Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose level caused by either absolute or relative deficiency of insulin. Classifications,sings and symptoms,complications,and prevalence of the disease particularly in Egypt are presented. Management of diabetic patients undergoing oral surgical procedures is discussed.
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.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
DKA
HHS
CASE DISCUSSION
DIABETES COMPLICATION
Hyperglycaemia is the main cause leading to dehydration due to osmotic diuresis which, if severe, results in hyperosmolarity. In HHS, unlike diabetic ketoacidosis, there is no significant ketone production and therefore no severe acidosis.
Hyperosmolarity may increase blood viscosity and the risk of thromboembolism. Factors precipitating HHS are infection, myocardial infarction, poor adherence with medication regimens or medicines which cause diuresis or impair glucose tolerance, for example, glucocorticoids.
This presentation gives an insight to management of diabetic patient with regard to dental treatments or procedures.
It also highlight the major emergencies that arises in treatment of diabetic patient and how to manage such incidences.
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose level caused by either absolute or relative deficiency of insulin. Classifications,sings and symptoms,complications,and prevalence of the disease particularly in Egypt are presented. Management of diabetic patients undergoing oral surgical procedures is discussed.
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.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
DKA
HHS
CASE DISCUSSION
DIABETES COMPLICATION
Hyperglycaemia is the main cause leading to dehydration due to osmotic diuresis which, if severe, results in hyperosmolarity. In HHS, unlike diabetic ketoacidosis, there is no significant ketone production and therefore no severe acidosis.
Hyperosmolarity may increase blood viscosity and the risk of thromboembolism. Factors precipitating HHS are infection, myocardial infarction, poor adherence with medication regimens or medicines which cause diuresis or impair glucose tolerance, for example, glucocorticoids.
This presentation gives an insight to management of diabetic patient with regard to dental treatments or procedures.
It also highlight the major emergencies that arises in treatment of diabetic patient and how to manage such incidences.
Antidepressants and anxiolytics by Dr. Basil TumainiBasil Tumaini
Antidepressants and anxiolytics by Dr. Basil Tumaini, prepared and presented during psychiatry rotation at Muhimbili University of Health and Allied Sciences
Acute inflammatory arthropathies by Dr. Basil TumainiBasil Tumaini
Acute inflammatory arthropathies by Dr. Basil Tumaini, presented in a rheumatology class during the residency in internal medicine at Muhimbili University of Health and Allied Sciences
Physiologic changes in pregnancy by Dr. Basil Tumaini, presented in a physiology class during the residency at Muhimbili University of Health and Allied Sciences
Standardization of rates by Dr. Basil TumainiBasil Tumaini
Standardization of rates by Dr. Basil Tumaini, presented during the residency at Muhimbili University of Health and Allied Sciences, Epidemiology class
A presentation on acute intermittent porphyria, cutaneous, hepatic and erythropoietic porphyrias by dr. basil tumaini during the residency in internal medicine at Muhimbili University of Health and Allied sciences in Dar es Salaam Tanzania
Physical examination: nervous system and cardiovascular systemBasil Tumaini
Physical examination: nervous system and cardiovascular system, prepared by Dr. Basil Tumaini during the residency in internal medicine at Muhimbili University
Peritoneal dialysis by Dr. Basil TumainiBasil Tumaini
Peritoneal dialysis by Dr. Basil Tumaini, prepared for nephrology lecture during the residency in Internal medicine at Muhimbili University of Health and Allied Sciences
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. Clinical presentation and diagnosis
A complete medical history should include:
Symptoms of the disease
Risk factors
Development of complications
Management that has been done
26 July 2011
4. Clinical presentation (2)
Common presenting symptoms of DM include
excess thirst (polydipsia), excess urination
(polyuria), weight loss, fatigue, weakness,
blurred vision, frequent superficial infections,
general itchiness, and poor wound healing.
A complete medical history should be
obtained with special emphasis on weight,
exercise, ethanol use, family history of DM,
and risk factors for cardiovascular disease.
26 July 2011
5. Clinical presentation (3)
In a patient with established DM, assessment of
prior diabetes care, HbA1c levels, self-monitoring
blood glucose results, frequency of
hypoglycemia, and pt’s knowledge about DM
should be obtained.
On physical exam special attention should be
given to retinal exam, orthostatic BP, foot exam
(including vibratory sensation and monofilament
testing), peripheral pulses, and insulin injection
sites.
26 July 2011
6. Clinical presentation (4)
Criteria for the Diagnosis of Diabetes Mellitus:
Symptoms of diabetes plus random blood
glucose concentration 11.1 mmol/L
(200 mg/dl )a or
Fasting plasma glucose 7.0 mmol/L (126
mg/dl)b or
Two-hour plasma glucose 11.1 mmol/L (200
mg/dl) during an oral glucose tolerance testc
26 July 2011
7. Clinical presentation (5)
Acute complications of DM that may be seen on
presentation include:
diabetic ketoacidosis (DKA),
hyperglycemic hyperosmolar state (HHS),
and hypoglycemia.
Chronic complications of DM affect many organ
systems and are responsible for the majority of
morbidity and mortality associated with the
disease.
26 July 2011
8. Chronic complications
1. VASCULAR a. MICROVASCULAR retinopathy
neuropathy
nephropathy
b. MACROVASCULAR coronary artery
disease
peripheral arterial disease
cerebrovascular disease
2. NON VASCULAR gastroparesis
infections
skin changes.
26 July 2011
9. Management (1)
When you are faced with a diabetic Pt,
consider the following:
A newly diagnosed Pt / a known Pt
Has severe symptoms /complications /
asymptomatic
Pt’s weight
Response to previous management
(known Pt)
26 July 2011
10. Management (2)
Management involves one or a combination
of the following:
Non-pharmacological means:
lifestyle changes
surgery
Pharmacological means:
oral hypoglycemic agents
insulin therapy
26 July 2011
11. Management (3)
LIFESTYLE CHANGES
Weight loss of 5 – 10 %.
Reduction in fat intake < 30 % of calories
Reduction in saturated fat intake < 10% of
calories
Increase in fibre intake as in traditional
African diets
26 July 2011
12. Management (4)
LIFESTYLE CHANGES (cont.)
Increase in physical activity levels. This type
of exercise (e.g. brisk walking) should last for
at least 30 min and should be undertaken at
least 3 times a week.
Reduction in high level of alcohol intake to
less than one drink per day of any type.
Stopping smoking
26 July 2011
13. SOME ORAL GLUCOSE LOWERING
AGENTS
NAME OF
DRUG
TABLET SIZE INITIAL
DOSAGE
MAXIMUM
DOSAGE
DURATION
OF ACTIVITY
CONTRAIND
ICATIONS
INSULIN SECRETAGOGUES
sulphonylureas Renal/liver
disease
Glibenclami
de (Daonil®)
5 mg 2.5 mg OD 10 mg BD Up to 24hrs
Chlorpropa
mide(Diabe
nese®)
250 mg 125-250 mg
BD
250 mg BD 60-90 hrs
INSULIN SPARING
biguanides liver disease
Metformin 500 mg 500 mg OD 1000 mg tds 12- 24 hrs
26 July 2011
14. Management (6)
INSULINS AND INSULIN ANALOGUES
INSULIN TYPE ONSET PEAK DURATION
SHORT ACTING
Human soluble
e.g. Actrapid®
s.c. 30-60 min
i.v. 10-30 min
2.5-5 hrs
30-60 min
6-8 hrs
30 min
INTERMEDIATE-
ACTING
Isophane e.g.
Insulatard®,
Lente®
s.c. 2-4 hrs 4-10 hrs 10-24 hrs
26 July 2011
16. Management (8)
• .
26 July 2011
lifestyle changes
Glycemic controlYES
NO
UNDERWEIGHT
YESNO
Add or start low dose SU
and increase 3-monthly
Start low dose of Metformin
and increase 3-monthly
17. Management (9)
26 July 2011
• Start low dose of Metformin
and increase 3-monthly
Add or start low dose SU and
increase 3-monthly
GLYCEMIC
CONTROL
YES
GLYCEMIC
CONTROL
YESNO
NO
Consider admission and
insulin therapy
18. Management (10)
ACUTE METABOLIC COMPLICATIONS OF DM
1. HYPOGLYCEMIA
blood glucose < 3.0 mmol/L
symptoms: hunger, sweating, anxiety,
awareness of heartbeat, headache,
confusion, convulsions, coma
commonest causes: taking more exercise
than usual, delay or omission of a snack or
26 July 2011
19. Management (11)
main meal, poor injection technique, eating
insufficient carbohydrate, overuse of alcohol,
over dosage of SU.
Management:
(a) Conscious Pts:
one carbohydrate exchange for conscious Pt with mild
symptoms (e.g. milk 200 ml, soft drink 200 ml)
two exchanges if neuroglycopenic symptoms
if symptoms persist after 10 min, repeat carbohydrate.
26 July 2011
20. Management (12)
(b) Unconscious Pts:
An IV 50% glucose bolus (40-50 ml) or 20% dextrose
(100-150 ml) followed by 5-10% dextrose if necessary.
Glucagon 1 mg IM can also be administered.
On recovery, give a long acting carbohydrate snack.
prolonged IV dextrose infusion (5-10% for 12-24 hrs)
may be necessary if hypoglycemia is a result of long
acting sulphonylureas/ long and intermediate acting
insulin or alcohol.
If IV access is impossible, consider nasogastric or
rectal glucose or IM glucagon.
26 July 2011
21. Management (13)
On recovery, attempt to identify the cause of
hypoglycemia and correct it.
Assess the type of insulin used, injection sites, and
injection techniques.
Enquire into and correct inappropriate habits of
eating, exercise and alcohol consumption.
Review of other drugs therapy and renal function.
26 July 2011
22. Management (14)
2. DIABETIC KETOACIDOSIS (DKA)
This is a medical emergency.
Occurs in type 1 DM.
Well defined peak at puberty.
Mortality remains up to 5% in the best centres.
Common precipitating factors: infection,
management errors, new cases, idiopathic in
40%.
26 July 2011
23. Management (15)
Pt will: ((a)) Investigations
have elevated blood glucose (check lab. Blood glucose)
have ketones in urine (check urine analysis for ketones)
be dehydrated, 5-10 litres deficient (check urea and
electrolytes)
be acidotic (low pH, low HCO3
- and possible î K+)
be obtunded, semi- or fully comatose.
Also check ABG
Use DKA chart to guide the treatment.
26 July 2011
24. Management (16)
(b) Insulin therapy in DKA
Inject soluble insulin 8 units both IM and IV
at a time.
Then give soluble insulin 8 units IM hourly.
When BG falls to 14 mmol/L or below, give
soluble insulin S.C. 4-hourly OR I.M. 2-hourly
and continue until the Pt is able to eat again
then change to B.D. or T.I.D. insulin
26 July 2011
25. Management (17)
(c) Fluids and electrolytes replacement:
Give 2 L of NS IV stat, then, 1 L of Darrow’s
solution hourly.
When BG falls to 14 mmol/L or below, start
5% dextrose 500 ml 4-hourly (or 1L 8-hourly)
Isotonic dextrose/saline (DNS) can be used in
place of 5% dextrose.
If the Pt is still dehydrated, continue NS or
half strength Darrow’s solution as well.
26 July 2011
26. Management (18)
(d) Correction of acidosis:
With severe acidosis, NaHCO3 50 mmol
should be given under Dr’s instruction.
(e) Monitoring:
Asses CVS for volume overload
Check BG 2-hourly if using IM route, or 4-hourly
if using S.C. route.
26 July 2011
27. Management (19)
3. HHS/ NON-KETOTIC HYPEROSMOLAR COMA
(HONC)
Occurs in type 2 DM
The Pt is very dehydrated and the blood
glucose may be very high.
There is little or no ketosis
Serum osmolality = 2 (Na+K) +
glucose(mmol/L) + urea (mmol/L).
26 July 2011
28. Management (20)
Normal serum osmolality is <310 but for
HONC Pts, it is usually > 330 mosm/L.
Note:
The Pt may be acidotic due to lactic acidosis
secondary to shock/ sepsis, etc.
The principles of management are similar to
those in DKA but IV fluids should be replaced as
half-normal saline (0.45%) if hypernatremia or NS
if serum sodium is normal.
26 July 2011
29. Management (21)
There is frequently an intercurrent illness, usually
sepsis, CVA or cardiac. This must be diagnosed
and treated.
Prophylactic heparin may be used.
26 July 2011