Type 1 diabetes is an autoimmune disease characterized by the body's inability to produce insulin. It results from the destruction of insulin-producing beta cells in the pancreas. The disease presents with symptoms of hyperglycemia and if left untreated can lead to serious acute complications such as diabetic ketoacidosis. Management involves insulin therapy, dietary changes, exercise, glucose monitoring and patient education to prevent acute complications and reduce the risk of long-term complications affecting the eyes, kidneys, nerves and cardiovascular system. Strict glycemic control is important for improving health outcomes and quality of life.
Neonatal hypoglycemia and hyperglycemia Dr vijitha ASVijitha A S
Neonatal hypoglycemia and hyperglycemia BY Dr VIJITHA A S
Hypoglycemia is most common metabolic problem seen in newborns
No universally accepted definition ; Hypoglycemia cut off variable
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
Neonatal hypoglycemia and hyperglycemia Dr vijitha ASVijitha A S
Neonatal hypoglycemia and hyperglycemia BY Dr VIJITHA A S
Hypoglycemia is most common metabolic problem seen in newborns
No universally accepted definition ; Hypoglycemia cut off variable
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
Diabetes mellitus is a disease caused by deficiency or diminished effectiveness of endogenous insulin. It is characterised by hyperglycaemia, deranged metabolism and sequelae predominantly affecting the vasculature.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Objectives :
1. Definition
2. Pathophysiology
3. Clinical Presentation
4. Diagnosis
5. Acute and Chronic complications eg; focusing on:
DKA: Triggering factors, Diagnosis and management
6. Management including:
Insulin therapy ( types, storage, injection sites, side effects and compliance.
Education (Diet, Exercise, Travelling, Schooling, Sick day management, HBGM).
7. Follow up
3. Type 1 diabetes is a chronic illness characterized by the
body’s inability to produce insulin due to the autoimmune
destruction of the beta cells in the pancreas. Although onset
frequently occurs in childhood, the disease can also develop
in adults.
Type 1 diabetes mellitus is a metabolic disorder characterized
by hyperglycemia due to absolute insulin deficiency.
Definition :
introduction
4. There are four stages in the development of Type 1 DM:
1. Preclinical period with positive β-cell antibodies
2. Hyperglycemia when 80-90% of the β- cells are destroyed.
3. Transient remission (honeymoon phase).
4. Establishment of the diseas
Pathophysiology of Type 1 DM
5. Etiology and pathophysiology
• It is polygenic disease .
• Progressive destruction of pancreatic cells.
• Autoantibodies cause a reduction of 80% to 90% of normal cell function
before manifestations occur.
• Up to 90% of patients will have autoantibodies to at least one of 4 antigens:
1- Glutamic acid decarboxylase (GAD).
2- insulin.
3- tyrosine-phosphatase-like molecule, islet auto-antigen-2
4- β-cell-specific zinc transporter 8 autoantibodies.
6. Pathophysiology:
Pathogenesis of Type 1A DM is explained on the basis of 3
mutually-interlinked mechanisms:
Pathogenesis of Type 1B DM remains idiopathic.
A. Genetic susceptibility.
B. Autoimmune factors.
C. Certain environmental factors.
7. Genetic issues :
o Monozygotic twins have 60% lifetime concordance for developing IDDM (insulin
dependent DM) .
o Dizygotic twins have an 8% risk of concordance, which is similar to the risk among
other siblings
o The frequency of diabetes developing in children with a diabetic mother is 2-3% and
5-6% if the father has IDDM
o The risk to children rises to almost 30% if both parents are diabetic.
o HLA class II molecules DR3 & DR4 are associated strongly with IDDM (risk
developing other autoimmune endocrinopathies & celiac disease in positive DR3)
11. Full history and physical examination
Initial evaluation and testing
Basic metabolic panel
CBC
Diagnosis
• Eelectrolytes , urinalysis
• Venous or arterial blood gas
• Liver function tests, and calcium, magnesium,
phosphorus
12. Random blood sugar test. This is the primary screening test for type 1
diabetes. A blood sugar level of 200 (mg/dL), or 11.1 (mmol/L), or higher
suggests diabetes.
Glycated hemoglobin (A1C) test.
An A1C level of 6.5 percent or higher on two separate tests indicates
diabetes.
Fasting blood sugar test. A fasting blood sugar level of 126 mg/dL (7.0
mmol/L) or higher suggests type 1 diabetes.
Diagnostic tests of diabetes in children:
(Criteria)
13. The diagnosis of type 1 diabetes is often obvious from the clinical
presentation, but can be confirmed through additional testing:
In addition to the Diagnostic Criteria :
1- Low C-peptide levels
2- Presence of one or more autoimmune markers are consistent
with a diagnosis of type 1 diabetes
15. 15
Acute complications of diabetes mellitus
Diabetic
ketoacidosis
Diabetic nonketotic
hyperosmolar coma
Hypoglycemia
16. Diabetic keto acidosis DKA :
• It is one of the acute complication of the
type 1 DM and sometime it is the first
presentation of the patient.
• Occurs in the absence of insulin and
Results in metabolic acidosis.
• characterized by hyperglycemia,
ketoacidosis, and ketonuria
17. 17
Diabetic ketoacidosis (DKA)
May be the 1
st
presentation of type 1 DM.
Mortality rate around 5%.
Result from absolute insulin deficiency or increase requirement.
Major, life-threatening complication of diabetes characterized by
hyperglycemia, ketoacidosis, and ketonuria.
18. 18
Predisposing factors for DKA
o Inappropriate withdrawal insulin
o Low socioeconomic status
o Delayed diagnosis
o young age
o Infection
o Stress
o Others
19. 19
Pathogenesis
=> glycosuria,
osmotic diuresis &
dehydration
Hepatic glucose
production increase ↑ &
↓glucose utilization of
peripheral tissue
Insulin decrease↓
Lead to the release of free
fatty acid into circulation
from fatty tissue.
Unrestrained hepatic fatty acid
oxidation to ketone bodies (β-
hydroxybutyrate, acetone,
acetoacetate)
=> resulting in ketonemia
and metabolic acidosis.
21. Diagnosis
• The diagnosis of DKA is based on identification of the biochemical triad of
hyperglycaemia, acidaemia and ketonaemia/ketonuria.
• Immediate investigations to establish diagnosis of DKA:
o Laboratory glucose: > 11.0 mmol/L
o Venous/arterial blood gas: pH < 7.3 or bicarbonate < 15 mmol/L
o Ketone testing: capillary blood ketone ≥ 3 mmol/L or *urinary ketones +++ or above
22.
23. Investigations
The main investigations in the management of DKA include a laboratory
glucose, venous/arterial blood gas and a ketone measurement (blood/urine).
Nevertheless, a full set of investigations are essential to properly assess for any DKA precipitants
and monitor for complications (e.g. electrolyte derangements, acute kidney injury).
Bedside tests
• ECG
• Urinalysis +/- MSU
• Urinary pregnancy test
Blood tests
• FBC
• U&Es
• CRP
• LFTs
• Blood cultures
• Troponin
Imaging
• Chest X-ray
27. 27
Hypoglycemic coma
Hypoglycemia is the level of blood glucose at
which autonomic and neurological dysfunction
begins
Hypoglycemia is the most frequent acute complication in
diabetes.
31. 31
Treatment of hypoglycemia
In mild cases oral rapidly
absorbed carbohydrate
In sever cases (comatose patient)
iv hypertonic glucose 25% or 50%
concentration
Glucagons injection
35. Nephropathy by ACR (albumin creatinine ration ) > 30-300 mg/g (give ACE inhibitors ) .
Retinopathy : by ophthalmologist >> if severe non-proliferative retinopathy or worse
and/or diabetic macular edema >> Laser treatment (photocoagulation ) and intravitreal
injections of anti-VEGF agents reduce the rate of visual loss.
Neuropathy >> by neurological examination .
Screening of the chronic complication (Nephropathy , Neuropathy , Retinopathy)
should start from age 11 years with 2 to 5 years diabetes duration.
36. Strict glycemic control.
Control the blood pressure.
Control the lipid profile.
Limitation of protein diet.
Prevention of chronic complication by:
42. 42
Storage of insulin
Store at room temperature ( 15 - 25 c ) after use .
Rapid acting in use should be stored at 4c .
43. 43
Six Essential Tips for Storing Insulin
2 4
31
Do not keep in
hot places.
Do not leave
in sunlight.
Write the date down
Never use insulin
if expired.
Do not keep in
freezing places.
5
6
Inspect your insulin
before each use
47. 47
Diabetes education
“Diabetes education is an interactive process that facilitates
and supports the individual and/or their families, those who
provide care or significant social contacts to acquire and
apply the knowledge, confidence, and practical, problem
solving and coping skills, needed to manage their life with
diabetes in order to achieve the best possible outcomes
within their own unique circumstances”
48. 48
Collaborative Care to Achieve Control of DM1
Patient teaching
Nutritional therapy
Drug therapy
,
Exercise
Self-monitoring of
blood glucose
Sick day management
49. - Physician
- Diabetic educator
- Dietician
- Patient parents
- Psychologist /
psychiatric
- Social worker
To Achieve Tight Control of
DM1 By 2 ways : Components of
Therapy ( education )
49
Diabetic Team
Approach
insulin
exercise
nutrition
50. HEALTH
1- Equipment and supplies needed to effectively manage insulin
therapy at home:
• Insulin
• Syringes or pen needles
• Blood glucose meter and strips
• Lancets and lancing device
• Glucagon emergency kit
• Contact information of diabetes care provider
Patient education : Insulin therapy
51. HEALTH
Patient education : Insulin therapy
2- What Patients Need to Know About Insulin and Delivery
Devices:
• Storage and expiration
• When it should be refrigerated
• When it can be at room temperature
• When medication expires after first use
• How to prepare product for first use
• How to properly use the device
• How to dispose of the device
53. HEALTH
• Current dietary management of diabetes emphasizes a healthy, balanced diet
that is high in carbohydrates and fiber and low in fat.
• The following are among the most recent dietary consensus recommendations
(although they should be viewed in the context of the patient’s culture) :
Nutrition therapy
Should provide 50-55% of daily energy intake :Carbohydrate intake should emphasize
nutrient-dense carbohydrate sources that are high in fiber, including vegetables, fruits,
legumes, whole grains, as well as dairy products.
1- Carbohydrates
54. Nutrition therapy
2- Fat
• Should provide 30-35% of daily energy intake
• diet rich in monounsaturated and polyunsaturated fats may be considered to improve
glucose metabolism and lower cardiovascular disease risk and can be an effective
alternative to a diet low in total fat but relatively high in carbohydrates
• Should provide 10-15% of daily energy intake
3- Protein
55. HEALTH3- Eexercise
Regular physical activity ≥3 times per week for ≥60 minutes
each time should be encouraged for all children with diabetes
56. HEALTH4- Home self-monitoring of glucose
tracks immediate and daily levels of glucose control.
Helps to determine immediate and ongoing basal and bolus insulin
requirements.
Detects hypoglycemia and assists in its management.
Assists in the appropriate management of hyperglycemia.
Helps guide insulin adjustments to decrease glucose fluctuations.
57. HEALTH4- Home self-monitoring of glucose
• For most patients who require insulin, HMBG is recommended two to four
times daily (usually before meals and at bedtime).
• For patients who take insulin before each meal, SMBG is required at least
three times daily before meals To determine each dose.
58. 58
Sick day management
sick day :A sick day is when there is illness or infection.
this needs to make changes to usual diabetes management plan to
keep blood glucose levels fin normal level
59. 59
Sick day management
Some illnesses, especially those associated with fever, raise blood glucose levels because
of higher levels of stress hormones promoting glycogenolysis, gluconeogenesis, and insulin
resistance.
Illness often increases ketone body production due to inadequate insulin levels and the
counter-regulatory hormone response.
In contrast, illness associated with vomiting and diarrhea (eg, viral gastroenteritis) may
lower glucose levels with the increased possibility of hypoglycemia rather than
hyperglycemia.
Why it’s important to manage sick days
60. 60
Sick day guidelines in management
. 5. Treat any
underlying,
precipitating
illness.
4. Monitor and
maintain hydration
with adequate salt
and water balance
3. DO NOT
STOP INSULIN
2-More frequent
blood glucose
and ketone
(blood or urine)
monitoring.
1- Sick day guidelines
including insulin
adjustments, should be
taught soon after
diagnosis and reviewed
at least annually with
patients and family
members in order to
reduce risk for DKA and
for severe hypoglycemia
(with GI illnesses).
61. Patient with diabetes Follow up
interval medical history,
assessment of medication- “taking behavior and intolerance/ side effects”
physical examination
laboratory evaluation as appropriate to assess attainment of A1C and metabolic targets,
assessment of risk for complications
diabetes self-management behaviors, nutrition, psychosocial health
and the need for referrals, immunizations, or other routine health maintenance screening.
If tests are normal for diabetes , repeat testing carried out at a minimum of 3-year intervals
is reasonable.
Most components of the initial comprehensive medical evaluation
including:
For people with type 1 diabetes and type 2 diabetes who are prescribed a flexible insulin therapy program, education on how to use carbohydrate counting and in some cases how to consider fat and protein content to determine meal time insulin dosing is recommended to improve glycemic control.