This document provides information on diabetes mellitus (DM), including its classification, pathophysiology, risk factors, clinical presentation, treatment, and management. It discusses the two main types of DM - type 1 characterized by insulin deficiency and type 2 resulting from insulin resistance and relative insulin deficiency. Treatment involves lifestyle modifications, glucose monitoring, and medications like insulin, sulfonylureas, and metformin to control blood glucose levels and prevent complications.
The document summarizes several classes of cardiovascular drugs used to treat conditions like hypertension and heart failure. It discusses the mechanisms of action, therapeutic effects, side effects and nursing considerations for drugs from classes like diuretics, beta blockers, calcium channel blockers, ACE inhibitors, ARBs, and cardiac glycosides like digoxin. The document provides an overview of how these drugs work and how they are used to treat various cardiac conditions.
Diabetes Mellitus Type 2 is a heterogeneous group of disorders characterized by elevated blood glucose levels. It occurs when the body becomes resistant to insulin or cannot produce enough insulin. Symptoms include frequent urination, excessive thirst, and unexplained weight loss. Risk factors include family history, obesity, hypertension, and sedentary lifestyle. Treatment involves diet, oral medications, insulin injections, blood glucose monitoring, and preventative foot and eye care to reduce complications which can include cardiovascular, kidney, nerve and foot problems. Non-pharmacological interventions like diet, exercise, weight control, and smoking cessation can also help manage the condition.
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
The document discusses diabetes mellitus and the role of insulin in the body. It defines diabetes as a group of metabolic diseases caused by defects in insulin production or insulin action that results in high blood glucose. Insulin regulates blood glucose levels by signaling the liver, muscles and fat cells to absorb glucose from the blood. The document outlines the different types of diabetes including Type 1, Type 2, gestational diabetes and prediabetes. It discusses the signs and symptoms of diabetes and diagnostic tests used to diagnose the condition.
Type 2 diabetes is a chronic metabolic disease characterized by high blood glucose levels resulting from defects in insulin secretion and insulin action. The document provides an overview of type 2 diabetes, including its causes, risk factors, pathophysiology, clinical presentation, diagnosis, management through diet, exercise and oral hypoglycemic agents. It also discusses the classification, epidemiology and complications of diabetes as well as the role of insulin and pancreatic function in glucose homeostasis.
Diabetes is a group of metabolic diseases characterized by high blood sugar levels. There are several types of diabetes including type 1 caused by the immune system destroying insulin-producing cells, type 2 caused by insulin resistance or lack of insulin production, and gestational diabetes during pregnancy. Symptoms include increased thirst, hunger, urination and fatigue. Diabetes is treated through medicines, diet, exercise and controlling blood sugar, blood pressure and cholesterol to reduce complications like kidney disease, eye disease and heart attack. Diabetes affects quality of life and has a significant societal impact through its associated healthcare costs and disability.
Telmisartan is a new angiotensin receptor blocker (ARB) that has several potential advantages over other ARBs. It has the strongest binding affinity to the AT1 receptor compared to other ARBs. This may provide stronger and longer-lasting blood pressure lowering effects. Telmisartan also has partial agonist effects on peroxisome proliferator-activated receptor gamma, which can improve insulin resistance and exert anti-inflammatory and anti-proliferative effects in the vasculature. Studies in animals and cells suggest Telmisartan may have insulin sensitizing effects and protect against diabetic complications by blocking upregulation of VEGF and AGE-RAGE protein expression in the retina. While more randomized clinical trials
The document summarizes several classes of cardiovascular drugs used to treat conditions like hypertension and heart failure. It discusses the mechanisms of action, therapeutic effects, side effects and nursing considerations for drugs from classes like diuretics, beta blockers, calcium channel blockers, ACE inhibitors, ARBs, and cardiac glycosides like digoxin. The document provides an overview of how these drugs work and how they are used to treat various cardiac conditions.
Diabetes Mellitus Type 2 is a heterogeneous group of disorders characterized by elevated blood glucose levels. It occurs when the body becomes resistant to insulin or cannot produce enough insulin. Symptoms include frequent urination, excessive thirst, and unexplained weight loss. Risk factors include family history, obesity, hypertension, and sedentary lifestyle. Treatment involves diet, oral medications, insulin injections, blood glucose monitoring, and preventative foot and eye care to reduce complications which can include cardiovascular, kidney, nerve and foot problems. Non-pharmacological interventions like diet, exercise, weight control, and smoking cessation can also help manage the condition.
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
The document discusses diabetes mellitus and the role of insulin in the body. It defines diabetes as a group of metabolic diseases caused by defects in insulin production or insulin action that results in high blood glucose. Insulin regulates blood glucose levels by signaling the liver, muscles and fat cells to absorb glucose from the blood. The document outlines the different types of diabetes including Type 1, Type 2, gestational diabetes and prediabetes. It discusses the signs and symptoms of diabetes and diagnostic tests used to diagnose the condition.
Type 2 diabetes is a chronic metabolic disease characterized by high blood glucose levels resulting from defects in insulin secretion and insulin action. The document provides an overview of type 2 diabetes, including its causes, risk factors, pathophysiology, clinical presentation, diagnosis, management through diet, exercise and oral hypoglycemic agents. It also discusses the classification, epidemiology and complications of diabetes as well as the role of insulin and pancreatic function in glucose homeostasis.
Diabetes is a group of metabolic diseases characterized by high blood sugar levels. There are several types of diabetes including type 1 caused by the immune system destroying insulin-producing cells, type 2 caused by insulin resistance or lack of insulin production, and gestational diabetes during pregnancy. Symptoms include increased thirst, hunger, urination and fatigue. Diabetes is treated through medicines, diet, exercise and controlling blood sugar, blood pressure and cholesterol to reduce complications like kidney disease, eye disease and heart attack. Diabetes affects quality of life and has a significant societal impact through its associated healthcare costs and disability.
Telmisartan is a new angiotensin receptor blocker (ARB) that has several potential advantages over other ARBs. It has the strongest binding affinity to the AT1 receptor compared to other ARBs. This may provide stronger and longer-lasting blood pressure lowering effects. Telmisartan also has partial agonist effects on peroxisome proliferator-activated receptor gamma, which can improve insulin resistance and exert anti-inflammatory and anti-proliferative effects in the vasculature. Studies in animals and cells suggest Telmisartan may have insulin sensitizing effects and protect against diabetic complications by blocking upregulation of VEGF and AGE-RAGE protein expression in the retina. While more randomized clinical trials
Glimepiride is an effective second-generation sulfonylurea for treating type 2 diabetes that offers several advantages over other sulfonylureas. It is more specific to pancreatic beta cells, improving both first and second phase insulin secretion. It also has extrapancreatic glucose-lowering effects and a longer duration of action from once-daily dosing. Glimepiride has a favorable safety profile with fewer side effects like hypoglycemia compared to other sulfonylureas.
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose levels resulting from defects in insulin production or insulin action. There are several types of diabetes including type 1, type 2, gestational diabetes, and other rare forms. The long-term complications of diabetes include damage to various organs such as the eyes, kidneys, nerves, and heart. Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Lifestyle changes such as diet and exercise have been shown to prevent or delay the onset of type 2 diabetes in those with prediabetes.
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 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.
This document discusses basics of insulin therapy including:
- The discovery of insulin in the 1920s and types of insulin including basal, mealtime, premixed, and newer combinations.
- Insulin action profiles, indications for insulin use, administration techniques using vials, syringes and pens, and common insulin regimens for type 2 diabetes including once or twice daily basal insulin +/- mealtime insulin or premixed insulin.
- Proper storage, mixing, and injection of insulin as well as recommended sites for injection are also reviewed.
Perform and interpret a critical appraisal (audit) of a given prescriptionDr Pankaj Kumar Gupta
The document discusses prescription audits, which involve systematically reviewing prescriptions to evaluate quality and improve patient care. It outlines the objectives of prescription audits such as assessing irrational prescribing and identifying opportunities for improvement. Expected outcomes include providing feedback to improve prescription quality and promote rational drug use. The document also discusses indicators for evaluating the completeness, legibility, and rationality of prescriptions based on factors like inclusion of required details, legible handwriting, and adherence to treatment guidelines. It emphasizes the importance of legible and accurate prescriptions to prevent medication errors.
This document provides information on diabetes mellitus (DM), including its definition, epidemiology, pathophysiology, diagnosis, management, and the differences between type 1 and type 2 DM. Some key points:
- DM is characterized by hyperglycemia resulting from defects in insulin secretion/action and is a major cause of illness and death worldwide. It is predicted to increase significantly by 2030.
- The pathophysiology involves abnormalities in carbohydrate, fat, and protein metabolism due to deficient insulin action. Chronic hyperglycemia can cause damage to various organs.
- Diagnosis is based on symptoms, random blood glucose levels, HbA1c levels, and glucose tolerance tests.
- Management involves diet,
Sodium glucose co transporter( SGLT2) Inhibitors Philip Vaidyan
This document discusses sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of drugs for treating type 2 diabetes. SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, increasing urinary glucose excretion in a glucose-dependent manner. Three SGLT2 inhibitors have been approved by the FDA - canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors offer advantages over other anti-diabetic drugs in that they are non-insulin dependent and can be used throughout the course of diabetes. However, long-term safety studies are still needed to fully assess their risk-benefit profile.
This document discusses various classes of drugs used to treat hypertension, including their mechanisms and side effects. It describes how diuretics, ACE inhibitors, calcium channel blockers, alpha/beta blockers, and other classes work to lower blood pressure by relaxing blood vessels, reducing fluid retention, or inhibiting hormone systems like renin-angiotensin-aldosterone. Common side effects across drug classes include low blood pressure, dizziness, fatigue, and electrolyte imbalances. Regular monitoring is important when taking antihypertensive medications.
This document discusses the classification, diagnosis, and prevalence of diabetes mellitus. It begins by classifying diabetes into type 1, type 2, and other specific types. The criteria for diagnosing diabetes include an A1C of 6.5% or higher, a fasting plasma glucose of 126 mg/dL or higher, or a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. The document also discusses gestational diabetes, noting it affects 4-5% of pregnancies. Risk factors for testing asymptomatic individuals are outlined.
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.
1. Metformin was introduced in 1957 and is effective for lowering blood glucose levels as monotherapy or in combination with other agents.
2. It works by decreasing hepatic glucose production and increasing insulin sensitivity. Common side effects include gastrointestinal issues.
3. Metformin is recommended for preventing type 2 diabetes in prediabetic patients and is the first-line treatment for type 2 diabetes.
SIGNIFICANCE
OVERVIEW
WHAT IS DIABETES?
DEFINITION
MECHANISM
PREVELANCE
EPIDEMIOLOGY
CLASSIFICATION
GESTATIONAL DIABETES
RISK FACTORS
DIAGNOSIS
COMPLICATIONS
MEDICAL TEST
MEDICAL NUTRITIONAL THERAPY
HERBS FOR DIABETES
MYTHS AND FACTS
REFERENCES
Based on the information provided:
- Betty should receive her usual Lantus dose as scheduled since it is a basal insulin that works continuously to control her blood sugar throughout the day and night. Missing the dose could lead to hyperglycemia.
- She should not receive any Humulin R (regular insulin) since she is NPO for surgery and regular insulin requires food to avoid hypoglycemia.
- She may receive her usual Humalog dose if her blood sugar is elevated, as Humalog is a rapid-acting insulin used to control post-meal blood sugars. However, since her current blood sugar of 130mg/dL is in a reasonable range, the Humalog dose can be held until after her surgery when she
Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
Cardiac arrhythmias can be caused by abnormalities in heart rate, rhythm, origin of impulses, or conduction. The main mechanisms are reentry, automaticity, parasystole, and triggered activity. Reentry requires two pathways that form a loop with a block in one pathway and slow conduction in the other. Common arrhythmias include atrial fibrillation, ventricular tachycardia, and supraventricular tachycardia. First-line drugs for treating arrhythmias include lignocaine, amiodarone, adenosine, beta-blockers, and calcium channel blockers. These drugs work via different mechanisms such as blocking sodium, potassium, or calcium channels to suppress arrhythmias.
Antiarrhythmic drugs are used to treat and prevent cardiac arrhythmias by blocking ion channels involved in cardiac impulse generation and conduction. Class I drugs like quinidine and procainamide block sodium channels to prolong the action potential duration, while Class IB drugs like lignocaine shorten repolarization. Class III drugs like amiodarone block potassium channels to prolong the action potential. Calcium channel blockers like verapamil inhibit calcium influx. Other drugs include adenosine for paroxysmal supraventricular tachycardia, beta blockers for supraventricular arrhythmias, and atropine for bradycardias. Adverse effects vary between drugs but include arrhythmias, heart block and QT prolong
Diabetes is a group of metabolic diseases characterized by high blood sugar levels. There are several types of diabetes including type 1 caused by the immune system destroying insulin-producing cells, type 2 caused by insulin resistance or lack of insulin production, and gestational diabetes during pregnancy. Symptoms include increased thirst, hunger, urination and fatigue. Diabetes is treated through medicines, diet, exercise and controlling blood sugar, blood pressure and cholesterol to reduce complications like kidney disease, eye disease and heart attack. Diabetes affects quality of life and has a significant societal impact through its associated healthcare costs and disability.
This document provides tips and information for managing diabetic emergencies. It discusses assessing altered mental status, identifying hypoglycemia and hyperglycemia symptoms, and explaining the management of both. Hypoglycemia can be caused by too much insulin, not eating, overexercising or vomiting. Hyperglycemia is caused by decreased insulin or insulin resistance. Treatment involves confirming blood glucose levels, obtaining history, giving oral glucose or IV dextrose if needed, and checking temperature since hypothermia can accompany hypoglycemic episodes.
Diabetes is a serious condition where your blood glucose level is too high. It can happen when your body doesn't produce enough insulin or the insulin it produces isn't effective. Or, when your body can't produce any insulin at all.
1. Diabetes mellitus is a chronic condition characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. It is classified into type 1, type 2, gestational diabetes, and other specific types.
2. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency. Type 2 diabetes involves both insulin resistance and inadequate compensatory insulin secretion.
3. Treatment of diabetes involves lifestyle modifications, glycemic control through oral medications and/or insulin, and management of comorbidities to prevent complications.
Glimepiride is an effective second-generation sulfonylurea for treating type 2 diabetes that offers several advantages over other sulfonylureas. It is more specific to pancreatic beta cells, improving both first and second phase insulin secretion. It also has extrapancreatic glucose-lowering effects and a longer duration of action from once-daily dosing. Glimepiride has a favorable safety profile with fewer side effects like hypoglycemia compared to other sulfonylureas.
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose levels resulting from defects in insulin production or insulin action. There are several types of diabetes including type 1, type 2, gestational diabetes, and other rare forms. The long-term complications of diabetes include damage to various organs such as the eyes, kidneys, nerves, and heart. Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Lifestyle changes such as diet and exercise have been shown to prevent or delay the onset of type 2 diabetes in those with prediabetes.
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 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.
This document discusses basics of insulin therapy including:
- The discovery of insulin in the 1920s and types of insulin including basal, mealtime, premixed, and newer combinations.
- Insulin action profiles, indications for insulin use, administration techniques using vials, syringes and pens, and common insulin regimens for type 2 diabetes including once or twice daily basal insulin +/- mealtime insulin or premixed insulin.
- Proper storage, mixing, and injection of insulin as well as recommended sites for injection are also reviewed.
Perform and interpret a critical appraisal (audit) of a given prescriptionDr Pankaj Kumar Gupta
The document discusses prescription audits, which involve systematically reviewing prescriptions to evaluate quality and improve patient care. It outlines the objectives of prescription audits such as assessing irrational prescribing and identifying opportunities for improvement. Expected outcomes include providing feedback to improve prescription quality and promote rational drug use. The document also discusses indicators for evaluating the completeness, legibility, and rationality of prescriptions based on factors like inclusion of required details, legible handwriting, and adherence to treatment guidelines. It emphasizes the importance of legible and accurate prescriptions to prevent medication errors.
This document provides information on diabetes mellitus (DM), including its definition, epidemiology, pathophysiology, diagnosis, management, and the differences between type 1 and type 2 DM. Some key points:
- DM is characterized by hyperglycemia resulting from defects in insulin secretion/action and is a major cause of illness and death worldwide. It is predicted to increase significantly by 2030.
- The pathophysiology involves abnormalities in carbohydrate, fat, and protein metabolism due to deficient insulin action. Chronic hyperglycemia can cause damage to various organs.
- Diagnosis is based on symptoms, random blood glucose levels, HbA1c levels, and glucose tolerance tests.
- Management involves diet,
Sodium glucose co transporter( SGLT2) Inhibitors Philip Vaidyan
This document discusses sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of drugs for treating type 2 diabetes. SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, increasing urinary glucose excretion in a glucose-dependent manner. Three SGLT2 inhibitors have been approved by the FDA - canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors offer advantages over other anti-diabetic drugs in that they are non-insulin dependent and can be used throughout the course of diabetes. However, long-term safety studies are still needed to fully assess their risk-benefit profile.
This document discusses various classes of drugs used to treat hypertension, including their mechanisms and side effects. It describes how diuretics, ACE inhibitors, calcium channel blockers, alpha/beta blockers, and other classes work to lower blood pressure by relaxing blood vessels, reducing fluid retention, or inhibiting hormone systems like renin-angiotensin-aldosterone. Common side effects across drug classes include low blood pressure, dizziness, fatigue, and electrolyte imbalances. Regular monitoring is important when taking antihypertensive medications.
This document discusses the classification, diagnosis, and prevalence of diabetes mellitus. It begins by classifying diabetes into type 1, type 2, and other specific types. The criteria for diagnosing diabetes include an A1C of 6.5% or higher, a fasting plasma glucose of 126 mg/dL or higher, or a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. The document also discusses gestational diabetes, noting it affects 4-5% of pregnancies. Risk factors for testing asymptomatic individuals are outlined.
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.
1. Metformin was introduced in 1957 and is effective for lowering blood glucose levels as monotherapy or in combination with other agents.
2. It works by decreasing hepatic glucose production and increasing insulin sensitivity. Common side effects include gastrointestinal issues.
3. Metformin is recommended for preventing type 2 diabetes in prediabetic patients and is the first-line treatment for type 2 diabetes.
SIGNIFICANCE
OVERVIEW
WHAT IS DIABETES?
DEFINITION
MECHANISM
PREVELANCE
EPIDEMIOLOGY
CLASSIFICATION
GESTATIONAL DIABETES
RISK FACTORS
DIAGNOSIS
COMPLICATIONS
MEDICAL TEST
MEDICAL NUTRITIONAL THERAPY
HERBS FOR DIABETES
MYTHS AND FACTS
REFERENCES
Based on the information provided:
- Betty should receive her usual Lantus dose as scheduled since it is a basal insulin that works continuously to control her blood sugar throughout the day and night. Missing the dose could lead to hyperglycemia.
- She should not receive any Humulin R (regular insulin) since she is NPO for surgery and regular insulin requires food to avoid hypoglycemia.
- She may receive her usual Humalog dose if her blood sugar is elevated, as Humalog is a rapid-acting insulin used to control post-meal blood sugars. However, since her current blood sugar of 130mg/dL is in a reasonable range, the Humalog dose can be held until after her surgery when she
Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
Cardiac arrhythmias can be caused by abnormalities in heart rate, rhythm, origin of impulses, or conduction. The main mechanisms are reentry, automaticity, parasystole, and triggered activity. Reentry requires two pathways that form a loop with a block in one pathway and slow conduction in the other. Common arrhythmias include atrial fibrillation, ventricular tachycardia, and supraventricular tachycardia. First-line drugs for treating arrhythmias include lignocaine, amiodarone, adenosine, beta-blockers, and calcium channel blockers. These drugs work via different mechanisms such as blocking sodium, potassium, or calcium channels to suppress arrhythmias.
Antiarrhythmic drugs are used to treat and prevent cardiac arrhythmias by blocking ion channels involved in cardiac impulse generation and conduction. Class I drugs like quinidine and procainamide block sodium channels to prolong the action potential duration, while Class IB drugs like lignocaine shorten repolarization. Class III drugs like amiodarone block potassium channels to prolong the action potential. Calcium channel blockers like verapamil inhibit calcium influx. Other drugs include adenosine for paroxysmal supraventricular tachycardia, beta blockers for supraventricular arrhythmias, and atropine for bradycardias. Adverse effects vary between drugs but include arrhythmias, heart block and QT prolong
Diabetes is a group of metabolic diseases characterized by high blood sugar levels. There are several types of diabetes including type 1 caused by the immune system destroying insulin-producing cells, type 2 caused by insulin resistance or lack of insulin production, and gestational diabetes during pregnancy. Symptoms include increased thirst, hunger, urination and fatigue. Diabetes is treated through medicines, diet, exercise and controlling blood sugar, blood pressure and cholesterol to reduce complications like kidney disease, eye disease and heart attack. Diabetes affects quality of life and has a significant societal impact through its associated healthcare costs and disability.
This document provides tips and information for managing diabetic emergencies. It discusses assessing altered mental status, identifying hypoglycemia and hyperglycemia symptoms, and explaining the management of both. Hypoglycemia can be caused by too much insulin, not eating, overexercising or vomiting. Hyperglycemia is caused by decreased insulin or insulin resistance. Treatment involves confirming blood glucose levels, obtaining history, giving oral glucose or IV dextrose if needed, and checking temperature since hypothermia can accompany hypoglycemic episodes.
Diabetes is a serious condition where your blood glucose level is too high. It can happen when your body doesn't produce enough insulin or the insulin it produces isn't effective. Or, when your body can't produce any insulin at all.
1. Diabetes mellitus is a chronic condition characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. It is classified into type 1, type 2, gestational diabetes, and other specific types.
2. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency. Type 2 diabetes involves both insulin resistance and inadequate compensatory insulin secretion.
3. Treatment of diabetes involves lifestyle modifications, glycemic control through oral medications and/or insulin, and management of comorbidities to prevent complications.
This document provides an overview of diabetes mellitus (DM), including its epidemiology, classification, etiology, clinical features, complications, oral manifestations, diagnostic criteria, investigations, management, and differences between type 1 and type 2 DM. DM is characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It is classified into type 1, type 2, gestational DM, and other types. Clinical features and complications are discussed, along with oral manifestations like periodontal disease and increased risk of infection. Diagnostic testing and treatment focus on glycemic control to prevent microvascular and macrovascular complications.
This document provides an overview of diabetes mellitus, including its classification, etiology, risk factors, pathophysiology, clinical presentation, diagnostic criteria, treatment, complications, and special patient populations. It discusses the two main types of diabetes - type 1 resulting from insulin deficiency and type 2 from insulin resistance and relative deficiency. Treatment involves lifestyle modifications like diet and exercise as well as pharmacological therapies like insulin, oral hypoglycemics, and management of complications through monitoring.
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
This document provides an overview of endocrinology with a focus on diabetes mellitus and thyroid disorders for second year anesthesia students. It defines diabetes mellitus and classifies it into two main types. Type 1 diabetes is characterized by an absolute insulin deficiency due to autoimmune destruction of beta cells, while type 2 diabetes involves insulin resistance and a relative insulin deficiency. The document discusses the pathogenesis, clinical features, diagnosis, treatment and complications of both types of diabetes mellitus. It also outlines the goals of diabetes management and various pharmacologic therapies.
Non-pharmacological Management of Diabetes Mellitus.pptxSamson Ojedokun
Diabetes mellitus DM, is a metabolic disorder of biomolecules characterized by chronic hyperglycemia due to defects in insulin synthesis or utilization or both
DM requires lifelong therapy. A multidisciplinary approach is needed to control glycemia, as well as to limit the development of its devastating complications and manage such complications when they do occur.
Increases cost of living and reduces life expectancy
Here are potential responses to the questions:
1. Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Complications of diabetes include:
- Acute complications like diabetic ketoacidosis and hyperosmolar hyperglycemic state.
- Microvascular complications like diabetic retinopathy (leading to blindness), nephropathy (leading to renal failure) and neuropathy (causing pain and impaired healing).
- Macrovascular complications like atherosclerosis leading to cardiovascular disease (heart attacks and strokes), peripheral vascular disease (leg pain and poor wound healing).
2. Diabetes is classified into Type 1 (caused by auto
This document summarizes the classification, diagnosis, and pharmacological treatment of diabetes mellitus. It discusses the following key points in 3 sentences:
Type 1 diabetes results from autoimmune destruction of beta cells leading to insulin deficiency. Type 2 diabetes involves progressive loss of insulin secretion against a background of insulin resistance. Gestational diabetes involves any degree of glucose intolerance with onset or first recognition during pregnancy. The document also discusses glycemic targets, criteria for diagnosing diabetes and prediabetes, screening for gestational diabetes, and the pharmacological approaches including metformin, sulfonylureas, GLP-1 receptor agonists, and DPP-4 inhibitors.
This document summarizes diabetes mellitus and its management. It defines diabetes as a clinical syndrome characterized by hyperglycemia. The two most common types are type 1, caused by autoimmune destruction of insulin-producing cells, and type 2, characterized by insulin resistance and inability to produce sufficient insulin. Environmental and genetic factors contribute to both types. Symptoms, diagnosis, and treatment options like diet, medications, and insulin are discussed in detail. The goals of management are to improve hyperglycemia symptoms and minimize long-term complications through glycemic control.
Type 2 diabetes is a major health problem in Pakistan, affecting 33 million adults. It occurs when the body does not produce enough insulin or cannot effectively use the insulin it produces, resulting in elevated blood sugar levels. Treatment involves lifestyle modifications like diet and exercise as well as medications to lower blood sugar. These include insulin, oral medications that stimulate insulin release, increase insulin sensitivity, or slow carbohydrate absorption. The goals of treatment are to reduce symptoms and prevent complications affecting the heart, blood vessels, eyes, kidneys and nerves.
This document discusses diabetes pharmacotherapy. It provides an overview of the different types of diabetes, including type 1, type 2, gestational diabetes, and maturity onset diabetes of youth. It describes the pathogenesis and clinical presentation of type 1 and type 2 diabetes. The major components of diabetes treatment are diet, exercise, oral hypoglycemic medications, and insulin therapy. The document discusses the different types of insulin preparations, including their sources, structures, mechanisms of action, and uses. It provides guidance on calculating insulin doses and adjusting doses based on blood sugar levels.
Diabetes mellitus is a global healthcare problem that is rising in prevalence worldwide. It is classified into type 1, type 2, gestational diabetes, and other specific types based on etiology. Risk factors include family history, obesity, physical inactivity, and ethnicity. Common signs and symptoms include polydipsia, polyuria, polyphagia, weight loss, and blurred vision. Complications of uncontrolled diabetes include macrovascular complications like cardiovascular disease and stroke as well as microvascular complications affecting the eyes, kidneys, and nerves. Management involves lifestyle modifications, oral medications, and insulin as needed to control blood glucose levels and minimize complications.
This document provides an overview of diabetes mellitus (DM). It defines DM as a group of metabolic disorders characterized by hyperglycemia. There are distinct types of DM caused by genetic and environmental interactions. The key hormones that regulate glucose homeostasis are insulin, glucagon, and somatostatin which are produced by cells in the pancreas. Screening for DM is recommended for those over age 45 or those with additional risk factors. Treatment involves patient education, lifestyle modifications, and medications like metformin, sulfonylureas, and thiazolidinediones.
The document discusses diabetes mellitus and insulin secretion and function. It provides details on the classification of diabetes, including type 1, type 2, and gestational diabetes. It also discusses the diagnosis, management through diet, exercise, medication and insulin, and complications of diabetes. Key tests discussed are fasting blood glucose, oral glucose tolerance test, and A1C.
This document discusses diabetes, including its definition, types, symptoms, management, and statistics. Some key points include:
- Diabetes is a metabolic disorder characterized by high blood glucose caused by insufficient insulin production or action.
- Over 25 million Americans have diabetes, and it is projected to affect over 333 million people worldwide by 2025, with 90% having type 2 diabetes.
- There are two main types of diabetes - type 1 is usually diagnosed in childhood and requires insulin injections, while type 2 usually occurs in adulthood and can sometimes be managed through diet and exercise.
- Symptoms vary depending on type but include increased urination, thirst, fatigue, and weight changes. Proper management is important to prevent
This document provides information on diabetes mellitus. It defines diabetes as a clinical syndrome characterized by hyperglycemia. The prevalence of diabetes is rising globally, estimated to affect 463 million people in 2019 and rising to 700 million by 2045. There are two main types of diabetes: type 1 is an autoimmune disease resulting in insulin deficiency, while type 2 is more common and associated with insulin resistance and relative insulin deficiency. The document outlines diagnostic criteria and testing for diabetes and pre-diabetes. It also discusses the classification, pathogenesis, risk factors, complications and management of both type 1 and type 2 diabetes.
This document provides information on diabetes mellitus (DM), including:
- DM results from defects in insulin production/action leading to hyperglycemia.
- The prevalence of DM in Nepal is approximately 3.6% overall, higher in urban vs. rural areas.
- The main types of DM are type 1, type 2, and gestational diabetes.
- Risk factors, symptoms, diagnostic criteria, treatment methods including diet, exercise, medications, education and potential acute/chronic complications are outlined.
This document discusses lipids, which are concentrated energy molecules that serve several functions in biology. Lipids include fats, oils, waxes, and hormones. They are used for energy storage and provide twice the energy of carbohydrates. Lipids also make up cell membranes and help cushion and insulate organs. Saturated fats from animals are solid at room temperature and contribute to heart disease, while unsaturated fats from plants and fish are liquid and are a healthier choice. Cell membranes contain phospholipids that form a barrier for the cell, with hydrophilic heads on the outside and hydrophobic tails on the inside.
This document discusses lipids and membranes. It describes the basic structures of lipids like fatty acids, glycerophospholipids, sphingolipids, and cholesterol. These lipids can assemble into structures like micelles and bilayers in aqueous environments due to their amphipathic nature. Bilayers allow for the formation of cell membranes. Membranes contain proteins that can be integral, peripheral, or lipid-anchored. Lipid composition and proteins influence membrane properties like fluidity.
The document discusses the evolution of cell membranes from early RNA molecules clinging to clay particles to the modern fluid mosaic model. Key events include the formation of lipid bilayers that separated internal and external chemistry, allowing more efficient reactions. Experiments showed lipids spontaneously forming enclosed compartments and lipid bilayers with integral membrane proteins that gave membranes a mosaic-like structure. The fluid mosaic model proposes membranes are fluid with lipids and proteins able to diffuse freely within the plane of the bilayer. Transport proteins like channels and carriers allow selective permeability while pumps use ATP to transport molecules against gradients.
This document provides information about lipids and fatty acids. It defines lipids as biomolecules that contain fatty acids or a steroid nucleus and are soluble in organic solvents but not water. There are different types of lipids containing fatty acids, including waxes, fats and oils (triacylglycerols), glycerophospholipids, and prostaglandins. Fatty acids are long-chain carboxylic acids that can be saturated or unsaturated. Fats and oils are esters of glycerol and three fatty acids called triacylglycerols. Unsaturated fatty acids have kinks that prevent close packing, giving oils and unsaturated fats lower melting points than saturated fats. Hydrogen
The octapeptide contains the amino acids A, C, D, G, L, M, S. Enzyme digestion and mass spectrometry identify the fragments D-C-M, A-S, C-M-A, S-G-A, and L-D. This information determines the primary structure is L-A-G-S-D-C-M-A. Secondary structure is based on bond rotations forming elements like alpha helices and beta pleated sheets. Tertiary structure describes the overall shape from peptide chain folding while quaternary structure involves interactions of multiple protein subunits.
This chapter discusses protein therapeutics including recombinant proteins and monoclonal antibodies. It provides examples of recombinant proteins approved for human use to treat disorders like hemophilia, diabetes, and cystic fibrosis. The chapter outlines different expression systems used to produce recombinant proteins, including bacteria, yeast, insect, and mammalian cells. It also describes the structure of antibodies and the development of monoclonal antibodies as therapeutic agents, from mouse antibodies to humanized antibodies to reduce immunogenicity.
Proteins are made up of chains of amino acids and are essential to many bodily functions. Amino acids link together through peptide bonds and proteins fold into complex three-dimensional shapes that determine their specific roles. Both insufficient and excessive protein intake can be harmful, so a balanced diet containing moderate protein is recommended.
This document provides an overview of amino acids, peptides, and proteins. It discusses the 20 standard amino acids, including their structures, properties, and classifications. Peptide bond formation between amino acids is described. Peptides are defined as short chains of amino acids, with examples of peptide functions. Proteins are introduced as longer polymers made up of amino acids that may also contain cofactors or modifications. The learning goals cover the key aspects of amino acid and peptide structures and properties.
Protein folding is the process by which a protein goes from an unfolded state to its biologically active three-dimensional structure. It is important to understand protein folding to help predict protein structures from sequence alone and to understand diseases caused by protein misfolding. Proteins typically fold through progressive formation of native-like structures rather than through a random search. Molecular chaperones help other proteins fold within cells. Misfolded proteins can form amyloid fibrils associated with diseases. Computational methods aim to predict protein structures from sequence using fragment libraries and modeling protein energy landscapes. Protein design techniques aim to computationally modify protein sequences to achieve desired stabilities, functions, and binding properties.
This document discusses protein classification and structure. It defines protein classification as grouping proteins based on structure, function or size. Proteins can have domains and subunits. They come in globular, fibrous, and other shapes. Proteins are linked within and between polypeptide chains using covalent bonds. Proteins bind other molecules specifically through interactions like ionic bonds. Binding allows proteins to regulate activity and form complexes with other molecules like opsins.
Heat shock proteins (HSPs) help other proteins properly fold and function. HSP90 and HSP70 are molecular chaperones that work sequentially to fold proteins in the cytoplasm. Misfolded proteins can cause disease. HSP90 helps buffer hidden genetic variations but under stress these variations are expressed and can lead to morphological changes. HSP90 is highly conserved across species and plays a role in evolution by allowing traits to change in response to stress. Current research studies HSP90 to better understand protein misfolding diseases.
1. Enzymes are biological catalysts that lower the activation energy of reactions and increase reaction rates. They are often proteins that contain cofactors.
2. Enzymes are classified based on the type of reaction they catalyze, such as oxidation-reduction, hydrolysis, or transfer of chemical groups. Common enzyme names end in "-ase".
3. The lock and key model describes how enzymes bind specifically to substrates in their active sites to form enzyme-substrate complexes. In the induced fit model, the enzyme structure changes to better fit the substrate.
Protein structures are classified to generate overviews of structure types and detect evolutionary relationships. Major classification schemes include SCOP, CATH, and FSSP. SCOP classifies proteins into classes, folds, superfamilies, and families based on structural and sequence similarities. CATH also uses a hierarchical system of classes, architectures, topologies, and superfamilies. FSSP provides fully automated and updated structural alignments and classifications.
This document discusses proteins from a chemist's perspective. It describes how proteins are made of amino acids, with 20 standard types but only 9 being essential. The unique side groups of each amino acid determine their individual properties. Protein structure and function depend on the specific amino acid sequence. Amino acids are linked through peptide bonds to form proteins. The document also covers protein digestion and roles of proteins in the body.
This document discusses protein structure and synthesis. It begins by describing the primary, secondary, tertiary, and quaternary structures of proteins. This includes the structures of alpha helices, beta sheets, turns, and domains. It then discusses protein translation, noting that proteins begin folding as they emerge from the ribosome in a co-translational manner. The final section discusses protein folding and some of the challenges of the folding process.
The document discusses heat shock proteins (Hsps), Hsp90 inhibitors, and protein degradation. It provides background on protein degradation mechanisms and heat shock proteins. Hsp90 plays a key role in cancer cell survival by regulating oncogenic signaling proteins. Hsp90 inhibitors like geldanamycin and 17-AAG bind Hsp90's ATP binding site, altering its function and inducing degradation of client proteins, stopping cancer cell growth. The paper found that tumor Hsp90 exclusively exists in active multichaperone complexes, conferring higher binding affinity for 17-AAG compared to normal cell Hsp90. This activated conformation in tumor cells represents a unique drug target.
This document summarizes protein therapeutics and provides a pharmacological classification. It notes that the human genome contains 25,000-40,000 genes that can undergo alternative splicing and post-translational modifications, resulting in a very high number of functionally distinct proteins. Protein therapeutics are classified into 4 groups based on their function: group I includes proteins with enzymatic or regulatory activity, group II targets specific molecules or organisms, group III are protein vaccines, and group IV are protein diagnostics. The document outlines some advantages of protein therapeutics but also challenges including solubility, immune response, stability, and costs.
1. Proteins are made up of amino acids and take on specific three-dimensional structures that dictate their function. Determining a protein's structure is important for understanding its role in biological processes.
2. There are several methods for determining and predicting protein structure, including X-ray crystallography, NMR, and computational methods like homology modeling or ab initio structure prediction.
3. Protein structure is hierarchical, ranging from secondary structure like alpha helices and beta sheets to the overall fold classified in databases like SCOP and CATH. Predicting secondary structure is easier than predicting a protein's full three-dimensional structure.
Amino acids are organic compounds that contain an amino group and a carboxyl group. There are 20 different amino acids that serve as the building blocks of proteins. Amino acids link together through peptide bonds to form polypeptide chains that fold into complex three-dimensional protein structures. Proteins serve essential functions and 10 of the 20 amino acids must be obtained through diet as humans cannot synthesize them. Common protein tests identify the presence of proteins using reactions that detect peptide bonds, amino acid side chains, or disulfide bridges.
- Proteins are made up of amino acids, which are the building blocks. There are 20 different amino acids, some are essential and must be obtained through diet.
- The specific sequence of amino acids determines the 3D shape of a protein and its function. Denaturation occurs when proteins lose their shape due to heat, acid, etc.
- Proteins serve many important functions in the body including structure, enzymes, transport, hormones, antibodies, and more. An inadequate intake can result in the body breaking down its own proteins to obtain energy.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
Encryption Standards: Learn what is necessary and what is overhyped.
Medical Messaging and Voice Data: Ensure secure handling of sensitive information.
IT Risk Factors: Identify and mitigate risks related to your IT infrastructure.
Why Attend:
Expert Instructor: Brian Tuttle, with over 20 years in Health IT and Compliance Consulting, brings invaluable experience and knowledge, including insights from over 1000 risk assessments and direct dealings with Office of Civil Rights HIPAA auditors.
Actionable Insights: Receive practical advice on preparing for audits and avoiding common mistakes.
Clarity on Compliance: Clear up misconceptions and understand the reality of HIPAA regulations.
Ensure your compliance strategy is up-to-date and effective. Enroll now and be prepared for the 2024 HIPAA audits.
Enroll Now to secure your spot in this crucial training session and ensure your HIPAA compliance is robust and audit-ready.
https://conferencepanel.com/conference/hipaa-training-for-the-compliance-officer-2024-updates
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
5. 5
Classification of DM
1. Type 1 DM
• It is due to insulin deficiency and is formerly known as.
• Type I
• Insulin Dependent DM (IDDM)
• Juvenile onset DM
2. Type 2 DM
• It is a combined insulin resistance and relative deficiency in
insulin secretion and is frequently known as.
• Type II
• Noninsulin Dependent DM (NIDDM)
• Adult onset DM
6. 6
3. Gestational Diabetes Mellitus (GDM):
Gestational Diabetes Mellitus (GDM) developing during some
cases of pregnancy but usually disappears after pregnancy.
4. Other types:
Secondary DM
14. 14
Characteristics Type 1 Type 2
% of diabetic pop 5-10% 90%
Age of onset Usually < 30 yr + some adults Usually > 40 + some obese
children
Pancreatic function Usually none Insulin is low, normal or high
Pathogenesis Autoimmune process Defect in insulin secretion,
tissue resistance to insulin,
increased HGO
Family history Generally not strong Strong
Obesity Uncommon Common
History of ketoacidosis Often present Rare except in stress
Clinical presentation moderate to severe symptoms:
3Ps, fatigue, wt loss and
ketoacidosis
Mild symptoms: Polyuria and
fatigue. Diagnosed on routine
physical examination
Treatment Insulin, Diet
Exercise
Diet ,Exercise
Oral antidiabetics,Insulin
15. 15
Epidemiology
• Type 1 DM
– It is due to pancreatic islet β-cell destruction
predominantly by an autoimmune process.
– Usually develops in childhood or early
adulthood
– It accounts for upto 10% of all DM cases
– Develops as a result of the exposure of a
genetically susceptible individual to an
environmental agent
16. 16
Type 2 DM
• It results from insulin resistance with a defect
in compensatory insulin secretion.
• Insulin may be low, normal or high!
• About 30% of the Type 2 DM patients are
undiagnosed (they do not know that they have
the disease) because symptoms are mild.
• It accounts for up to 90% of all DM cases
17. 17
Risk Factors
• Type 1 DM
– Genetic predisposition
• In an individual with a genetic
predisposition, an event such as virus
or toxin triggers autoimmune
destruction of b-cells probably over a
period of several years.
18. 18
Risk Factors
• Type 2 DM
– Family History
– Obesity
– Habitual physical inactivity
– Previously identified impaired glucose tolerance
(IGT) or impaired fasting glucose (IFG)
– Hypertension
– Hyperlipidemia
20. 20
Carbohydrate Metabolism
– Carbohydrates are metabolized in the body
to glucose.
– CNS uses glucose as its primary energy
source. This is independent of insulin.
– Glucose is taken by the muscle to produce
energy (insulin required).
– Glucose is stored in the liver as glycogen
and in adipose tissues as fat.
– Insulin is produced and stored by the β-
cells of the pancreas
21. 21
Carbohydrate Metabolism (Cont’d)
– Postprandial glucose metabolism in normal
individuals:
– After food is ingested, blood glucose concs
rise and stimulate insulin release.
– Insulin action:
– glucose uptake by the tissues
– liver glycogen formation and glycogen
breakdown
– lipid synthesis and inhibits fatty acid
breakdown to ketone bodies
–Promotes protein synthesis
22. 22
Carbohydrate Metabolism
(Cont’d)
• Fasting glucose metabolism in normal
individuals:
– In the fasting state, insulin release is inhibited.
– Hormones that promote an increase in blood
glucose are released:
• Glucagon, epinephrine, growth hormone,
glucocorticoids, and thyroid hormones.
– Glycogenolysis
– Gluconeogenesis: AA are transported from muscle
to liver and converted to glucose.
– TG are broken down into free FAs as an alternative
fuel source.
23. 23
Pathophysiology
• Type 1 DM
– Type 1 DM is characterized by an absolute
deficiency of insulin due to immune- mediated
destruction of the pancreatic b-cells
– In rare cases the b-cell destruction is not due to
immune mediated reaction (idiopathic type 1 DM)
25. 25
Pathophysiology
• Type 1 DM
There are four stages in the development of
Type 1 DM:
1. Preclinical period with positive b-cell antibodies
2. Hyperglycemia when 80-90% of the
β- cells are destroyed.
3. Transient remission (honeymoon phase).
3. Establishment of the disease
27. 27
Pathophysiology
• Type 2 DM
– Type 2 DM is characterized by the presence of both insulin
resistance (tissue insensitivity) and some degree of insulin
deficiency or b- cell dysfunction
– Type 2 DM occurs when a diabetogenic lifestyle (excessive
calories, inadequate caloric expenditure and obesity) is
superimposed upon a susceptible genotype
28. 28
Pathophysiology
• Type 2 DM
Glucose
mg/dL
Relative
b- cell
Function
%
250
200
150
100
50
0
b-cell failure
300
250
200
150
100
50
0
Fasting blood glucose
Post-meal glucose
Years of diabetes
29. 29
Laboratory Tests
1. Glucosuria
– To detect glucose in urine by a paper strip
• Semi-quantitative
• Normal kidney threshold for glucose is essential
2. Ketonuria
– To detect ketonbodies in urine by a paper strip
• Semi-quantitative
30. 30
Laboratory Tests (Cont’d)
3. Fasting blood glucose
– Glucose blood concentration in samples obtained after at
least 8 hours of the last meal
4. Random Blood glucose
– Glucose blood concentration in samples obtained at any
time regardless the time of the last meal
31. 31
Laboratory Tests (Cont’d)
5. Glucose tolerance test
– 75 gm of glucose are given to the patient with 300 ml of
water after an overnight fast
– Blood samples are drawn 1, 2, and 3 hours after taking the
glucose
– This is a more accurate test for glucose utilization if the
fasting glucose is borderline
32. 32
Laboratory Tests (Cont’d)
6. Glycosylated hemoglobin (HbA1C)
– HbA1C is formed by condensation of glucose with free
amino groups of the globin component of hemoglobin
– Normally it comprises 4-6% of the total hemoglobin.
– Increase in the glucose blood concentration increases the
glycated hemoglobin fraction.
– HbA1C reflects the glycemic state during the preceding 8-
12 weeks.
33. 33
Laboratory Findings (Cont’d)
7. Serum Fructosamine
– Formed by glycosylation of serum protein (mainly albumin)
– Since serum albumin has shorter half life than hemoglobin,
serum fructosamine reflects the glycemic state in the
preceding 2 weeks
– Normal is 1.5 - 2.4 mmole/L when serum albumin is 5 gm/dL.
34. 34
Self Monitoring Test
• Self-monitoring of blood glucose
– Extremely useful for outpatient monitoring specially for
patients who need tight control for their glycemic state.
– A portable battery operated device that measures the color
intensity produced from adding a drop of blood to a glucose
oxidase paper strip.
– e.g. One Touch, Accu-Chek, DEX, Prestige and Precision.
36. 36
Diagnostic Criteria
• Any one test should be confirmed with a second test, most
often fasting plasma glucose (FPG).
• This criteria for diagnosis should be confirmed by
repeating the test on a different day.
38. 38
Clinical Presentation
• Type 1 DM
- Polyuria
- Polydipsia
- Polyphagia
- Weight loss
- Weakness
- Dry skin
- Ketoacidosis
• Type 2 DM
- Patients can be asymptomatic
- Polyuria
- Polydipsia
- Polyphagia
- Fatigue
- Weight loss
- Most patients are discovered
while performing urine glucose
screening
39. 39
Treatment
- Relieve symptoms
- Reduce mortality
- Improve quality of life
- Reduce the risk of microvascular and macrovascular
disease complications
- Macrovascular complications:
Coronary heart disease, stroke and peripheral vascular disease
- Microvascular Complications:
Retinopathy, nephropathy and neuropathy
Desired outcome
40. 40
How to achieve the goals ?
- Near normal glycemic control reduce the risk
of developing microvascular disease
complications
- Control of the traditional CV risk factors such
as smoking, management of dyslipidemia,
intensive BP control and antiplatelet therapy.
Treatment
44. 44
Treatment
Self-monitoring of blood glucose
- Frequent self monitoring of blood
glucose to achieve near normal level
- More intense insulin regimen require
more frequent monitoring
45. 45
Treatment
Nonpharmacological therapy
- For type 1 the goal is to regulate insulin
administration with a balanced diet
- In most cases, high carbohydrate, low fat, and low
cholesterol diet is appropriate
- Type 2 DM patients need caloric restriction
Diet
46. 46
Treatment
Nonpharmacological therapy
- Artificial sweeteners:
- e.g. Aspartame, saccharin, sucralose, and acesulfame
- Safe for use by all people with diabetes
- Nutritive sweeteners:
- e.g. fructose and sorbitol
- Their use is increasing except for acute diarrhea in
some patients
Diet (Cont’d)
47. 47
Treatment
Nonpharmacological therapy
- Exercise improves insulin resistance and achieving glycemic
control.
- Exercise should start slowly for patients with limited activity.
- Patients with CV diseases should be evaluated before
starting any exercise
Activity
52. 52
Sulfonylureas (Cont’d)
Classification
• First generation
• e.g. tolbutamide, chlorpropamide, and acetohexamide
• Lower potency, more potential for drug interactions
and side effects
• Second generation
• e.g. glimepiride, glipizide, and glyburide
• higher potency, less potential for drug interactions and
side effects
• All sulfonylurea drugs are equally effective in reducing the
blood glucose when given in equipotent doses.
53. 53
Major Pharmacokinetic Properties of Sulfonyl Ureas
Eqv. Dose
(mg)
Duration
(h)
Active metabolites
First Generation
Tolbutamide 1000-1500 12-24 Yes (p-OH derivative)
Chlorpropamide 250-375 24-60 Yes (2’-OH and 3’OH groups)
Tolazamide 250-375 12-24 No (4-COOH derivative)
Second
generation
Glipizide 10 10-24 No (cleavage of pyrazine ring)
Glyburide
(glibenclamide)
Third generation
5 16-24 Some (trans + cis 4’-OH groups)
Glimepiride 1-2 24 Yes (-OH on CH3 of R’ group)
56. 56
2. Short-acting Secretogogues
Pharmacological effect
– Stimulation of the pancreatic secretion of insulin
– The insulin release is glucose dependent and is decreased
at low blood glucose
– With lower potential for hypoglycemia (incidence 0.3%)
– Should be given before meal or with the first bite of each
meal. If you skip a meal don’t take the dose!
– Repaglinide
– Nateglinide
57. 57
Secretogogues (Cont’d)
Adverse effect
– Incidence of hypoglycemia is very low about 0.3 %
Drug Interactions
– Inducers or inhibitors of CYP3A4 affect the action of repaglinide
– Nateglinide is an inhibitor of CYP2C9
58. 58
3. Biguanides
Pharmacological effect
– Reduces hepatic glucose production
– Increases peripheral glucose utilization
Metformin (Glucophage)
Adverse effects
– Nausea, vomiting, diarrhea, and anorexia
– Phenformin: another biguanide, was taken off the market
because it causes lactic acidosis in almost 50% of patients
– As a precaution metformin should not be used in patients
with renal insufficiency, CHF, conditions that lead to
hypoxia
59. 59
4. Glitazones (PPARg Agonists)
PPARg Agonists:
Peroxisome proliferator-activated receptor g gonists
- Rosiglitazone - Pioglitazone
– Reduces insulin resistance in the periphery (Sensitize muscle and
fat to the action of insulin) and possibly in the liver
– The onset of action is slow taking 2-3 months to see the full effect
– Edema and weight gain are the most common side effects. (no
hepatotoxicity)
Pharmacological effect
60. 60
5. a-Glucosidase Inhibitors
Pharmacological effect
• Prevent the breakdown of sucrose and complex
carbohydrates
– The net effect is to reduce postprandial blood glucose rise
– The effect is limited to the luminal side of the intestine with
limited systemic absorption. Majority eliminated in the feces.
– Postprandial glucose conc is reduced.
– FPG relatively unchanged.
– Average reduction in HbA1c: 0.3-1.0%
- Acarbose - Miglitol
61. 61
Pharmacotherapy :Type 2 DM
General considerations:
- Consider therapeutic life style changes (TLC) for
all patients with Type 2 DM
- Initiation of therapy may depend on the level of HbA1C
- HbA1C < 7% may benefit from TLC
- HbA1C 8-9% may require one oral agent
- HbA1C > 9-10% my require more than one oral agent
62. 62
Pharmacotherapy :Type 2 DM
Obese Patients >120% LBW:
Metformin or glitazone
Add SU or short-acting insulin
secretagogue
Add Insulin or glitazone
63. 63
Pharmacotherapy :Type 2 DM
Non-obese Patients <120% LBW:
SU or short-acting insulin
secretagogue
Add Metformin or
glitazone
Add Insulin
64. 64
Pharmacotherapy :Type 2 DM
Elderly Patients with newly diagnosed
DM :
SU or short-acting insulin
secretagogue or a-glucosidase
inhibitor or insulin
Add or substitute insulin
65. 65
Pharmacotherapy :Type 2 DM
Early insulin resistance :
Metformin or glitazone
Add glitazone or metformin
Add SU or short-acting insulin
secretagogue or insulin
66. 66
Clinical Trials: Diabetes Mellitus
1- Diabetes Prevention Program
• Population: Over-weight patients with impaired
glucose tolerance.
• Intervention: Low-fat diet and 150 min of exercise
per week.
• Results: Decrease the risk of progression to Type 2
DM by 58%
69. 69
Insulin (Cont’d)
- The number of units/ml
e.g. U-100 , U-20, U-10
Strength
Source
- Pork: Differs by one a.a.
- Beef-Pork
- Human (recombinant DNA technology)
70. 70
Insulin (Cont’d)
Changing the properties of insulin preparation can
alter the onset and duration of action
- Lispro: (Monomeric) absorbed to the circulation
very rapidly
- Aspart: (Mono- and dimeric) absorbed to the
circulation very rapidly
- Regular: (Hexameric) absorbed rapidly but slower
than lispro and aspart
Onset and duration of effect
71. 71
Insulin (Cont’d)
- Lent insulin: Amorphous precipitate of insulin and
zinc and insoluble crystals of insulin and zinc.
Releases insulin slowly to the circulation
- NPH: R-insulin + Protamine zinc insulin. Releases
insulin slowly to the systemic circulation
- Insulin glargine: Prepared by modification of the
insulin structure. Precipitate after S.C. injection to
form microcrystals that slowly release insulin to the
systemic circulation (N.B. cannot be mixed with other
insulins)
Onset and duration of effect
72. 72
Insulin (Cont’d)
- Rapid-acting insulin
- e.g. Insulin lispro and insulin aspart
- Short-acting insulin
- e.g. Regular insulin
- Intermediate-acting insulin
- e.g. NPH and Lente insulin
- Long-acting insulin
- e.g. Insulin Glargine
- Mixture of insulin can provide glycemic control over
extended period of time
- e.g. Humalin 70/30 (NPH + regular)
Onset and duration of effect
73. 73
Insulin (Cont’d)
- Hypoglycemia
- Treatment:
- Patients should be aware of symptoms of hypoglycemia
- Oral administration of 10-15 gm glucose
- IV dextrose in patients with lost consciousness
- 1 gm glucagon IM if IV access is not available
- Skin rash at injection site
- Treatment: Use more purified insulin preparation
- Lipodystrophies (increase in fat mass) at injection site
- Treatment: rotate the site of injection
Adverse effects
74. 74
Insulin (Cont’d)
Drugs interfering with glucose tolerance
• The most significant interactions are with drugs that alter
the blood glucose level:
- Diazoxide
- Thiazide diuretics
- Corticosteroids
- Oral contraceptives
- Streptazocine
- Phenytoin
• All these drugs increase the blood glucoseconcentration.
• Monitoring of BG is required
75. 75
Insulin (Cont’d)
Methods of Insulin Administration
• Insulin syringes and needles
• Pen-sized injectors
• Insulin Pumps
76. 76
Pharmacotherapy :Type 1 DM
The goal is:
To balance the caloric intake with the
glucose lowering processes (insulin and
exercise), and allowing the patient to live
as normal a life as possible
77. 77
Pharmacotherapy :Type 1 DM
Breakfast Lunch Supper
Insulin
Concentration
Time of day
Normal insulin secretion during he day
- Constant background level (basal)
- Spikes of insulin secretion after eating
78. 78
Pharmacotherapy :Type 1 DM
- -The insulin regimen has to mimic the physiological
secretion of insulin
- With the availability of the SMBG and HbA1C
tests adequacy of the insulin regimen can be
assessed
- More intense insulin regimen require more intense
monitoring
79. 79
Pharmacotherapy :Type 1 DM
Example:
1- Morning dose (before breakfast):
Regular + NPH or Lente
2- Before evening meal:
Regular + NPH or Lente
Require strict adherence to the timing of meal and
injections
80. 80
Pharmacotherapy :Type 1 DM
Modification
- NPH evening dose can be moved to bedtime
- Three injections of regular or rapid acting insulin
before each meal + long acting insulin at bedtime (4
injections)
- The choice of the regimen will depend on the patient
81. 81
Pharmacotherapy :Type 1 DM
How much insulin ?
- A good starting dose is 0.6 U/kg/day
- The total dose should be divided to:
- 45% for basal insulin
- 55% for prandial insulin
The prandial dose is divided to
- 25% pre-breakfast
- 15% pre-lunch
- 15% pre-supper
82. 82
Pharmacotherapy :Type 1 DM
Example: For a 50 kg patient
- The total dose = 0.6X50 = 30 U/day
- 13.5 U for basal insulin (45% of dose)
- Administered in one or two doses
- 16.5 U for prandial insulin (55% of dose)
The 16.5 U are divided to:
- 7.5 U pre-breakfast (25%)
- 4.5 U pre-lunch (15%)
- 4.5 U pre-supper (15%)
83. 83
Pharmacotherapy :Type 1 DM
Monitoring
- Most Type 1 patients require
0.5-1.0 U/kg/d
- The initial regimen should be modified
based on:
- Symptoms
- SMBG
- HbA1C
85. 85
Pharmacotherapy :Type 1 DM
Insulin Pump Therapy
- This involves continuous SC administration of
short-acting insulin using a small pump
- The pump can be programmed to deliver basal
insulin and spikes of insulin at the time of the
meals
- Requires intense SMBG
- Requires highly motivated patients because
failure to deliver insulin will have serious
consequences
87. 87
II. Surgery
• Islet transplantation has been investigated as a
treatment for type 1 diabetes mellitus in selected
patients with inadequate glucose control despite
insulin therapy.
• Observations in patients with type 1 diabetes
indicate that islet transplantation can result in
insulin independence with excellent metabolic
control
Ref. Shapiro A.M. J., et al. N Engl J Med 2000; 343:230-238, Jul 27, 2000
88. 88
Diabetes Mellitus Complications
1. Hypoglycemia
- Cause: Missing meals or excessive exercise or too
much insulin
- Symptoms: Tachycardia, palpitation, sweating,
nausea, and vomiting. Progress to mental confusion,
bizarre behavior and coma
- Treatment: Candy or sugar
IV glucose
Glucagon 1 gm IM
- Identification: MedicAler bracelet
90. 90
Diabetes Mellitus Complications
3. Diabetes nephropathy
- 30-40 % of all type 1 DM patients develop
nephropathy in 20 years
- 15-20 % of type 2 DM patients develop nephropathy
- Manifested as:
- Microalbuminuria
- Progressive diabetic nephropathy leading to end-
stage renal disease
91. 91
Diabetes Mellitus Complications
Diabetes nephropathy (Cont’d)
- All diabetic patients should be screened annually for
microalbuminurea to detect patients at high risk of
developing progressive diabetic nephropathy
- Tight glycemic control and management of the blood
pressure can significantly decrease the risk of
developing diabetic nephropathy.
- ACE-inhibitors are recommended to decrease the
progression of nephropathy
92. 92
Diabetes Mellitus Complications
4. Diabetes neuropathy
Autonomic neuropathy:
- Manifested by orthostatic hypotension, diabetic
diarrhea, erectile dysfunction, and difficulty in
urination.
93. 93
Diabetes Mellitus Complications
5. Peripheral vascular disease and foot ulcer
Incidence of gangrene
of the feet in DM is 20
fold higher than control
group due to:
- Ischemia
- Peripheral neuropathy
- Secondary infection
94. 94
Special Patient Population
1. Adolescent Type 2 DM
- Type 2 DM is increasing in adolescent
- Lifestyle modification is essential in these patients
- If lifestyle modification alone is not effective,
metformin the only labeled oral agent for use in
children (10-16 years)
95. 95
Special Patient Population
2. Gestational DM
- Dietary control
- If blood glucose is not controlled by dietary control,
insulin therapy is initiated
- One dose of NPH or NPH + regular insulin (2:1) given
before breakfast. Adjust regimen according to SMBG.
- Sulfonylureas: Effective, but require further studies to
demonstrate safety.
96. 96
Special Situations
3. Diabetic ketoacidosis
- It is a true emergency
- Usually results from omitting insulin in type 1 DM or
increase insulin requirements in other illness (e.g.
infection, trauma) in type 1 DM and type 2 DM
- Signs and symptoms:
- Fatigue, nausea, vomiting, evidence of
dehydration, rapid deep breathing, fruity breath
odor, hypotension and tachycardia
97. 97
Special Situations
Diabetic ketoacidosis (Cont’d)
- Diagnosis
- Hyperglycemia, acidosis, low serum
bicarbonate, and positive serum ketones
- Abnormalities:
- Dehydration, acidosis, sodium and
potassium deficit
- Patient education is important
98. 98
Special Situations
Diabetic ketoacidosis (Cont’d)
Management:
- Fluid administration: Rapid fluid administration to
restore the vascular volume,
- IV infusion of insulin to restore the metabolic
abnormalities. Titrate the dose according to the blood
glucose level.
- Potassium and phosphate can be added to the fluid if
needed.
Follow up:
- Metabolic improvement is manifested by an
increase in serum bicarbonate or pH.