Case studies in the managment of type 2 diabetes NasserAljuhani
Case 1:Poorly controlled type 2 diabetes on triple oral therapies
Case 2:Morning hypoglycemia on premixed InsulinCase 3
Case 3:Newly diagnosed D.M Type1D.M or type 2 D.M ?
Case studies in the managment of type 2 diabetes NasserAljuhani
Case 1:Poorly controlled type 2 diabetes on triple oral therapies
Case 2:Morning hypoglycemia on premixed InsulinCase 3
Case 3:Newly diagnosed D.M Type1D.M or type 2 D.M ?
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopitalUsama Ragab
Inpatient Diabetes Management
By Dr. Usama Ragab Youssif
Lecturer of Medicine Zagazig University
Why we need this lecture?
Diabetes inhospital is common problem
Increased diabetes morbidities
Increased mortality
Cross hypersensivity to NSIADs, Allergic and pseudoallergic reactions.Utai Sukviwatsirikul
Cross hypersensitivity of NSAIDs
Allergic and pseudoallergic reactions
source of info: http://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/423_18_3.pdf
To Treat or Not to Treat.
This is a frequent question we encounter in practice. Here's looking into the latest studies on whether treating patients with Asymptomatic Hyperuricemia with urate lowering therapy helps improves cardiovascular outcomes.
การใช้ยาในสตรีมีครรภ์และมารดาที่ให้นมบุตร
(Drug used in pregnancy and lactation)
อ.ภญ.นันทวรรณ กิติกรรณากรณ์
แหล่งข้อมูล
http://phamacy.nkh.go.th/Doc/Lactation.pdf
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopitalUsama Ragab
Inpatient Diabetes Management
By Dr. Usama Ragab Youssif
Lecturer of Medicine Zagazig University
Why we need this lecture?
Diabetes inhospital is common problem
Increased diabetes morbidities
Increased mortality
Cross hypersensivity to NSIADs, Allergic and pseudoallergic reactions.Utai Sukviwatsirikul
Cross hypersensitivity of NSAIDs
Allergic and pseudoallergic reactions
source of info: http://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/423_18_3.pdf
To Treat or Not to Treat.
This is a frequent question we encounter in practice. Here's looking into the latest studies on whether treating patients with Asymptomatic Hyperuricemia with urate lowering therapy helps improves cardiovascular outcomes.
การใช้ยาในสตรีมีครรภ์และมารดาที่ให้นมบุตร
(Drug used in pregnancy and lactation)
อ.ภญ.นันทวรรณ กิติกรรณากรณ์
แหล่งข้อมูล
http://phamacy.nkh.go.th/Doc/Lactation.pdf
Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.[2] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications.[3] Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma.[4] Serious long-term complications include cardiovascular disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.[3]
Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.[5] There are three main types of diabetes mellitus:
Type 1 DM results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.[3]
Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[3] As the disease progresses a lack of insulin may also develop.[6] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.[3]
Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood-sugar levels.[3]
Prevention and treatment involve a healthy diet, physical exercise, maintaining a normal body weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care are important for people with the disease. Type 1 DM must be managed with insulin injections.[3] Type 2 DM may be treated with medications with or without insulin.[7] Insulin and some oral medications can cause low blood sugar.[8] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM.[9] Gestational diabetes usually resolves after the birth of the baby
This presentation is all about the well-known disease "Diabetes". I have tried to focus on the molecular level of the disease, and I've discussed in detail the proteins and genes related in the process. I definitely looked through many references, watched many videos and read many articles about it. I was pretty much confused, but thanks to God, I was finally able to put together all I had learned into a nice, neat PowerPoint presentation. Wether you are a college student seeking a presentation about diabetes, or maybe just a normal person wanting to get some info, maybe a patient with diabetes, then you should be in the right place. My presentation should help you get through!
I have first begun with an introduction to the disease, including some data from International Diabetes Federation to show the huge number of people worldwide having diabetes.
I have then talked about how our body functions normally without diabetes. This will help you understand what goes wrong during the disease.
After that, I have discussed both type 1 and type 2 diabetes and what causes each type at a molecular level as well as talking about some differences.
Then I've come to talk about symptoms and complications of diabetes. The signs that could indicate someone has diabetes, and if someone has it for a long time, it's going to have impact on the various body systems and cause other diseases - known as complications. So I have also made clear what the complications of diabetes are in very easy to understand diagrams.
Finally, I have talked about how diabetes may be diagnosed and what the possible treatments are for each type. I've used many graphics in my presentation, so I'm sure you're going to enjoy studying it!
Teneligliptin the next generation gliptinAKSHATA RAO
Teneligliptin , one of the emerging gliptins have established its prowess among the gliptin giants like Sitagliptin Vildagliptin and Linagliptin. Proven to be safe in renally compromised patients, this one is to watch out for.
Diabetic control
55 year old male with t2DM for 5 years and history of ischemic stroke 3 years ago
BMI 29, HbA1 8.5%
Current medication: metformin 3 g/d, glibenlamide 20 mg/d, pioglitazone 30 mg/d
23. HbA1c goals
• Short duration of
diabetes
• T2DM treated with
lifestyle or metformin
• Long life expectancy
• No cardiovascular
disease
<6.5%
• Most non pregnant
adult
• Reduce
microvascular
complications in
T1DM and T2DM
• Reduce mortality in
T1DM
< 7%
• History of severe
hypoglycemia
• Limited life expectancy
• Advanced micro-
vascular or
macrovascular
complications
• Extensive comorbid
conditions
• Long-standing diabetes
< 8%
58. Risk factors for
patients with diabetes
Dyslipidemia
Hypertension
Smoking
Family history of premature coronary disease
Presence of albuminuria
62. Lipid management
Lifestyle modification
Weight loss
Reducing intake of saturated fat, trans fat, and cholesterol
Increasing intake of omega-3 fatty acids, viscous fiber, and plant
stanols or sterols
Increasing physical activity
Start when
TG ≥ 150 mg/dL
HDL < 40 mg/dL in men
HDL < 50 mg/dL in women
IF TG ≥ 500 mg/dL medication
63.
64.
65. Antiplatelet agents
Aspirin therapy , dose 75 to 162 mg/d
Primary prevention strategy
Recommend in patients with T1DM and T2DM who are at
increased cardiovascular risk (10- year risk >10%) (C rating)
Not recommend in low ASCVD risk (10- year risk < 5 %)
Clinical judgment is necessary for patients with diabetes < 50
years and have several other risk factors (for example, 10-year
ASCVD risk of 5% to 10%)
Editor's Notes
Screening เบาหวานที่ GA 24-28 wk
1st step 75 OGTT
2nd step กิน 50 g nonfast ต่อด้วย 100 g OGTT
DM ขณะตั้งครรภ์ ต้อง screen เพื่อหา persistent diabetes at 6-12 wk หลังคลอด และ screen ทุก 3 ปี
Glycemic index การจัดลำดับอาหารคาร์โบไฮเดรต ม่ผลต่อระดับน้ำตาลในเลือดมากน้อยเพียงใดหลังกินอาหารชนิดนั้น 1-2 hr
GI สูง จะดูดซึมเร็วกว่า ทำให้ระดับน้ำตาลในเลือดสูงกว่าอาหารที่มี GI ต่ำ
อาหารที่มี GI ต่ำ จะถูกย่อยช้า ทำให้กลูโคสปล่อยเข้าไปในกระแสเลือดช้าๆ ค่าสูงสุดคือ 100
ปลา กินเพื่อให้ได้ omega 3
Moderate: can talk but cannot sing , เดินเร็ว ว่ายน้ำเร็ว ปั่นจักรยานอยู่กับที่แบบไม่ฝืด ตัดหญ้า เต้นแอโรบิกเบาๆ
Viforous: can’t say more than few words at a time ออกกำลังกายต่อเนื่องในโรงยิม ปั่นจักรยานอยู่กับที่แบบฝืด ปั่นจักรยานแข่งขัน
The activity can be in 1 session or several sessions lasting 10 minutes or more.
insulin secretagogue กระตุ้นให้มีการหลั่งอินซุลินจากตับอ่อนเพิ่มขึ้น
Glinide: repaglinide
SU : First generation drugs include acetohexamide, carbutamide, chlorpropamide, glycyclamide (tolhexamide), metahexamide, tolazamide and tolbutamide.
Second generation drugs include glibenclamide (glyburide), glibornuride, gliclazide, glipizide
Third generation drugs include glimepiride,
TZD ห้ามให้ในคนที่มีประวัติเป็นโรค heart failure : glitazone
DPP 4 inhibitor : glinide : sitagliptin, vildagliptin
SGLT 2 inhibitor : empagliflozin, canagliflozin, dapagliflozin, ipragliflozin
Human insulin โครงสร้างเหมือนอินซูลินที่คนสร้างขึ้น
Insuin analog ดัดแปลง human insulin ให้ออกฤทธิ์ตามต้องการ
SU : First generation drugs include acetohexamide, carbutamide, chlorpropamide, glycyclamide (tolhexamide), metahexamide, tolazamide and tolbutamide.
Second generation drugs include glibenclamide (glyburide), glibornuride, gliclazide, glipizide
Third generation drugs include glimepiride,
TZD ห้ามให้ในคนที่มีประวัติเป็นโรค heart failure : glitazone
DPP 4 inhibitor : glinide : sitagliptin, vildagliptin
SGLT 2 inhibitor : empagliflozin, canagliflozin, dapagliflozin, ipragliflozin
Atherosclerotic cardiovascular disease
acute coronary syndrome,
a history of myocardial infarction,
stable or unstable angina,
coronary or other arterial revascularization,
stroke,
transient ischemic attack, or
peripheral arterial disease (PAD)