal of controlling blood glucose levels to minimize health complications.
This document summarizes different classes of drugs used to treat diabetes, including their mechanisms of action, effects, clinical applications, pharmacokinetics, and toxicities. The main classes discussed are insulins, sulfonylureas, glitinides, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and incretin-based drugs. Insulins are used to treat type 1 and type 2 diabetes by activating insulin receptors and reducing blood glucose levels. Common side effects include hypoglycemia and weight gain. Sulfonylureas and glitinides are insulin secretagogues used for type 2 diabetes that close potassium channels on beta cells to increase insulin release, while
This document provides an overview of diabetes mellitus, including its classification, pathophysiology, clinical features, investigations, diagnostic criteria, and management. It discusses the different types of diabetes, risk factors, characteristics, and laboratory findings. Type 1 diabetes results from beta cell destruction leading to insulin deficiency, while type 2 involves insulin resistance with relative insulin deficiency. Gestational diabetes occurs during pregnancy.
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
Advances and Management of Diabetes MellitusPratiksha Doke
Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. High blood glucose levels are symptomatic of diabetes mellitus as a consequence of inadequate pancreatic insulin secretion or poor insulin-directed mobilization of glucose by target cells. Diabetes mellitus is aggravated by and associated with metabolic complications that can subsequently lead to premature death. This presentation explores diabetes mellitus in terms of its types, causes and management interventions for improved lifestyle for patient.
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.
Aspirin therapy is reasonable for those with 10-year
CVD risk >10% who are not at increased risk of bleeding
Aspirin therapy is recommended for those with a history of
CVD to reduce the risk of recurrent events
Diabetes Care. 2012 Jan;35 Suppl 1:S11-63
Circulation. 2007;116:e418-e499.
BMJ 2012 Feb 22;344:e874 22
Management Plan
Glycemic control
Goal: HbA1c < 7% for most adults
Lifestyle modification:
Diet and exercise
Or
The document provides an overview of diabetes mellitus, including its classification, pathophysiology, risk factors, symptoms, diagnostic criteria, management through nutrition, exercise, glucose monitoring, drug therapy including insulin and oral hypoglycemic agents, and potential complications. It discusses the different types of diabetes in detail.
RECENT ADVANCES IN THE TREATMENT OF DIABETES MELLITUS AND ITS COMPLICATIONSSANJAY YADAV
This document summarizes recent advances in the treatment of diabetes mellitus and its complications. It discusses the classification and pathogenesis of diabetes as well as its major complications affecting the cardiovascular system, eyes, kidneys, nerves and increased risk of infections. The document also reviews recent oral and injectable medications used to treat diabetes, including newer drug classes such as GLP-1 analogues, DPP-4 inhibitors, SGLT2 inhibitors and amylin analogues. It provides details on specific drugs like exenatide, liraglutide and other GLP-1 receptor agonists that mimic the effects of endogenous GLP-1.
Diabetic drugs is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Type 1 diabetes is characterized by an absolute deficiency of insulin due to the autoimmune destruction of pancreatic beta cells. It typically presents in childhood or early adulthood with symptoms of polyuria, polydipsia, and unexplained weight loss. Treatment involves lifelong insulin replacement therapy via injections to control blood glucose levels and minimize the risk of complications. Rapid-, short-, intermediate-, and long-acting insulin formulations have different onset and duration profiles suited to individual treatment regimens. Strict glycemic control is important to reduce microvascular and macrovascular risks.
This document discusses the management of diabetes including diagnosis, treatment, treatment of complications, and prevention. It covers types of diabetes, oral hypoglycemic agents and insulins used to treat diabetes, and managing complications related to hypertension, nephropathy, coronary heart disease, dyslipidemia, and diabetic foot disease. Lifestyle modifications such as diet, exercise, smoking cessation, foot care, and medication are emphasized for both treatment and prevention of diabetes and its associated health issues.
INSULIN MANAGEMENT OF TYPE 1 DIABETES DR. NEVA JAY
This document discusses insulin management for type 1 diabetes mellitus. It provides information on diabetic ketoacidosis, goals of treatment, criteria for diabetes diagnosis, the treatment team, intensive insulin therapy including different insulin preparations and regimens, goals for blood sugar and HbA1c levels, and home blood glucose monitoring. The standard treatment involves multiple daily insulin injections or insulin pump therapy to closely mimic normal insulin secretion and intensive education to allow patients to lead normal lives.
This document discusses the management of diabetes in pregnancy. It defines diabetes and describes how pregnancy causes insulin resistance and increased insulin demands. It covers screening and diagnosis of gestational and pregestational diabetes. The effects of diabetes and pregnancy on each other are outlined. The goals of management are good glycemic control through diet, exercise, oral medications or insulin as needed. Fetal surveillance and maternal monitoring during pregnancy and delivery are also discussed.
Type 1 diabetes is characterized by a lack of insulin production and requires lifelong insulin treatment. Type 2 diabetes results from insulin resistance and relative lack of insulin and can often be managed through lifestyle changes and oral medications, though some people may eventually require insulin therapy. Gestational diabetes develops during pregnancy and usually resolves after giving birth but increases the risk of developing type 2 diabetes later in life. The main goals of diabetes treatment and management are to control blood glucose levels and minimize the risk of short and long-term complications.
The document discusses the pancreas and its role in producing both digestive enzymes and peptide hormones like insulin, glucagon, and somatostatin. It focuses on the different types of diabetes, their causes and classifications. Type 1 diabetes results from beta cell destruction leading to absolute insulin deficiency. Type 2 diabetes involves insulin resistance and relative insulin deficiency. Gestational diabetes occurs during pregnancy. The roles and mechanisms of insulin and other hormones in regulating blood glucose levels are described.
This document summarizes the pharmacotherapy of diabetes mellitus. It discusses the classification, diagnosis, and pathophysiology of diabetes. It also describes the types of insulin preparations including human insulin, insulin analogs, and their mechanisms of action and indications. The document provides examples of insulin dosing regimens for type 1 diabetes, including an example case of calculating the initial daily insulin dose for a 14-year-old patient presenting with polydipsia, polyuria, and weight loss.
Type 2 diabetes results from insulin resistance and inadequate insulin secretion. It is characterized by hyperglycemia and increases the risk of microvascular and macrovascular complications if poorly controlled. Treatment involves lifestyle modifications and medications to control blood glucose levels and prevent complications. The goals are to eliminate symptoms, prevent complications, and achieve an A1C under 7%. First line treatment is often metformin, while additional drugs may be added if goals are not met.
This document provides an overview of diabetes mellitus (DM), including its pathogenesis, signs and symptoms, diagnostic criteria, complications, and management. It discusses the two main types of DM (type 1 and type 2), their distinguishing characteristics, and the role of insulin in the body. The document outlines microvascular and macrovascular complications of long-term hyperglycemia, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. It also covers diabetic ketoacidosis, risk factors for type 2 DM, and the increased risk of coronary heart disease in diabetic patients.
Update on diabetes treatment strategies 2017Indhu Reddy
This document discusses strategies for treating type 2 diabetes, including lifestyle changes and medication options. It provides guidelines on initiating treatment at diagnosis, individualizing treatment based on patient characteristics, and adjusting therapy over time to achieve glycemic targets. Intensive control is recommended to reduce microvascular and macrovascular complications, though treatment needs to be tailored based on each patient's situation to minimize risks like hypoglycemia. Both oral medications and insulin therapy are covered, along with considerations for renal function.
This document discusses diabetes mellitus (DM), including the different types of DM, symptoms, causes, long-term effects, risk factors, and management strategies. It defines DM as a metabolic disorder characterized by high blood glucose levels due to defects in insulin production or action. The three main types of DM are type 1, type 2, and gestational diabetes. Management involves lifestyle changes like diet and exercise, oral medications, and sometimes insulin therapy, with the goal of controlling blood glucose levels to minimize health complications.
This document summarizes different classes of drugs used to treat diabetes, including their mechanisms of action, effects, clinical applications, pharmacokinetics, and toxicities. The main classes discussed are insulins, sulfonylureas, glitinides, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and incretin-based drugs. Insulins are used to treat type 1 and type 2 diabetes by activating insulin receptors and reducing blood glucose levels. Common side effects include hypoglycemia and weight gain. Sulfonylureas and glitinides are insulin secretagogues used for type 2 diabetes that close potassium channels on beta cells to increase insulin release, while
This document provides an overview of diabetes mellitus, including its classification, pathophysiology, clinical features, investigations, diagnostic criteria, and management. It discusses the different types of diabetes, risk factors, characteristics, and laboratory findings. Type 1 diabetes results from beta cell destruction leading to insulin deficiency, while type 2 involves insulin resistance with relative insulin deficiency. Gestational diabetes occurs during pregnancy.
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
Advances and Management of Diabetes MellitusPratiksha Doke
Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. High blood glucose levels are symptomatic of diabetes mellitus as a consequence of inadequate pancreatic insulin secretion or poor insulin-directed mobilization of glucose by target cells. Diabetes mellitus is aggravated by and associated with metabolic complications that can subsequently lead to premature death. This presentation explores diabetes mellitus in terms of its types, causes and management interventions for improved lifestyle for patient.
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.
Aspirin therapy is reasonable for those with 10-year
CVD risk >10% who are not at increased risk of bleeding
Aspirin therapy is recommended for those with a history of
CVD to reduce the risk of recurrent events
Diabetes Care. 2012 Jan;35 Suppl 1:S11-63
Circulation. 2007;116:e418-e499.
BMJ 2012 Feb 22;344:e874 22
Management Plan
Glycemic control
Goal: HbA1c < 7% for most adults
Lifestyle modification:
Diet and exercise
Or
The document provides an overview of diabetes mellitus, including its classification, pathophysiology, risk factors, symptoms, diagnostic criteria, management through nutrition, exercise, glucose monitoring, drug therapy including insulin and oral hypoglycemic agents, and potential complications. It discusses the different types of diabetes in detail.
RECENT ADVANCES IN THE TREATMENT OF DIABETES MELLITUS AND ITS COMPLICATIONSSANJAY YADAV
This document summarizes recent advances in the treatment of diabetes mellitus and its complications. It discusses the classification and pathogenesis of diabetes as well as its major complications affecting the cardiovascular system, eyes, kidneys, nerves and increased risk of infections. The document also reviews recent oral and injectable medications used to treat diabetes, including newer drug classes such as GLP-1 analogues, DPP-4 inhibitors, SGLT2 inhibitors and amylin analogues. It provides details on specific drugs like exenatide, liraglutide and other GLP-1 receptor agonists that mimic the effects of endogenous GLP-1.
Diabetic drugs is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Type 1 diabetes is characterized by an absolute deficiency of insulin due to the autoimmune destruction of pancreatic beta cells. It typically presents in childhood or early adulthood with symptoms of polyuria, polydipsia, and unexplained weight loss. Treatment involves lifelong insulin replacement therapy via injections to control blood glucose levels and minimize the risk of complications. Rapid-, short-, intermediate-, and long-acting insulin formulations have different onset and duration profiles suited to individual treatment regimens. Strict glycemic control is important to reduce microvascular and macrovascular risks.
This document discusses the management of diabetes including diagnosis, treatment, treatment of complications, and prevention. It covers types of diabetes, oral hypoglycemic agents and insulins used to treat diabetes, and managing complications related to hypertension, nephropathy, coronary heart disease, dyslipidemia, and diabetic foot disease. Lifestyle modifications such as diet, exercise, smoking cessation, foot care, and medication are emphasized for both treatment and prevention of diabetes and its associated health issues.
INSULIN MANAGEMENT OF TYPE 1 DIABETES DR. NEVA JAY
This document discusses insulin management for type 1 diabetes mellitus. It provides information on diabetic ketoacidosis, goals of treatment, criteria for diabetes diagnosis, the treatment team, intensive insulin therapy including different insulin preparations and regimens, goals for blood sugar and HbA1c levels, and home blood glucose monitoring. The standard treatment involves multiple daily insulin injections or insulin pump therapy to closely mimic normal insulin secretion and intensive education to allow patients to lead normal lives.
This document discusses the management of diabetes in pregnancy. It defines diabetes and describes how pregnancy causes insulin resistance and increased insulin demands. It covers screening and diagnosis of gestational and pregestational diabetes. The effects of diabetes and pregnancy on each other are outlined. The goals of management are good glycemic control through diet, exercise, oral medications or insulin as needed. Fetal surveillance and maternal monitoring during pregnancy and delivery are also discussed.
Type 1 diabetes is characterized by a lack of insulin production and requires lifelong insulin treatment. Type 2 diabetes results from insulin resistance and relative lack of insulin and can often be managed through lifestyle changes and oral medications, though some people may eventually require insulin therapy. Gestational diabetes develops during pregnancy and usually resolves after giving birth but increases the risk of developing type 2 diabetes later in life. The main goals of diabetes treatment and management are to control blood glucose levels and minimize the risk of short and long-term complications.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. Risk factors include obesity, family history of diabetes, and prior GDM. Screening involves a glucose challenge test and potential oral glucose tolerance test. Treatment consists of medical nutrition therapy, physical activity, blood glucose monitoring, and possibly insulin therapy to achieve targets. Fetal monitoring is also important given risks of macrosomia, hypoglycemia, and other issues.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
1. Gestational diabetes is characterized by carbohydrate intolerance that begins or is first recognized during pregnancy. It can increase risks for both mother and baby.
2. It is diagnosed through screening tests such as a glucose challenge test and confirmed with an oral glucose tolerance test. Treatment involves diet, exercise, blood sugar monitoring, and possibly insulin.
3. Complications for the mother include preeclampsia and infections. Complications for the baby include hypoglycemia, jaundice, and respiratory distress. Strict control of blood sugar levels can help reduce risks.
1) Gestational diabetes occurs in 3-5% of pregnancies and 90% of women with abnormal glucose tolerance have gestational diabetes. Approximately 50% will later develop type 2 diabetes.
2) Gestational diabetes increases risks for both mother and fetus, including preeclampsia for the mother and fetal macrosomia, hypoglycemia and birth trauma for the fetus.
3) Gestational diabetes is managed primarily through diet and exercise, with insulin therapy if needed to control blood glucose levels and minimize complications. Women with gestational diabetes have increased monitoring during and after pregnancy.
H:\Capp Diabetes In Pregnancy 04 08 3 With Monitoring[1]cslonern
Diabetes in pregnancy affects approximately 4% of pregnancies and increases risks for both mother and fetus if not properly treated. There are three main types of diabetes - Type 1 caused by failure to produce insulin, Type 2 caused by insulin resistance, and gestational diabetes which develops during pregnancy. Untreated diabetes can lead to fetal macrosomia and complications during delivery as well as long term risks for the child like obesity and diabetes. Proper management through diet, exercise, glucose monitoring and insulin therapy when needed can reduce risks to levels equivalent to pregnancies without diabetes.
This is a presentation describing the management principles of a newly diagnosed diabetic patient, including, diet therapy, medical treatment and exercise
The document presents a case study of a 51-year-old Filipino woman diagnosed with type 2 diabetes mellitus and hypertension. Her lab results and physical exam are provided. She is currently taking medications including Glimeperide, Metformin, Pioglitazone, and Nifedepine to manage her conditions. The document also provides general information on diabetes mellitus, including diagnostic criteria, treatment goals, glucose-lowering therapies and nutritional recommendations.
This document provides an overview of diabetes mellitus (DM), including its definition, types, causes, clinical features, diagnosis, treatment, and complications. It discusses the two main types of DM - type 1 caused by autoimmune destruction of beta cells resulting in absolute insulin deficiency, and type 2 caused by multiple factors including genetics, lifestyle, and obesity resulting in insulin resistance. The document outlines the diagnostic criteria and tests for DM, as well as medical management including lifestyle changes, oral hypoglycemic drugs that work via different mechanisms of action, and insulin therapy when other options fail or for severe cases. It concludes by describing the acute and long-term complications of uncontrolled DM.
Type1 diabetes mellitus Final yr MBBS LectureSajjad Sabir
This document provides information on pediatric diabetes mellitus (DM). It discusses that juvenile DM results from absolute lack of insulin and most pediatric patients have type 1 DM requiring lifelong insulin. The causes include progressive loss of islet cell function and insulin resistance. Type 1 DM is insulin dependent and most common in childhood while type 2 DM usually occurs in older children. The management of pediatric DM involves insulin therapy, diet, exercise, blood glucose monitoring, patient education and managing complications like hypoglycemia, diabetic ketoacidosis, and long-term effects.
The document discusses guidelines for managing type 2 diabetes mellitus, including focusing on reducing cardiovascular risks like hypertension and dyslipidemia in addition to blood glucose control. Lifestyle interventions and metformin are recommended first for treating prediabetes/impaired glucose tolerance, while a stepped approach including oral medications and potentially insulin is recommended for treating type 2 diabetes. Treatment goals include achieving an A1C under 7%, blood pressure under 130/80, and LDL cholesterol under 100.
Gestational diabetes mellitus (GDM) is a type of diabetes diagnosed during pregnancy that causes high blood sugar levels. GDM is usually diagnosed between 24-28 weeks of pregnancy through a glucose screening test and can increase the risk of complications for both mother and baby. Women with GDM may need to monitor their blood sugar levels closely and manage the condition through medical nutrition therapy, exercise, oral medications, or insulin to control blood sugar and minimize risks. Proper management of GDM can help lead to healthy outcomes for both mother and baby.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, effects during pregnancy, screening and diagnosis guidelines, management, and fetal surveillance. GDM is glucose intolerance that begins during pregnancy and usually resolves after delivery. It increases risks for both mother and baby, so screening and treatment are important. Guidelines recommend screening all pregnant women for GDM, and treating it with medical nutrition therapy, exercise and possibly insulin to control blood glucose levels if needed. Close fetal monitoring is also recommended during pregnancy.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
Diabetes mellitus complete Disorder Exclusively for Nursing Students Baljinder Singh
This document discusses diabetes mellitus, a metabolic disorder characterized by high blood sugar levels resulting from defects in insulin production or insulin action. There are three main types of diabetes: type 1 caused by lack of insulin production; type 2 caused by insulin resistance; and gestational diabetes during pregnancy. Risk factors include family history, age, obesity, and physical inactivity. Symptoms include frequent urination, increased thirst and hunger. Diagnosis involves blood and urine tests. Treatment depends on diabetes type but may include medications to increase insulin production/sensitivity, insulin injections, diet control, exercise, blood sugar monitoring and management of complications which can include kidney disease, vision loss and heart disease if uncontrolled.
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
This document provides guidance on managing diabetes in the hospital setting. It covers diagnosing diabetes, distinguishing between type 1 and type 2, managing newly diagnosed patients, established diabetes, and diabetic emergencies. It discusses insulin regimens, sliding scales, sick day rules, ketoacidosis, and the hyperosmolar state. The goal is to provide healthcare workers with the knowledge to properly diagnose, treat, and manage diabetes and its complications in hospitalized patients.
There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where there is resistance to insulin; and gestational diabetes during pregnancy. Diabetes is caused by high blood sugar levels and symptoms include increased thirst and urination. It is diagnosed through blood tests and managed through lifestyle changes like diet, exercise, and sometimes medication or insulin depending on the type. Complications can affect the feet, eyes, kidneys, heart and nerves if blood sugar levels are not well controlled. Proper foot care and blood glucose monitoring are important for diabetes management and prevention of complications.
Diabetes Mellitus in pregnancy " Gestational diabetes mellitus''Nassr ALBarhi
This document discusses a case of gestational diabetes in a 24-year-old pregnant woman. It defines gestational diabetes as glucose intolerance that develops during pregnancy. Risk factors, diagnostic tests such as OGTT, management including diet, exercise and insulin therapy if needed, and maternal and fetal complications of gestational diabetes are described. The goals of antepartum care including fetal surveillance to minimize risks are also mentioned.
Urinary tract infections (UTIs) are very common, especially in bedridden patients. UTIs can affect the lower urinary tract (urethra, bladder) or upper tract (kidneys, ureters). Symptoms range from asymptomatic bacteriuria to systemic symptoms like fever. Risk factors include female sex, age, pregnancy, sexual activity, and anatomical or functional abnormalities of the urinary tract. Treatment involves antibiotics, with drug and duration depending on infection severity and location. Catheter use increases risk and they should be inserted aseptically and changed if malfunctioning to prevent UTIs.
This document discusses upper gastrointestinal (UGI) symptoms including dysphagia, dyspepsia/heartburn, and nausea & vomiting. It provides details on the pathophysiology, causes, evaluation, and treatment of each condition. Dysphagia can be mechanical or motor in origin and caused by issues like esophagitis or achalasia. Dyspepsia is mostly functional but can be due to conditions like GERD. Nausea and vomiting are mediated by brain centers and receptors that can be stimulated by infections, medications, or other visceral issues. Treatment involves addressing the underlying cause, rehydration, and antiemetics as appropriate for the condition.
Sexually transmitted disease and pelvic inflammatory diseasePuneet Shukla
This document discusses sexually transmitted infections (STIs), their causes, symptoms, treatments, and prevention. It covers bacterial STIs like gonorrhea, chlamydia, and syphilis. It also mentions viral STIs like HIV, HPV, and HSV. Protozoal STIs discussed include trichomoniasis. The document further describes pelvic inflammatory disease (PID) as an inflammation of the uterus, fallopian tubes or ovaries often caused by untreated STIs. PID is a leading cause of infertility, with a single episode causing infertility in around 13% of women. Prevention methods mentioned include abstinence, condom use, vaccination against HBV and HPV, and timely evaluation and treatment of ST
This document discusses the rational use of antibiotics. It notes that 50% of antibiotics are used inappropriately and that many infections like diarrhea and bronchitis are viral, not bacterial. It provides details on selecting antibiotics based on the infection severity, likely bacteria, patient factors, and cost. Empiric antibiotic choices are outlined for various infections. The side effects and costs of common antibiotics are also reviewed. The document emphasizes using antibiotics appropriately only for bacterial infections.
Peptic ulcer disease is caused by Helicobacter pylori infection in about 60% of stomach ulcers and 90% of duodenal ulcers. Symptoms include epigastric or retrosternal pain associated with meals. Treatment involves stopping NSAIDs, taking a PPI or H2RB to heal 90% of ulcers, and treating any H. pylori infection with a PPI and antibiotics. Complications include bleeding, perforation, penetration into adjacent organs, and gastric outlet obstruction.
This document summarizes pulmonary function tests, which are used to evaluate respiratory mechanics and gas exchange. Spirometry and tests of diffusing capacity are described. Spirometry measures volumes like forced vital capacity and flows like forced expiratory volume in 1 second. Pattern recognition can identify obstructive or restrictive lung disease. Diffusing capacity evaluates pulmonary vascular function and gas exchange. Arterial blood gases directly measure oxygen and carbon dioxide levels to diagnose hypoxemia and hypoventilation.
This document discusses liver function tests and how to evaluate liver disease patterns. It outlines the clinical presentation of hepatocellular and cholestatic liver disease. Key investigations covered include liver enzymes, bilirubin, albumin, clotting factors and their significance. Imaging modalities like ultrasound, CT and MRI are also mentioned. The patterns of hepatocellular vs obstructive liver disease are compared in terms of symptoms, enzyme levels and imaging findings.
Interstitial and occupational lung diseasePuneet Shukla
This document summarizes interstitial lung disease (ILD) and occupational lung disease. ILD is characterized by diffuse involvement of the interstitium and includes idiopathic pulmonary fibrosis. Occupational lung disease results from inhalation of noxious substances at work and includes pneumoconiosis like coal worker's pneumoconiosis, silicosis, and asbestosis. Diagnosis involves clinical evaluation, imaging like chest X-ray and HRCT, and may include procedures like bronchoscopy and biopsy. Treatment depends on underlying cause but often includes avoiding further exposure and supplemental oxygen.
Irritable bowel syndrome (IBS) is a functional bowel disorder that is common, affecting around 20% of patients presenting to outpatient departments. IBS symptoms are not due to any underlying pathological cause, but rather are influenced by factors like altered gut motility or secretion in response to stimuli, hypersensitivity of the gut, and dysregulation of the brain-gut axis associated with greater stress reactivity. Diagnosis is based on Rome II criteria of abdominal pain relieved by defecation and changes in stool frequency or form occurring for at least 3 days per month over the past 3 months. Treatment focuses on education, diet, exercise, antispasmodics, laxatives, antidepressants, and psychotherapy depending on
Upper GI bleed occurs proximal to the ligament of Treitz, while lower GI bleed occurs distal to it. Acute upper GI bleeding causes hematemesis or melena, while lower GI bleeding presents as hematochezia. In the ER, management of acute GI bleeding involves stabilizing ABCs, administering IV fluids and blood products, and performing tests like CBC, INR, and UGI endoscopy once stabilized. Later management may include identifying the bleeding source, treating with drugs like PPIs or vasopressors, or pursuing interventions like TIPS or surgery if bleeding persists. Obscure GI bleeding has no identified source on initial endoscopy and workup may involve repeated endoscopy, capsule end
The document discusses the basics of electrocardiography including the electrical conduction system of the heart, the placement of ECG leads, components of the ECG waveform, and how to interpret key aspects of the ECG such as heart rate, rhythm, intervals, and complexes. It also summarizes the most common arrhythmias like bradycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia, as well as their typical treatments with medications, cardioversion, ablation, or pacemaker implantation.
Deep vein thrombosis and pulmonary thromboembolismPuneet Shukla
This document discusses deep vein thrombosis (DVT) and pulmonary embolism (PE). It covers the definition and risk factors of DVT, signs and symptoms, diagnosis, treatment including anticoagulation options, prevention of DVT and PE, and potential complications like post-phlebitic syndrome. It also discusses the definition, risk factors, signs, symptoms, diagnosis and treatment of PE.
Diphtheria is caused by Corynebacterium diphtheriae and presents with a sore throat and formation of a gray membrane in the throat. Pertussis or whooping cough is caused by Bordetella pertussis and presents in three stages including coughing fits. Tetanus is caused by Clostridium tetani spores entering wounds and producing a neurotoxin resulting in painful muscle spasms. Vaccines exist to protect against all three diseases.
COPD is the 6th leading cause of death worldwide characterized by narrowing of airways. The two main types are chronic bronchitis, causing inflammation and fibrosis of airways, and emphysema, causing enlargement of airspaces. Smoking is the primary cause. Diagnosis involves spirometry showing reduced FEV1. Treatment focuses on smoking cessation, bronchodilators, steroids, oxygen therapy, and managing exacerbations.
HIV/AIDS is caused by infection with HIV which damages immune cells. There are 33.2 million people living with HIV/AIDS globally. HIV is transmitted through contact with infected bodily fluids. The progression of HIV to AIDS typically takes 9-10 years if untreated, during which time the virus progressively destroys CD4+ immune cells. This leaves individuals vulnerable to opportunistic infections like PCP, TB, and cancers like Kaposi's sarcoma. Highly Active Antiretroviral Therapy (HAART) using a combination of at least three antiretroviral drugs from two classes can suppress the virus and prolong healthy life. Proper treatment and prevention measures can control the spread of the virus.
This document provides guidance on performing an abdominal examination. It outlines important components of history to obtain including symptoms like dyspepsia, dysphagia, and altered bowel habits. The examination involves inspecting the abdomen and specific regions, palpating the abdomen and organs like the liver and spleen, performing percussion, and auscultating bowel sounds. Specific techniques for examining each organ are described along with signs to note. The full examination is supported by additional tests as needed.
This document discusses acid-base homeostasis and disorders. It defines normal acid-base parameters and describes the body's response through buffering, lungs, and kidneys. It outlines the approach to evaluating acid-base disorders including initial assessment, acid-base diagnosis using arterial blood gases and electrolytes, identifying compensation, and formulating a diagnosis. Several examples are provided to demonstrate the systematic evaluation and diagnosis of mixed acid-base disorders.
This document discusses various causes of acute infectious diarrhea including food poisoning caused by Staphylococcus aureus and Bacillus cereus producing preformed exotoxins as well as viral and bacterial pathogens like rotavirus, ETEC, and Vibrio cholerae producing enterotoxins. Evaluation involves assessing duration of symptoms, stool characteristics, and signs of dehydration or inflammation. Management consists of oral rehydration with solutions like ORS, antiemetics, antibiotics for invasive causes, and prevention through hygiene and vaccination. Specific conditions discussed in more detail include cholera, E. coli pathotypes, Salmonella Typhi causing typhoid fever, and constituents of ORS.
Acute renal failure, also known as acute kidney injury, is a sudden decrease in renal function over a period of less than 48 hours resulting in the inability to excrete waste and maintain fluid and electrolyte balance. It is commonly seen in 30% of ICU admissions and 5% of hospital admissions, and develops in around 25% of inpatients. Acute renal failure can be classified as pre-renal (decreased renal perfusion), renal (acute tubular necrosis, acute interstitial nephritis, acute glomerulonephritis), or post-renal (obstruction of the urinary tract). The most common cause is pre-renal acute renal failure due to conditions that decrease intravascular volume or
Acute rheumatic fever is an inflammatory disease that occurs 2-3 weeks following a group A streptococcal infection, due to antigenic similarities between the bacteria and heart tissues. It is most common in children ages 5-15. The pathogenesis involves an autoimmune response triggered by the streptococcal infection. If left untreated, recurrent streptococcal infections increase the risk of further acute rheumatic fever episodes and the development of rheumatic heart disease. Diagnosis is based on modified Jones criteria requiring evidence of prior streptococcal infection and either two major or one major and two minor clinical manifestations, which may include arthritis, carditis, subcutaneous nodules, and Sydenham's chorea. Treatment involves
2. Epidemiology
Worldwide- 30 million patients in 1985, 177 million in 2000,
>360 million by 2030 (projected)- mostly in developing nations
In US in 2008- 24 million with DM & 57 million with pre-diabetes
Predicted lifetime risk of DM- 1 in 3 Americans born after 2000
Prevalence ~7% in US (1 in 14)
Prevalence increases with age-
Age <20- 0.22%
Age >20- 9.6%- ~1 in 10
Age >60- 20.9%- ~1 in 5
5th
leading cause of death, responsible for ~3 million deaths per
year
3. Insulin
An anabolic peptide hormone
Secreted by beta cells of pancreas
Actions-
Decrease liver glucose production
Increase glycogen synthesis
Promote glucose transport into muscle/fat (GLUT-4)
Inhibit lipolysis, promote lipogenesis
Inhibit protein catabolism, promote protein synthesis
20. Practical drug use
Dx of Type 2 DM
Lifestyle changes
+Metformin
+sulfonylurea or glitazone or gliptin
+glitazone or gliptin or sulfonylurea
+NPH Insulin once/twice a day
+regular Insulin before each meal
21. Monitoring glucose control
HbA1c- every 3 months
Self-monitoring of blood glucose-
ideal, but impractical, specially in T2DM
Random/planned checking of FBG/PPBG
Beware of HYPOGLYCEMIA
22. T1DM T2DM
Onset <30 years
Obesity uncommon
Very low Insulin level
Twin concordance:
<50%
Asso. With HLA-D Ags.
Autoantibodies +nt
Mostly symptomatic
Rx- Insulin
Onset >30 years
Obesity common
Insulin- variable
Twin concordance:
>90%
No HLA association
No autoantibodies
Mostly asymptomatic
Rx- OHAInsulin
23. Management of prediabetes
Modest weight loss- 5-7%
Regular physical activity
(30 mins x 5 days/week)
Drugs- metformin, acarbose, rosiglitazone
24. Syndrome X
Metabolic-
IFG- >100 mg%
Central obesity- WC-
>102/90-M, >88/80-F
HT- >130/85 mm Hg
TG- >150 mg%
HDL-C- <40-M, <50-F
Prevalence ~20-33%
Increases R/O CVD
Cardiac-
Angina
Abnormal stress test
Normal cor. Angiogram
More in females
Commonly associated
with metabolic
Syndrome X
25. Diabetes and pregnancy
Good glycemic control (target HbA1c <6.1%),
before conception and during pregnancy
HbA1c >10%- avoid pregnancy
Monitor weight gain and blood pressure
SMBG
Safe anti-diabetics-
Insulin, Metformin, Glibenclamide
Stop ACEI, statins, other anti-diabetics
Check for retinopathy and nephropathy
26. Gestational DM
OGTT at 24-28 weeks
Diagnostic criteria- 75 gm. oral glucose
Fasting- >95 mg%
1 hour post-glucose- >180 mg%
2 hour post-glucose- >155 mg%
Risk factors- OGTT at 16-18 weeks
Age >25 years
BMI >25
F/H of DM
h/o IFG/IGT, PCOD, bad obstretic history, previous GDM,
delivery of baby >4 kgs
27. Management of GDM
Diet
Exercise
SMBG
Target- FBG- 60-100, 1-hr PPBG-<140
Avoid hypoglycemia
Ultrasound at 18-20 weeks for congenital
malformation
US every 4 weeks from 28th
-36th
week for fetal
growth and amniotic fluid volume
Delivery after 38 weeks (normal/LSCS)
32. DKA- management
IV fluids- average fluid deficit is 4-5 liters
NS- raise BP, ensure adequate urine output
½ NS- normal BP, adequate UO
DNS- BG ~250 mg%
IV Insulin
0.1 U/kg bolus, followed by
0.1 U/kg/hour infusion continued till anion gap normalizes & no
ketones in blood/urine
Manage potassium
Initial hyperkalemia due to acidosisextracellular shift
Correction of acidosis & Insulin shift K in to cells
Monitor & replace K frequently
33. Hyperosmolar coma
Acute complication, mostly of T2DM
Mortality- ~50%
Characterised by hyperglycemia, dehydration,
hyperosmolar plasma, altered sensorium
No ketosis, because Insulin present prevents
ketogenesis
Dx- hyperglycemia, increased serum
osmolarity
With raised BUN/Cr, hypo/hyper-natremia,
normal/mildly low K, mild lactic acidosis
34. Hyperosmolar coma- Rx
IV fluids- average deficit ~10 liters
NS- raise BP, adequate urine output
½ NS- when BP normalizes
IV Insulin
0.1 U/kg IV bolus, then
0.1 U/kg/hr infusion till BG~200 mg%, then
1-2 U/hr infusion till complete rehydration
Correction of hypokalemia
40 mEq/hr for K<3.3 mEq/L, then
20-30 mEq/hr for K 3.3-5.0 mEq/L
35. Hypertension
~25% of T1DM & ~50% of T2DM
patients have HT
HT accelerates chronic complications of
diabetes
Target BP- 130/80 mm Hg in diabetics
Preferable anti-HTive- ACEI/ARB
Individualize HT Rx according to
comorbidities
36. Lipid management
Dyslipidemia worsens cardiovascular
complications of DM
Goals- LDL- <70, HDL- M>40; F>50, TG
<150
Lifestyle modifications- diet, exercise,
smoking
Statins are Rx of choice
Fibrates (fenofibrate) for raised TG
Niacin/nicotinic acid for low HDL
Aspirin for primary prophylaxis of CAD
39. Diabetic retinopathy
A major cause of blindness
Over lifetime 70% of IDDM will develop
PDR & 40% will have macular edema
Mostly asymptomatic
Regular monitoring required for timely
detection
Rx- LASER
Prevention- good glycemic control
40. Diabetic nephropathy
Leading cause of ESRD
AlbuminuriaHTCRIESRD
40% of IDDM have ESRD after 20 yrs.
Earliest finding of microalbuminuria-
30-300 mg albumin
excretion/24hours
Pathology- glomerulosclerosis-
thickened GBM & mesangial expansion
41. Diabetic nephropathy
Prevention-
Monitoring & control of BS & BP
Prompt Rx of UTI
Avoid potentially nephrotoxic drugs/dyes
Rx-
Aggressively monitor & treat BP- target <130/80
Limit dietary protein intake- <0.8 mg/kg/day
Good glycemic control- using Insulin
Rx other urinary problems
Early RRT- dialysis/transplantation
43. Diabetic neuropathy
Monitor for s/s
Good glycemic control
Foot care- avoid trauma, good footwear
Painful neuropathy- amitriptyline,
carbamazepine, gabapentin, pregabalin
Other problems- symptomatic treatment
44. Cardiovascular disease
Leading cause of morbidity & mortality in
diabetics
Risk 2-3 times greater in diabetics
Risk equal in women with diabetes
Risk factors-
Poorly controlled DM
Smoking
HT
Hyperlipidemia
46. Foot problems in diabetics
DM is leading cause of amputation
Due to peripheral neuropathy, PVD &
increased infections
Needs-
Good glycemic control
Quit smoking
Early detection of neuropathy
Proper footcare & footwear
Correct deformities, other surgeries as required