This document discusses the impact of diabetes on COVID-19. It notes that diabetes increases the risk of severe complications from COVID-19 due to factors like higher expression of ACE2 receptors and pre-existing vascular damage. The pathogenesis of COVID-19 infection is worse in diabetics due to immune dysregulation and an impaired immune response. Good management of blood glucose levels and prevention of hyperglycemia is important for diabetics who contract COVID-19.
COVID-19, CORONA VIRUS, SARS.MERS, HUMAN CORONA VIRUS, CHARACTERISTICS OF CORONA VIRUS, HISTORY OF EPIDEMICS, TIMELINE OF COVID 19 OUTBREAK, GLOBAL SITUATION, INDIAN SITUATION, RISK ASSESSMENT OF COVID 19, SIGN AND SYMPTOMS, COMPLICATION, DIAGNOSIS, MANAGEMENT, PREVENTION, HAND HYGIENE, PPE, ONGOING RESEARCH OF ICMR, ISOLATION, QUARANTINE, SOCIAL DISTANCING
COVID-19, CORONA VIRUS, SARS.MERS, HUMAN CORONA VIRUS, CHARACTERISTICS OF CORONA VIRUS, HISTORY OF EPIDEMICS, TIMELINE OF COVID 19 OUTBREAK, GLOBAL SITUATION, INDIAN SITUATION, RISK ASSESSMENT OF COVID 19, SIGN AND SYMPTOMS, COMPLICATION, DIAGNOSIS, MANAGEMENT, PREVENTION, HAND HYGIENE, PPE, ONGOING RESEARCH OF ICMR, ISOLATION, QUARANTINE, SOCIAL DISTANCING
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
Acute and Chronic Bronchitis is amongst most common presenting illness for Family Physicians considering its prevalence in all ages. Revisiting it with perspective of a family physician helps improve understanding and management at Family PRactice
Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.
There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices.
COVID-19 can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS. Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs.
Reducing saturated fat intake for cardiovascular disease: What's the evidence? Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effect of reducing saturated fat intake for cardiovascular disease. Click here for access to the audio recording for this webinar: https://youtu.be/Zwe_JF7Aqb8
Lee Hooper, Reader in Research Synthesis, Nutrition & Hydration in the Norwich Medical School at the University of East Anglia lead the session and presented findings from her latest Cochrane review:
Hooper L., Martin N., Abdelhamid A., & Smith G.D. (2015). Reduction in saturated fat intake for cardiovascular disease . Cochrane Database of Systematic Reviews, 2015, CD011737.
Public health recommendations for fat reduction and modification as prevention of cardiovascular disease have changed little over time. This Cochrane review examines the effect of reducing saturated fat intake through modification on cardiovascular morbidity and mortality through 15 randomised control trials. 17 comparisons with 59,000 participants demonstrate a 17% (RR 0.83; 95% CI 0.72 to 0.96) reduction of cardiovascular events by reducing dietary saturated fat. This webinar will examine the effect of replacing saturated fat with carbohydrate, polyunsaturated and monounsaturated fat on cardiovascular morbidity and mortality, and explore future recommendations.
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
Acute and Chronic Bronchitis is amongst most common presenting illness for Family Physicians considering its prevalence in all ages. Revisiting it with perspective of a family physician helps improve understanding and management at Family PRactice
Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.
There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices.
COVID-19 can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS. Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs.
Reducing saturated fat intake for cardiovascular disease: What's the evidence? Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effect of reducing saturated fat intake for cardiovascular disease. Click here for access to the audio recording for this webinar: https://youtu.be/Zwe_JF7Aqb8
Lee Hooper, Reader in Research Synthesis, Nutrition & Hydration in the Norwich Medical School at the University of East Anglia lead the session and presented findings from her latest Cochrane review:
Hooper L., Martin N., Abdelhamid A., & Smith G.D. (2015). Reduction in saturated fat intake for cardiovascular disease . Cochrane Database of Systematic Reviews, 2015, CD011737.
Public health recommendations for fat reduction and modification as prevention of cardiovascular disease have changed little over time. This Cochrane review examines the effect of reducing saturated fat intake through modification on cardiovascular morbidity and mortality through 15 randomised control trials. 17 comparisons with 59,000 participants demonstrate a 17% (RR 0.83; 95% CI 0.72 to 0.96) reduction of cardiovascular events by reducing dietary saturated fat. This webinar will examine the effect of replacing saturated fat with carbohydrate, polyunsaturated and monounsaturated fat on cardiovascular morbidity and mortality, and explore future recommendations.
Covid-19 is a disease caused by SARS-CoV-2 that can trigger what doctors call a respiratory tract infection. It can affect the upper respiratory tract, viz. sinuses, nose, and throat or lower respiratory tract, viz. windpipe, and lungs. Severe cases can lead to serious respiratory disease, and even pneumonia.
On January 30, 2020, the WHO declared the Covid-19 outbreak a global health emergency. On March 11, 2020, the WHO declared it a global pandemic.
I have tried to create awareness about causes, types and symptoms of diabetes. As millions of people are sufferings from this disease, so this article will be helpful to control the sugar level.
While talking about diabetes, you may be frightened from the idea that you may have it. Or maybe, you may have it in the future. You want to know if you are at risk to develop diabetes and anxiously you’re looking to find if you have any diabetes symptoms.
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Mellitus is Latin for “sweet as honey”.
Pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.
The Pancreas secretes insulin and Glucagon directly into the blood stream.
It also secretes digestive enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.
Insulin and Glucagon have opposite effects on liver and other tissues for controlling blood-glucose levels.
More people die annually from medication errors than from workplace injuries. An error in the prescribing, dispensing, administration of a drug irrespective of whether such errors lead to adverse consequences or not. In India, Medication Error is just a TERM and its significance is undervalued and remains unreported. Reported incidence of this iatrogenic disease related to medication error- tip of the iceberg. medication error can be visualized with the SWISS CHEESE MODEL OF SYSTEM accidents
Medication errors are described under prescription errors, transcription errors, administration errors. Based on the causes of errors the NCC MERP Index is formulated to categorize medication errors from Category A- I. Appropriate monitoring, good team communication, knowledgeable staff, RCA and policy on check of medication errors can reduce its incidence and make patient more safe.
Most people have been accustomed to believe that "Size Matters”. Men experience stress if they feel they fall short of average size. Men tend to conceptualize that they will be more attractive to their counterpart (partner) (or perceived to be more manly/masculine) if they possess a larger penile size. However, this is largely untrue.
It is essential to keep in mind that there is no “normal” when it comes to size of penis. Too small or too large penis occupy only 1% of the population while rest lie at average size. Concern about the penile size can be of major stress and may proceed to have sexual dysfunction in men who tend to think that they have small penis. The major dilemma is that many men perceive that the "average penis" is actually larger than what they actually possess. Various research studies reveal that female counterparts inclined to prefer penises of average size as compared to a large penis.
Once a male completes his puberty, the penis size is more or less "set." According to a research study conducted in 2014 on more than 15,000 men published in The British Journal of Urology, the average size of flaccid penis is 3.61 inches long and 3.67 inches in circumference, while the average size of erect penis coming in at 5.17 inches long and 4.59 inches in circumference.
It’s interesting to know that, even though the official averages are revealed, it doesn’t mean a man’s penis will be of exactly same size at every moment in his life. While most men would rather be a bit above average than below, there’s nothing wrong with having a penis below the average size – it is an average after all, so 50% of men will. Having a larger penis may not always be a good thing. In fact, a 2015 study found that, among 75 women surveyed, one of every 15 had left a relationship because their partner's penis size was "too large”
Women perceive penis size much differently than men do. What men think is small, she probably perceives as average, and what he consider average, she probably thinks is pretty big. That’s because unlike men, she doesn’t experience any penis size related anxiety.
Moreover a women’s vagina is only around 3 or 4 inches, which may expand to 4 or 5 when a woman is aroused. Too big size could be discomfort and painful. A larger penis poses similar risks in MSM who have anal sex, including an increased risk of HIV.
In a study of heterosexual people published in the British Journal of Urology International, 85% of women were satisfied with the size of their partner’s penis, while 45% of men thought that their own penis was too small. It is important to remember there is no “normal” when it comes to penis size. Remember that penis shouldn’t control one’s life, and hopefully, some of the researches prove that a below-average penis is not the end of the world and larger size doesn’t bring all the sexual pleasures. But if you’re truly unsatisfied, there are safe and effective ways to increase the size of your penis – its not end of the world
Constipation is the symptom and is associated with primary & Secondary causes. Constipation is defined as occurrence of >3 episodes of bowel movements. the Rome III criteria defines the objective classification and bristol stool chart helps in assessing the type of stools passed. Management of constipation deals with early assess, treating the cause, adjuvant management, Pharmacological Management (laxatives, suppositories & enemas) and following constipation prevention bundle.
High prevalence of hypertension in older persons (nearly one of two subjects aged >60 years). It is a significant and often asymptomatic chronic disease. HTN is a major cause of morbidity and mortality among aged. Hypertension in older adults is generally defined by SBP ≥ 140 mmHg or DBP ≥ 90 mmHg over two clinic visits (systolodiastolic HTN)
Isolated systolic hypertension (ISH): SBP of ≥140 with a DBP of <90 mm Hg.
The recognition and treatment of HTN should be a priority among elderly. Controlled, RCTs have shown that treatment of hypertension decreases the incidence of complications in older adults.
Introduction and pathophysiology of hypertension in elderly. Differences among hypertension in adults and elderly in terms of symptoms, treatment consideration. Issues and Challenges among elderly patients. Stroke among Elderly population. Issues and challenges in stroke elderly population.
Communication with ICU patients: Knowing their needsPrabhjot Saini
Need and barriers in Communication among ICU patients who are aphasic. Consequences of failed communication. Discussion on various methods and assistive devices to communicate. Discussion on the development & usability of a self structured communication chart as method of easy communication with ICU patients on ventilators.
Lifestyle modifications in Diabetes mellitusPrabhjot Saini
Lifestyle choices in Diabetes mellitus patients, current factors, Dietary modifications, exercises, alcohol and smoking cessation, stress management and personal and foot care required to manage diabetes and blood sugar levels
Brain Death concepts, Its changes and life after brain death, is the body still alive?? what are the determinants of brain death and who can declare it, bio ethical dimensions of nursing care in BD
Foe whatever the physical virtues of maleness, longeivity is not among them. Every year, almost 1,00,000 men are dying prematurely compared to 66,000 women. Women live longer than men
Evidence Based Nursing Practice: Current Scenario & eay forwardPrabhjot Saini
Explains about Research practice gap, present scenario, research utilization, constraints & barriers for research utilization, how to find evidences for EBP and strategiesto do it
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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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
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
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!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. Impact of Diabetes On
Covid-19
DR. PRABHJOT SAINI BSN MSN PhD(Nursing)
PROFESSOR & PRINCIPAL
SKSS COLLEGE OF NURSING
SARABHA, LUDHIANA, PUNJAB
email: psaini.dr@gmail.com , skssconsarabha@gmail.com
2. Lots of questions ponder our minds:
Who contacts covid infection?
Who is at higher risk?
What makes diabetics and elderly more at risk?
What should be done to prevent infection in diabetic population?
What is the mortality rate among diabetics suffering from covid-
19
How can we manage the complications?
3. Unit objectives
Introduction
Covid 19 : current scenario
Epidemiology
Covid & Diabetes
Pathogenesis of covid among diabetes
Control of diabetes
Management among diabetes during covid infection
5. Covid-19
The novel coronavirus
First identified in Wuhan, China in Dec’ 2019
It is an enveloped RNA virus
Also called severe respiratory syndrome coronavirus
(SARS-CoV-2)
SARS-CoV, MERS-CoV and SARS-CoV-2 can cause
severe disease, whereas HKU1, NL63, OC43 and 229E
are associated with mild symptoms
SARS-CoV-2 causes the disease COVID-19 Corona
Virus Disease- 2019 (COVID-19)
6. Covid-19: An overview
COVID-19 (Coronavirus Disease-2019) is caused by the coronavirus
SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), which
has spread quickly to more than 160 countries across the world.1
The spreading mechanism of the virus is primarily by transmission of
respiratory droplets between people.1
The incubation time is on average 6–8 days, followed by 1–2 weeks of
symptomatic disease.
10. What we know about COVID-19?
Spreads faster and more efficiently than cold and flu viruses
A person with COVID might infect up to 2-4 people compared with
1-2 for other viruses
85-90% will “easily” recover within 2 weeks
Worldwide, severe disease in people over 60, greater in men,
diabetes and other chronic health conditions
11. What we don’t know about Covid-19?
How long it has been here?
How many of us has been exposed
or already immune?
Seasonality
Will it “burn out” with
warm weather?
Smoking
How it affect risk?
India difference
Why do risk factors
and strain so different
than other countries
14. Are people with diabetes at risk for COVID-19?
The COVID-19 infection is a double challenge for people with diabetes.
Diabetes has been reported to be a risk factor for the severity of the
disease
Much attention has been focused on people with diabetes because of poor
prognosis in those with the infection.
Initial reports were mainly on people with type 2 diabetes, although
recent surveys have shown that individuals with type 1 diabetes are also
at risk of severe COVID-19.
The reason for worse prognosis in diabetes- multifactorial (syndromic
nature of diabetes).
15. Are people with diabetes at risk for COVID-19?
Age, sex, ethnicity, comorbidities such as hypertension and
cardiovascular disease, obesity, and a pro-inflammatory and pro-
coagulative state all contribute to the risk of worse outcomes.
Glucose-lowering agents and anti-viral treatments can modulate the risk
19. If I am a diabetic patient....
I may get infection just
like any other…
but if I get it....
I may have more
severe complications
20. Current CDC : Definition of High risk
Those at high risk for severe illness from COVID-19 include:
People aged >65 years
People living in nursing home or long-term care facility
Other high risk conditions could include:
People with chronic lung disease or moderate/severe asthma
People who have heart diseases with complications
People who are immunocompromized
People of any age with a BMI>40 or underlined medical condition, particularly if not well controlled, such
as those with diabetes, renal failure or liver disease might also be at high risk.
People who are pregnant should be monitored since they are known to be at risk with severe viral illness
(lack of evidence)
29. Pathogenesis:
Diabetes with covid infection
I. AMPLIFICATION
On beta cell of langerhans in pancreas: ACE 2 receptors increase expression due to
hyperglycemia
Increases attachment of coronavirus: causing more infection
Increase viral load in beta cells causing its destruction
II. VASCULAR PERFUSION
Hyperglycemia (increased glucose will attach to proteins) and stick on Endothelial cells
of artery (known as non-enzymatic glycosylation) –normally shouldn’t attach
Glycation moves down to basement membrane and cause atherosclerosis in arteries
Plaque is formed, blood vessels become narrow and thicken
Cause reduced blood supply to organs like kidneys, tissues, liver, lungs, etc thus
reducing supply of immune cells at target organ of infection.
30. Pathogenesis:
Diabetes with covid infection
III. INSULIN RESISTANCE
Diabetes mellitus causes decreased glucose inside cells: causing lack of energy
Resulting in adipocytes releasing free fatty acids
FFA get into cells, causing insulin resistance further leading to reduced
glucose uptake
Causing reactive oxygen species (ROS)
Leading to damage of cells – damage increases multiple folds in covid-19
infection
31. Pathogenesis:
Diabetes with covid infection
IV. IMMUNE DYSREGULATION
Type of response that we get in the immune system- immune dysregulation (suppressed
response)
1. Acidic enviornment – less CHO causing acid production, ketones produced, cellular
enzymes not function properly. Immune cells cannot function correctly
2. Immune system is not coordinated: In presence of COVID -Macrophages, neutrophil
cells and CD4 cells are weakened and increased of IL-17 causes pro-inflammatory cells
(promote unnecessary inflammatory response causing damage
3. Binding to endothelium by non enzymatic glycation
32. Pathogenesis
During COVID infection in lungs in diabetic patients
The immune system will not work properly
Leading to chemotaxis, diapedesis of Blood vessels happen and inflammatory cells
are not able to reach in appropriate amount to area of infection
In hyperglycemia
Calcium influx occurs in cells- causing cells (poly-morphonuclear cells) function to
reduce
Lower ATP in cells- no energy in immune cells (macrophages) to destroy the corona
cells
More fatty acids causing –insulin resistance
Beta defensive function is reduced in viral infection by covid. Causing immune cell
function goes down
Macrophage becomes suppressed in diabetes causing T helper 17 cells becomes
active-pro-inflammatory cells become active causing cytokine storm leading to
dysregulation (vit D consumption reduced pro-inflammatory effect)
36. Time-in-Range : Blood glucose regulation
Time-in-Range” (TIR) is the percentage of time that a person spends
with their blood glucose levels in a target range.
The range will vary depending on the person, but general guidelines
suggest starting with a range of 70 to 180 mg/dl.
45. Diabetes & Covid-19: Management
Stay calm
Know what to do
I. Preparation
II. Prevention
III. Know emergency sypmtoms
IV. Be watchful of ketoacidosis
46. Preparedness
Preparation
Purchance additional non-perishable food and supplies,
Extra medication
Glucometer & test strips
Glucagon
Ketone & test strips
Sugary & non-sugary fluids
Simple carbohydrates for treating hypoglycemia
Electrolyte tablets
47. Prevention
Stop the spread of infection
Wash hands frequently and thoroughly
Disinfect “high touch” surfaces & objects in home regularly
Cover mouth during cough & sneezes with tissue, and wash
hands
Keep a distance of atleast six feet with others
Stay home as much as possible
Closely monitor blood glucose levels (keep in time range)
Continue taking insulin or diabetes medication
Stay hydrated with fluids
48. Seek medical attention
Difficulty breathing
Persistant pain or pressure in the chest
Confusion/ inability to stay alert
Bluish lips or face
56. Exercise in DIABETES ! A FEW
ALERTS!!
Keep exercising as per routine: keep social
distancing at all times
Do Not Exercise :
In full or empty stomach
When insulin action is at peak
Under extremes of temperature
During other illnesses
If blood sugar is over 250 and ketones present
Is chest pain occurs during exercise
57.
58. “Sick Day”
Avoid dehydration : when vomiting, diarrhea, fever, extreme
temperatures
Drink plenty of fluids
Prevent hypoglycemia
Maintain and check blood glucose, BP
Do not stop any medication till advised
59.
60. When to test for ketones?
If blood sugar is high (>16mmol)
Check urine or blood ketones every 4hours
If taking SGLT2 inhibitors , get test of ketones if hyperglycemia
More insulin may be administrered to correct hyperglycemia
61. Self-education/management of diabetes in
COVID-19 pandemic
PWD follow their “current routine” including
checking feet daily,
keeping to a healthy diet,
and keeping active.
The interventions generally fall into four categories:
text-message;
mobile phone app;
web or computer-based;
self-monitoring of blood glucose.
62.
63.
64.
65.
66.
67.
68.
69. Summary
Diabetes patients have impaired immune-response to infection.
No risk of getting it, however there could be increased risk of complications after
getting positive
Poor glycaemic control impairs several aspects of the immune response to viral
infection and also to the potential secondary infection in the lungs.
Poor glycaemic control is a risk factor for covid-19 infection and adverse outcomes.
However, the reverse is also true and the risk of infection, including covid-19, can be
reduced through good glycaemic control.
70. Covid and diabetes can cause loss of glycaemic control, and treatment of
hyperglycaemia is difficult during intercurrent disease
To maintain optimal glycaemic control requires more frequent blood glucose
monitoring
In many patients with type 2 diabetes, insulin treatment will be preferred and need
to be initiated.
In patients with type 1 diabetes, the insulin doses should be titrated using
frequent glucose and ketone monitoring to avoid hypoglycaemia in patients
71. Diabetes patients to treat for COVID-19, may need increased
requirement of hospitalisation.
Patients with diabetes need intensive attention to reduce the risk of
fatalities.
Patients with diabetes should follow the general prevention advice
given by the authorities thoroughly to avoid infection with COVID-19.
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Coronavirus is for ages … as it causes flu, but this strain of virus is new which could be dangerous for human beings
Doesn’t mean every patient with diabetes will be at risk, and everyone will be fatal
Time-in-Range” (TIR) is the percentage of time that a person spends with their blood glucose levels in a target range. The range will vary depending on the person, but general guidelines suggest starting with a range of 70 to 180 mg/dl.
Time-in-Range” (TIR) is the percentage of time that a person spends with their blood glucose levels in a target range. The range will vary depending on the person, but general guidelines suggest starting with a range of 70 to 180 mg/dl.
Sodium glucose transport protein inhibitor
Glucagon like peptides
Never stop insulin even though diet and exercise is ok
