This document discusses diagnostic criteria and management strategies for diabetes mellitus. It outlines diagnostic thresholds for fasting plasma glucose, 2-hour post-glucose levels, and HbA1c that define normal, prediabetes, and diabetes states. Management involves glycemic control through diet, exercise, oral medications, insulin therapy, and treatment of associated conditions like hypertension and dyslipidemia, with goals of preventing complications. Intensive glucose control is important to delay microvascular and macrovascular disease progression.
This document discusses various laboratory tests used for the diagnosis and monitoring of diabetes, including the oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), glycated albumin, fructosamine assay, and C-peptide assay. It provides details on each test, including what they measure, indications for use, limitations, and normal/abnormal ranges. It also outlines recommendations from diabetes organizations for screening and diagnosing both type 1 and type 2 diabetes using blood glucose criteria and HbA1c levels.
LAB DIAGNOSIS N INVESTIGATION OF DIABETES MELLITUS.madhursejwal
The document outlines the diagnostic criteria for diabetes mellitus, including having a fasting plasma glucose level of 126 mg/dL or higher, symptoms of hyperglycemia with a casual plasma glucose of 200 mg/dL or higher, or a 2 hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also lists the WHO criteria for diagnosing metabolic syndrome which includes having any two of the following: diabetes, high blood pressure, high triglycerides or low HDL cholesterol, central obesity, or insulin resistance. The document notes that microalbuminuria, lipid profiles, electrolytes, lactate, C-peptide levels, and evaluating complications are also important for diagnosis.
Laboratory diagnosis of Diabetes mellitus Monika Nema
This document summarizes Dr. Monika Nema's presentation on laboratory diagnosis and monitoring of diabetes mellitus. It discusses various laboratory tests used for diagnosis of diabetes including estimation of blood glucose, oral glucose tolerance test, and glycated hemoglobin (HbA1c). It also describes tests used to assess glycemic control such as periodic HbA1c measurement and self-monitoring of blood glucose. Laboratory tests for screening and diagnosis of gestational diabetes are also summarized.
Hypoglycemia is defined as a glucose level below 55 mg/dL with symptoms relieved by raising glucose levels. It can occur in diabetes due to excessive insulin or missed meals, and in non-diabetics due to drugs, critical illness, or tumors. Symptoms include autonomic symptoms like sweating and tremors, and neuroglycopenic symptoms like confusion and drowsiness. Treatment involves oral glucose if able, or IV glucose and glucagon injections. Prevention focuses on glucose monitoring, education, flexible regimens, and glycemic goals tailored to each individual.
This document provides information on diabetes mellitus (DM), including its classification, differences between type 1 and type 2 DM, etiology, pathophysiology, and genetics. It discusses that DM is classified based on the pathogenic process causing hyperglycemia into type 1 and type 2. Type 1 DM results from beta cell destruction leading to insulin deficiency, while type 2 DM ranges from insulin resistance with relative deficiency to a secretory defect with resistance. The document outlines the etiology and pathophysiology of both types of DM in detail. It also addresses the genetic considerations for type 1 DM.
This document provides current guidelines for the diagnosis of diabetes. It defines diabetes and outlines the main types and stages. It describes the diagnostic tests used, including A1C, fasting plasma glucose and oral glucose tolerance tests. Criteria for diagnosing diabetes and prediabetes are provided. Guidelines are given for testing asymptomatic adults and children. Targets for glycemic control in nonpregnant adults are also summarized.
glucose tolerance test indication and procedurePrakash Mishra
The glucose tolerance test involves measuring blood glucose levels before and after consuming a glucose drink, to evaluate a person's ability to metabolize glucose. It is used to help diagnose diabetes and evaluate hypoglycemia. During the test, fasting blood glucose is measured and the patient drinks a glucose solution. Further blood samples are taken over 2-3 hours to analyze the glucose curve and see how quickly levels return to normal. Abnormal curves can indicate diabetes, renal glycosuria, or other conditions. Precise procedures, interpretations, and clinical significance are provided.
Diabetes mellitus is a disease characterized by high blood glucose levels due to the body's inability to produce or properly use insulin. There are two main types of diabetes - Type 1 is caused by an autoimmune destruction of insulin-producing beta cells, while Type 2 is associated with insulin resistance and impaired insulin secretion. Both types result in insufficient insulin and subsequent hyperglycemia. The document provides historical context on diabetes and outlines the roles of insulin, pancreatic hormones, and the metabolic processes involved in both healthy and diabetic states.
This document discusses various laboratory tests used for the diagnosis and monitoring of diabetes, including the oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), glycated albumin, fructosamine assay, and C-peptide assay. It provides details on each test, including what they measure, indications for use, limitations, and normal/abnormal ranges. It also outlines recommendations from diabetes organizations for screening and diagnosing both type 1 and type 2 diabetes using blood glucose criteria and HbA1c levels.
LAB DIAGNOSIS N INVESTIGATION OF DIABETES MELLITUS.madhursejwal
The document outlines the diagnostic criteria for diabetes mellitus, including having a fasting plasma glucose level of 126 mg/dL or higher, symptoms of hyperglycemia with a casual plasma glucose of 200 mg/dL or higher, or a 2 hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also lists the WHO criteria for diagnosing metabolic syndrome which includes having any two of the following: diabetes, high blood pressure, high triglycerides or low HDL cholesterol, central obesity, or insulin resistance. The document notes that microalbuminuria, lipid profiles, electrolytes, lactate, C-peptide levels, and evaluating complications are also important for diagnosis.
Laboratory diagnosis of Diabetes mellitus Monika Nema
This document summarizes Dr. Monika Nema's presentation on laboratory diagnosis and monitoring of diabetes mellitus. It discusses various laboratory tests used for diagnosis of diabetes including estimation of blood glucose, oral glucose tolerance test, and glycated hemoglobin (HbA1c). It also describes tests used to assess glycemic control such as periodic HbA1c measurement and self-monitoring of blood glucose. Laboratory tests for screening and diagnosis of gestational diabetes are also summarized.
Hypoglycemia is defined as a glucose level below 55 mg/dL with symptoms relieved by raising glucose levels. It can occur in diabetes due to excessive insulin or missed meals, and in non-diabetics due to drugs, critical illness, or tumors. Symptoms include autonomic symptoms like sweating and tremors, and neuroglycopenic symptoms like confusion and drowsiness. Treatment involves oral glucose if able, or IV glucose and glucagon injections. Prevention focuses on glucose monitoring, education, flexible regimens, and glycemic goals tailored to each individual.
This document provides information on diabetes mellitus (DM), including its classification, differences between type 1 and type 2 DM, etiology, pathophysiology, and genetics. It discusses that DM is classified based on the pathogenic process causing hyperglycemia into type 1 and type 2. Type 1 DM results from beta cell destruction leading to insulin deficiency, while type 2 DM ranges from insulin resistance with relative deficiency to a secretory defect with resistance. The document outlines the etiology and pathophysiology of both types of DM in detail. It also addresses the genetic considerations for type 1 DM.
This document provides current guidelines for the diagnosis of diabetes. It defines diabetes and outlines the main types and stages. It describes the diagnostic tests used, including A1C, fasting plasma glucose and oral glucose tolerance tests. Criteria for diagnosing diabetes and prediabetes are provided. Guidelines are given for testing asymptomatic adults and children. Targets for glycemic control in nonpregnant adults are also summarized.
glucose tolerance test indication and procedurePrakash Mishra
The glucose tolerance test involves measuring blood glucose levels before and after consuming a glucose drink, to evaluate a person's ability to metabolize glucose. It is used to help diagnose diabetes and evaluate hypoglycemia. During the test, fasting blood glucose is measured and the patient drinks a glucose solution. Further blood samples are taken over 2-3 hours to analyze the glucose curve and see how quickly levels return to normal. Abnormal curves can indicate diabetes, renal glycosuria, or other conditions. Precise procedures, interpretations, and clinical significance are provided.
Diabetes mellitus is a disease characterized by high blood glucose levels due to the body's inability to produce or properly use insulin. There are two main types of diabetes - Type 1 is caused by an autoimmune destruction of insulin-producing beta cells, while Type 2 is associated with insulin resistance and impaired insulin secretion. Both types result in insufficient insulin and subsequent hyperglycemia. The document provides historical context on diabetes and outlines the roles of insulin, pancreatic hormones, and the metabolic processes involved in both healthy and diabetic states.
This document discusses hypoglycemia, including its definition, causes, symptoms, management and prevention. It defines hypoglycemia as low blood glucose levels that cause symptoms which resolve with increased glucose levels. Hypoglycemia is common in type 1 diabetes and can be caused by insulin excess, missed meals, exercise or other medical conditions. Symptoms range from autonomic reactions like sweating to neuroglycopenic effects like confusion. Management involves recognizing symptoms, treating with fast-acting carbohydrates, and educating patients to prevent future episodes.
This document discusses hypoglycemia, defining it as low plasma glucose levels leading to symptoms that are resolved by raising glucose levels. It notes hypoglycemia is common in type 1 diabetes and less frequent in type 2 diabetes. The defenses against hypoglycemia are impaired in diabetes due to defective insulin, glucagon, and epinephrine responses. Recent low blood sugar can cause hypoglycemia-associated autonomic failure, increasing risk of future episodes. Causes of hypoglycemia include medications, medical conditions, and nonislet cell tumors.
This document summarizes the regulation of blood glucose levels. It discusses how blood glucose levels fluctuate after meals and during fasting states. The pancreas plays a key role by secreting hormones like insulin and glucagon that work to maintain normal blood glucose levels. Insulin promotes glucose uptake by cells to lower blood glucose, while glucagon has the opposite effect of raising blood glucose levels. The body uses negative feedback loops and other hormones to precisely control blood glucose levels through processes like glycogenesis and glycogenolysis in the liver.
This document defines and describes various types of diabetes. It begins by defining diabetes mellitus as a chronic disease related to abnormal insulin production or utilization. The two most common types are type 1 and type 2 diabetes. Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells and requires lifelong insulin treatment. Type 2 diabetes is caused by insulin resistance and relative insulin deficiency and accounts for over 90% of diabetes cases. Other types discussed include gestational diabetes and secondary/prediabetes. The document provides detailed information on the pathogenesis, clinical presentation, diagnosis and management of the different diabetes types.
Glycated hemoglobin (HbA1c) is a form of hemoglobin used primarily to identify a person's average blood glucose level over the past 3 months. HbA1c is formed through a non-enzymatic process as glucose binds to the hemoglobin in red blood cells. The HbA1c test measures the amount of glycated hemoglobin and provides an indication of a person's blood glucose control over the past 120 days (3 months), which corresponds to the average lifespan of red blood cells. Several methods can be used to measure HbA1c levels including HPLC, immunoassay, and boronate affinity chromatography.
Unit 7 : Carbohydrates metabolism & disordersDrElhamSharif
This document provides an overview of carbohydrate metabolism and disorders by Dr. Elham Sharif. It covers objectives, carbohydrate classification and functions, glucose metabolism pathways, hormonal control of glucose levels, normal blood glucose and urine glucose levels, hormones that affect blood glucose, abnormalities in carbohydrate metabolism including lactose intolerance and hypoglycemia, causes and symptoms of diabetes mellitus, and classification of diabetes into type 1 and type 2. The key topics covered include glucose regulation by insulin and glucagon, glucose metabolism pathways in the body, and abnormalities related to carbohydrate metabolism and diabetes.
This document discusses diabetes mellitus, including its diagnosis, types, complications, management, and treatment. It defines diabetes as a chronic disorder resulting from insulin deficiency or abnormal insulin function. There are three main types - type 1 caused by autoimmune destruction of beta cells, type 2 often associated with obesity and aging, and gestational diabetes during pregnancy. Complications arise from long-term hyperglycemia and include damage to various organs. Management involves dietary changes, physical activity, medication including insulin when needed, and treating complications.
This document provides information for diabetes educators on self-monitoring of blood glucose (SMBG). It explains that SMBG, as part of diabetes self-management education and support, can help patients understand the importance of monitoring, interpreting results, and maintaining a logbook to improve diabetes care. The document then answers frequently asked questions about how to properly use a glucometer, when to test blood glucose levels, normal ranges, and what to do if levels are too high or too low. It emphasizes the importance of keeping accurate records in a logbook to share with physicians.
This document provides information about the glucose tolerance test (GTT), including:
1. The GTT measures a person's body's ability to utilize glucose by analyzing blood glucose levels after a glucose dose is administered orally or intravenously.
2. It can help diagnose prediabetes or diabetes, especially when symptoms are present but blood sugar levels are normal. It is also used during pregnancy to check for gestational diabetes.
3. The test involves fasting overnight, drinking a glucose dose, and having blood drawn every 30 minutes for 2.5 hours to analyze the blood glucose curve and see how quickly glucose is cleared from the bloodstream. Abnormal curves can indicate diabetes or other conditions.
Detail information about Oral Glucose Tolerance Test.
Here we discuss about the type, indications, contra-indications, precautions, Medication avoiding, Nursing care plan, Risks of OGTT & explain the technique, procedures of doing the test. Thus OGTT is a very important test in medical field. Upgrade your knowledge by reading this. Thanks.
This document provides information about various diagnostic tests for diabetes, including glucose tolerance tests and glycated hemoglobin (HbA1c) tests. It discusses the different types of glucose tolerance tests, how they are performed and interpreted. It also outlines the use of HbA1c testing to assess long-term glycemic control in patients with diabetes and the guidelines for treatment targets based on HbA1c levels. Laboratory methods for measuring HbA1c are also mentioned.
The lipid profile is a group of blood tests that measure cholesterol and triglyceride levels to determine risk for heart disease. It includes measurements of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. High LDL ("bad") cholesterol increases risk of plaque buildup in arteries while high HDL ("good") cholesterol helps remove cholesterol from arteries. An abnormal lipid profile can indicate risk for conditions like atherosclerosis and help diagnose underlying issues like hyperlipidemia.
Hyperglycemia, or high blood sugar, occurs when the body has too little insulin or cannot use insulin properly to regulate blood glucose levels. Insulin moves glucose from the blood into cells where it is used for energy. Without enough insulin, glucose builds up in the blood. Hyperglycemia can be caused by diabetes, certain medications, critical illness, gestational diabetes, or other factors. High blood glucose levels over time can damage organs and blood vessels. Symptoms of hyperglycemia include increased thirst, frequent urination, blurred vision, and fatigue. Risks include dehydration, blood clots, pancreatitis, and long-term organ damage.
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.
A 76-year old man with diabetes and hypertension was brought to the emergency room in an unresponsive state. His blood sugar was low at 35 mg/dL. He was given dextrose which caused him to become responsive again. Hypoglycemia can be caused by issues with insulin secretion or counterregulation in diabetes. Symptoms range from autonomic to neuroglycopenic. Treatment involves ingestion of fast-acting carbohydrates for mild episodes or intravenous dextrose for more severe cases. Lifestyle changes and medication adjustments are also important to prevent future hypoglycemia.
This document discusses hyperglycemia and hypoglycemia. Hyperglycemia is an abnormally high blood glucose level and is a hallmark of diabetes. The main symptoms are increased thirst and frequent urination. Treatment involves controlling blood sugar levels through medication, diet, and exercise. Hypoglycemia is low blood glucose and can be caused by diabetes medications. Symptoms include confusion, weakness, and blurred vision. Treatment focuses on preventing and responding to low blood sugar episodes. Recent research has studied the effects of tea on blood sugar levels and the relationship between hypoglycemia and cognitive dysfunction.
Dr. Zeenat Hussain Foundation is working to create awareness against diseases like diabetes among the common people of Pakistan. This lecture is part of their campaign. The lecture discusses diabetes, including the different types of diabetes, symptoms, complications, diagnosis, management through lifestyle changes and medications, and prevention. Feedback from attendees is appreciated to help improve awareness efforts.
This document provides an overview of diabetes mellitus. It begins by defining type 2 diabetes and noting its increasing prevalence globally and in India. It then discusses the history and terminology of diabetes. The document outlines the anatomy and function of the pancreas and hormones insulin and glucagon. It describes the classification, risk factors, clinical presentation, diagnosis, and management of diabetes through medical nutrition therapy, oral hypoglycemic agents, and insulin.
The document outlines the diagnostic criteria for diabetes mellitus, including symptoms of excess urination and thirst plus random venous plasma glucose over 200 mg/dl or fasting venous plasma glucose over 126 mg/dl. It also describes a glucose tolerance test procedure involving a fasting blood sample, drinking 75g of glucose, and a 2-hour post-drink blood sample to diagnose diabetes if over 200 mg/dl. Reasons for delayed diabetes diagnosis include lack of awareness, negligence, economic factors, and access to medical services.
This document provides an overview of diabetes mellitus (DM), including its classification, pathogenesis, complications, diagnosis and treatment. DM is a group of metabolic disorders characterized by hyperglycemia and is classified as type 1 DM, type 2 DM, and other specific types. Chronic complications of DM can affect the eyes, kidneys, nerves, heart and blood vessels. Treatment involves patient education, medical nutrition therapy, exercise and medications like insulin and oral hypoglycemics to control blood glucose levels.
This document discusses hypoglycemia, including its definition, causes, symptoms, management and prevention. It defines hypoglycemia as low blood glucose levels that cause symptoms which resolve with increased glucose levels. Hypoglycemia is common in type 1 diabetes and can be caused by insulin excess, missed meals, exercise or other medical conditions. Symptoms range from autonomic reactions like sweating to neuroglycopenic effects like confusion. Management involves recognizing symptoms, treating with fast-acting carbohydrates, and educating patients to prevent future episodes.
This document discusses hypoglycemia, defining it as low plasma glucose levels leading to symptoms that are resolved by raising glucose levels. It notes hypoglycemia is common in type 1 diabetes and less frequent in type 2 diabetes. The defenses against hypoglycemia are impaired in diabetes due to defective insulin, glucagon, and epinephrine responses. Recent low blood sugar can cause hypoglycemia-associated autonomic failure, increasing risk of future episodes. Causes of hypoglycemia include medications, medical conditions, and nonislet cell tumors.
This document summarizes the regulation of blood glucose levels. It discusses how blood glucose levels fluctuate after meals and during fasting states. The pancreas plays a key role by secreting hormones like insulin and glucagon that work to maintain normal blood glucose levels. Insulin promotes glucose uptake by cells to lower blood glucose, while glucagon has the opposite effect of raising blood glucose levels. The body uses negative feedback loops and other hormones to precisely control blood glucose levels through processes like glycogenesis and glycogenolysis in the liver.
This document defines and describes various types of diabetes. It begins by defining diabetes mellitus as a chronic disease related to abnormal insulin production or utilization. The two most common types are type 1 and type 2 diabetes. Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells and requires lifelong insulin treatment. Type 2 diabetes is caused by insulin resistance and relative insulin deficiency and accounts for over 90% of diabetes cases. Other types discussed include gestational diabetes and secondary/prediabetes. The document provides detailed information on the pathogenesis, clinical presentation, diagnosis and management of the different diabetes types.
Glycated hemoglobin (HbA1c) is a form of hemoglobin used primarily to identify a person's average blood glucose level over the past 3 months. HbA1c is formed through a non-enzymatic process as glucose binds to the hemoglobin in red blood cells. The HbA1c test measures the amount of glycated hemoglobin and provides an indication of a person's blood glucose control over the past 120 days (3 months), which corresponds to the average lifespan of red blood cells. Several methods can be used to measure HbA1c levels including HPLC, immunoassay, and boronate affinity chromatography.
Unit 7 : Carbohydrates metabolism & disordersDrElhamSharif
This document provides an overview of carbohydrate metabolism and disorders by Dr. Elham Sharif. It covers objectives, carbohydrate classification and functions, glucose metabolism pathways, hormonal control of glucose levels, normal blood glucose and urine glucose levels, hormones that affect blood glucose, abnormalities in carbohydrate metabolism including lactose intolerance and hypoglycemia, causes and symptoms of diabetes mellitus, and classification of diabetes into type 1 and type 2. The key topics covered include glucose regulation by insulin and glucagon, glucose metabolism pathways in the body, and abnormalities related to carbohydrate metabolism and diabetes.
This document discusses diabetes mellitus, including its diagnosis, types, complications, management, and treatment. It defines diabetes as a chronic disorder resulting from insulin deficiency or abnormal insulin function. There are three main types - type 1 caused by autoimmune destruction of beta cells, type 2 often associated with obesity and aging, and gestational diabetes during pregnancy. Complications arise from long-term hyperglycemia and include damage to various organs. Management involves dietary changes, physical activity, medication including insulin when needed, and treating complications.
This document provides information for diabetes educators on self-monitoring of blood glucose (SMBG). It explains that SMBG, as part of diabetes self-management education and support, can help patients understand the importance of monitoring, interpreting results, and maintaining a logbook to improve diabetes care. The document then answers frequently asked questions about how to properly use a glucometer, when to test blood glucose levels, normal ranges, and what to do if levels are too high or too low. It emphasizes the importance of keeping accurate records in a logbook to share with physicians.
This document provides information about the glucose tolerance test (GTT), including:
1. The GTT measures a person's body's ability to utilize glucose by analyzing blood glucose levels after a glucose dose is administered orally or intravenously.
2. It can help diagnose prediabetes or diabetes, especially when symptoms are present but blood sugar levels are normal. It is also used during pregnancy to check for gestational diabetes.
3. The test involves fasting overnight, drinking a glucose dose, and having blood drawn every 30 minutes for 2.5 hours to analyze the blood glucose curve and see how quickly glucose is cleared from the bloodstream. Abnormal curves can indicate diabetes or other conditions.
Detail information about Oral Glucose Tolerance Test.
Here we discuss about the type, indications, contra-indications, precautions, Medication avoiding, Nursing care plan, Risks of OGTT & explain the technique, procedures of doing the test. Thus OGTT is a very important test in medical field. Upgrade your knowledge by reading this. Thanks.
This document provides information about various diagnostic tests for diabetes, including glucose tolerance tests and glycated hemoglobin (HbA1c) tests. It discusses the different types of glucose tolerance tests, how they are performed and interpreted. It also outlines the use of HbA1c testing to assess long-term glycemic control in patients with diabetes and the guidelines for treatment targets based on HbA1c levels. Laboratory methods for measuring HbA1c are also mentioned.
The lipid profile is a group of blood tests that measure cholesterol and triglyceride levels to determine risk for heart disease. It includes measurements of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. High LDL ("bad") cholesterol increases risk of plaque buildup in arteries while high HDL ("good") cholesterol helps remove cholesterol from arteries. An abnormal lipid profile can indicate risk for conditions like atherosclerosis and help diagnose underlying issues like hyperlipidemia.
Hyperglycemia, or high blood sugar, occurs when the body has too little insulin or cannot use insulin properly to regulate blood glucose levels. Insulin moves glucose from the blood into cells where it is used for energy. Without enough insulin, glucose builds up in the blood. Hyperglycemia can be caused by diabetes, certain medications, critical illness, gestational diabetes, or other factors. High blood glucose levels over time can damage organs and blood vessels. Symptoms of hyperglycemia include increased thirst, frequent urination, blurred vision, and fatigue. Risks include dehydration, blood clots, pancreatitis, and long-term organ damage.
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.
A 76-year old man with diabetes and hypertension was brought to the emergency room in an unresponsive state. His blood sugar was low at 35 mg/dL. He was given dextrose which caused him to become responsive again. Hypoglycemia can be caused by issues with insulin secretion or counterregulation in diabetes. Symptoms range from autonomic to neuroglycopenic. Treatment involves ingestion of fast-acting carbohydrates for mild episodes or intravenous dextrose for more severe cases. Lifestyle changes and medication adjustments are also important to prevent future hypoglycemia.
This document discusses hyperglycemia and hypoglycemia. Hyperglycemia is an abnormally high blood glucose level and is a hallmark of diabetes. The main symptoms are increased thirst and frequent urination. Treatment involves controlling blood sugar levels through medication, diet, and exercise. Hypoglycemia is low blood glucose and can be caused by diabetes medications. Symptoms include confusion, weakness, and blurred vision. Treatment focuses on preventing and responding to low blood sugar episodes. Recent research has studied the effects of tea on blood sugar levels and the relationship between hypoglycemia and cognitive dysfunction.
Dr. Zeenat Hussain Foundation is working to create awareness against diseases like diabetes among the common people of Pakistan. This lecture is part of their campaign. The lecture discusses diabetes, including the different types of diabetes, symptoms, complications, diagnosis, management through lifestyle changes and medications, and prevention. Feedback from attendees is appreciated to help improve awareness efforts.
This document provides an overview of diabetes mellitus. It begins by defining type 2 diabetes and noting its increasing prevalence globally and in India. It then discusses the history and terminology of diabetes. The document outlines the anatomy and function of the pancreas and hormones insulin and glucagon. It describes the classification, risk factors, clinical presentation, diagnosis, and management of diabetes through medical nutrition therapy, oral hypoglycemic agents, and insulin.
The document outlines the diagnostic criteria for diabetes mellitus, including symptoms of excess urination and thirst plus random venous plasma glucose over 200 mg/dl or fasting venous plasma glucose over 126 mg/dl. It also describes a glucose tolerance test procedure involving a fasting blood sample, drinking 75g of glucose, and a 2-hour post-drink blood sample to diagnose diabetes if over 200 mg/dl. Reasons for delayed diabetes diagnosis include lack of awareness, negligence, economic factors, and access to medical services.
This document provides an overview of diabetes mellitus (DM), including its classification, pathogenesis, complications, diagnosis and treatment. DM is a group of metabolic disorders characterized by hyperglycemia and is classified as type 1 DM, type 2 DM, and other specific types. Chronic complications of DM can affect the eyes, kidneys, nerves, heart and blood vessels. Treatment involves patient education, medical nutrition therapy, exercise and medications like insulin and oral hypoglycemics to control blood glucose levels.
The document reviews criteria for diagnosing diabetes and pre-diabetes, treatment goals, and therapeutic options. It discusses classifying diabetes types 1 and 2, criteria for diagnosis including HbA1c, fasting plasma glucose and oral glucose tolerance tests. Goals for glycemic control include HbA1c less than 7% and fasting/post-prandial blood glucose targets. Treatment options include lifestyle changes, metformin, other oral medications, and insulin to lower blood glucose and achieve goals.
Overview of Therapeutic options in Diabetes MellitusBarwon Health BPT
This document discusses various aspects of diabetes mellitus including diagnostic criteria, treatment targets, therapeutic options, insulin types, continuous subcutaneous insulin infusion, and inpatient management. It describes the differences between type 1, type 2, and LADA diabetes. First line treatment is usually metformin, but sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors are also discussed as therapeutic options. Insulin therapy including various insulin types is summarized. Inpatient management goals are outlined as well as HbA1c testing on hospital admission.
This document discusses the Transtheoretical Model of behavior change, also known as the Stages of Change Model. It describes the five stages of change that individuals progress through when modifying a problem behavior: pre-contemplation, contemplation, preparation, action, and maintenance. For each stage, goals for the patient and physician are provided, as well as approaches and techniques. The model was developed by Prochaska and DiClemente to understand how individuals intentionally change behaviors. The stages are not linear, as relapse can occur. The document also reviews the Decisional Balance technique, a counseling approach used to help patients weigh the pros and cons of behavior change.
Diabetic ketoacidosis is a life-threatening complication that occurs predominantly in patients with type 1 diabetes due to a lack of insulin. The body switches to burning fatty acids which produces acidic ketone bodies, causing symptoms like weakness, shortness of breath, fruity breath, confusion and abdominal pain. Diagnosis is based on high plasma glucose, low pH and bicarbonate levels, high anion gap, and strong urine and serum ketones. Treatment involves gradual fluid replacement, electrolyte correction, low-dose insulin therapy to gradually lower blood glucose levels, and treating any precipitating causes.
The document discusses diabetic ketoacidosis (DKA), providing information on its pathophysiology, classification, epidemiology, clinical manifestations, diagnosis, and treatment in individuals with type 1 diabetes mellitus. DKA results from a lack of insulin leading to hyperglycemia and ketone production. Its presentation includes vomiting, Kussmaul breathing, and if severe, cerebral edema. Treatment involves fluid resuscitation, electrolyte replacement, low-dose insulin infusion to resolve acidosis without rapidly lowering blood glucose, and careful monitoring to prevent cerebral edema.
The document discusses diabetic ketoacidosis (DKA), a life-threatening complication that occurs most often in patients with type 1 diabetes. DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis. It results from a lack of insulin and excess counterregulatory hormones that cause fat and protein breakdown. This leads to ketone accumulation and high blood glucose levels. Treatment involves insulin, intravenous fluids, electrolyte replacement, and monitoring for complications like cerebral edema.
This document contains a biochemistry quiz with multiple choice and short answer questions. The quiz covers topics like diseases, laboratory tests, enzymes, structures, techniques, and more. Each question is followed by the answer in the next page. There are a total of 55 questions and answers in the quiz document.
This document summarizes the clinical manifestations and complications of diabetes mellitus. It discusses the symptoms of type 1 and type 2 diabetes, including polyuria, polydipsia, weight loss, and ketoacidosis in type 1 patients. Acute complications covered are diabetic ketoacidosis, hyperglycemic hyperosmolar state, lactic acidosis, and hypoglycemia. Chronic complications are also briefly mentioned. The pathophysiology, clinical features, diagnosis, and management of diabetic ketoacidosis are described in detail.
This document contains a biochemistry quiz with multiple choice and short answer questions testing various concepts. Over 40 questions are presented across topics including enzyme reactions, protein synthesis, laboratory techniques, disease identification, biochemical structures and processes, and metabolic pathways. For each question, the corresponding answer is provided. The quiz covers foundational biochemistry content for medical students.
Glucose tolerance test- Indications, contraindications, preparation of a patient, precautions, types of GTT, normal curve, diabetic curve, renal glycosuria, lag curve, Criteria for diagnosis of DM
The document outlines management goals and treatment strategies for diabetes mellitus. The main goals are to eliminate hyperglycemia symptoms, reduce microvascular and macrovascular complications, and allow patients to achieve a normal lifestyle. To achieve these goals, physicians should identify an appropriate glycemic target for each patient and provide education, medications, and complication monitoring and treatment. Comprehensive diabetes care involves emphasis on nutrition, exercise, medication, and glycemic control monitoring, and often requires glucose-lowering medications.
This document provides treatment guidelines for diabetes mellitus. It discusses the types of diabetes, symptoms, complications, goals of treatment, and treatment options. Treatment involves lifestyle changes like diet and exercise. Pharmacological treatment starts with metformin for type 2 diabetes and insulin for type 1 diabetes. Insulin therapy is initiated at 0.4-1.0 units/kg/day for type 1 diabetes. Additional agents may be added if blood sugar levels remain uncontrolled. The goal of treatment is to achieve a hemoglobin A1c level below 7% through lifestyle management and medication adjustments.
Diabetes mellitus-treatment and psychiatric effectsMegha Isac
This document provides information on the diagnosis and management of diabetes mellitus. It defines the diagnostic criteria for diabetes as either a random blood glucose of 200 mg/dL or higher, a fasting plasma glucose of 126 mg/dL or higher, an A1C of 6.5% or higher, or a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also outlines treatment goals and management strategies, including lifestyle modifications, oral medications, and insulin therapies.
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
Approach to case of type 2 DM
lifestyle modificatios
indications to start drug therapy
classification of antidiabetic drugs , mechanism of action , adeverse drug effects , doses , drug interactions , how to add differents class of drugs to give combination therapy . over view insulin therapy
This document provides an overview of diabetes mellitus, including its definition, classification, pathophysiology, clinical features, diagnosis, treatment and complications. It defines DM as a group of metabolic disorders involving hyperglycemia due to defects in insulin secretion or action. DM is classified into type 1, type 2, gestational and other specific types. The pathophysiology of type 1 involves autoimmune destruction of beta cells, while type 2 results from insulin resistance and relative insulin deficiency due to genetic and lifestyle factors. Treatment involves medical nutrition therapy, oral hypoglycemic drugs, insulin therapy, exercise and monitoring of blood glucose and HbA1c levels. Complications can be microvascular (retinopathy, neuropathy, nephro
This document is a case study submitted by Reynel Dan L. Galicinao to their professor Prof. Maricar M. Mutia at Misamis University's Graduate School. It discusses diabetes mellitus-II with chronic kidney disease-IV, covering topics like insulin secretion and function, classifications of diabetes, diagnostic tests, and general procedures and treatment modalities. Key points include the different types of diabetes, factors that affect insulin and blood glucose levels, laboratory tests used to diagnose and monitor diabetes, and nursing considerations for administering those tests.
This document provides information on therapy for diabetes mellitus. It defines diabetes and describes its pathophysiology and complications. Risk factors and diagnostic tests are outlined. The goals of therapy are to control symptoms and prevent complications. Nonpharmacologic therapy involves diet, exercise and weight control. Pharmacologic options include insulin, oral hypoglycemics like sulfonylureas, biguanides, thiazolidinediones and others. Adverse effects of different drugs are also discussed.
DR. Wedad Bardisi DM Saudi Guideline.pptxFayzaRayes
Diabetes is a serious and growing problem in Saudi Arabia. Studies show prevalence of diabetes in Saudi Arabia is around 23-34%, and costs associated with diabetes and its complications place a significant burden on the healthcare system. The guidelines provide recommendations for screening, diagnosing, and managing diabetes through lifestyle changes and pharmacologic treatment. The guidelines recommend metformin as initial treatment and emphasize individualizing treatment based on patient factors. Glycemic targets of A1C <7% and fasting blood glucose 70-130 mg/dL are provided.
DR. Wedad Bardisi DM Saudi Guideline.pptxFayzaRayes
Diabetes is a serious and growing problem in Saudi Arabia. Studies show prevalence rates of 23-34% and costs of $3,686 more per person with diabetes annually. Guidelines recommend screening those over 40 every 3 years or those at high risk. Treatment begins with lifestyle changes and metformin, adding other oral drugs or insulin as needed to reach an A1C target of 7%. Insulin therapy is often required long-term for type 2 diabetes control. Low-dose aspirin is recommended for cardiovascular protection depending on age and risk factors.
This document provides an overview of diabetes mellitus, including its pathophysiology, classification, risk factors, symptoms, diagnostic criteria, management through nutrition, exercise, glucose monitoring, drug therapy including insulin and oral hypoglycemic agents, complications, and patient education. It describes the four main types of diabetes as type 1, type 2, gestational, and other specific types, and discusses the characteristics, causes, and treatment of each.
This document summarizes the pharmacotherapy of diabetes mellitus. It describes the types of diabetes, diagnostic criteria, goals of treatment, and various classes of medications used to treat diabetes. The main drug classes discussed include insulin, sulfonylureas, meglitinides, incretin mimetics, DPP-4 inhibitors, metformin, thiazolidinediones, and SGLT-2 inhibitors. For each class, the mechanisms of action, pharmacokinetics, indications, and side effects are summarized. The document provides an overview of current best practices for treatment and medication management of both type 1 and type 2 diabetes.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first recognized during pregnancy. The document discusses the definition, classification, screening, and management of GDM. It notes that GDM screening involves a 75 gram oral glucose tolerance test, with results over certain thresholds indicating GDM. Management of GDM may involve medical nutrition therapy, exercise, insulin, and in some cases oral hypoglycemic medications. Close monitoring of blood glucose levels and fetal growth is important. Women with GDM require postpartum testing to determine if diabetes persists after pregnancy.
A review of the investigation and management of diabetic ketoacidosis in newly diagnosed type I diabetes. Patient details have been changed and anonymised to protect the identity of the individual.
Dr gopal k shah m.d.consultant physician udhana surat gujaratDrgopal Shah
This document provides information on the diagnosis and management of type 2 diabetes mellitus. It discusses the different types of diabetes, risk factors for type 2 diabetes, acute and chronic complications, glucose monitoring techniques, lifestyle management including diet and exercise, oral and injectable drug therapies, and considerations for diabetes management in special populations and situations.
Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. DM prevalence in Saudi Arabia is high at 23.7%. DM is diagnosed based on classic symptoms and elevated blood glucose levels. Prediabetes conditions like impaired fasting glucose and impaired glucose tolerance are risk factors for future diabetes and cardiovascular disease. Glycemic goals aim for an A1C below 7% and treatment involves medical nutrition therapy, oral medications, insulin, and preventing complications. Management of DM focuses on controlling blood glucose, blood pressure, lipids, and screening for and treating common complications.
The document provides an overview of diabetes mellitus, including its classification, pathophysiology, risk factors, symptoms, diagnostic criteria, management through nutrition, exercise, glucose monitoring, drug therapy including insulin and oral hypoglycemic agents, and potential complications. It discusses the different types of diabetes in detail.
This document discusses diabetes mellitus and its management. It provides information on:
1) The classification and prevalence of diabetes in Saudi Arabia, finding an overall prevalence of 23.7% with higher rates in males.
2) The diagnostic criteria and thresholds for diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests. Screening is recommended for those over 45 or with risk factors.
3) Treatment involves lifestyle modifications, metformin as first line therapy, and additional oral medications or insulin as needed to achieve glycemic targets. Managing associated cardiovascular risk factors is also emphasized.
Anaesthetic Management of Diabetes Mellitus in Pediatricscairo1957
This document discusses the anesthetic management of pediatric diabetes mellitus. The key goals are providing balanced glycemic control to avoid hypoglycemia and hyperglycemia. Various insulin regimens and preparations are outlined. Preoperative assessment focuses on blood glucose, metabolic control, and electrolyte balance. Intraoperatively, blood glucose is closely monitored and IV insulin may be used. Postoperatively, the child's usual insulin or oral medication regimen is restarted once oral intake resumes. Hypoglycemia is avoided through careful glucose monitoring during all phases of care.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
1. Investigations of D.M :
American Diabetes Association Plasma Glucose Diagnostic
Criteria for Diabetes Mellitus:
Test Condition
------Plasma Glucose, mg/dL - -----
Diagnosis Fasting >_8 hr 2 hr after 75 g.
oral glucose
Normal <110 <140
Impaired glucose tolerance (lGT) <126 >_140 - <200
Impaired fasting glucose (lFG) >_110 - <126 <200
Diabetes mellitus >_ 126 ---
Diabetes mellitus <126 >_200
Diabetes mellitus (classic symptoms
+ casual plasma glucose,>200 mg/dL) ---- ----
2.
3.
1. Testing for diabetes should be considered in all persons at age 45
years and older; if results are normal, testing should be repeated at 3·yr
intervals.
2. Testing should be considered at younger ages or performed more
frequently in:
• are obese ( >_20% desirable body weight or a BMI >_25 kg/m2)
• have a first-degree relative with diabetes
• are members of a high-risk ethnic population (eg, African American.
Hispanic American, Native American, Asian American, Pacific Islander)
• have delivered a baby weighing >9 Ib or have a diagnosis of
gestational D.M
• are hypertensive (>_140/90 mm Hg)
• have an HDL cholesterol level <_35 mg/dL and/or a triglyceride level
>_250 mg/ dL
• were shown to have impaired glucose tolerance or impaired fasting
glucose
• have polycystic ovary syndrome
• have history of vascular disease
• are habitually physically inactive
4. Management
the strategies of RX. Include:
Glycemic control
diet & exercise
insulin therapy
oral agents
other therapies
treatment of associated conditions.
dyslipidemia
HT
obesity
CHD
treatment of complications
5. The goals of therapy :
(1) eliminate symptoms related to hyperglycemia,
(2) reduce or eliminate the long-term microvascular and
macrovascular complications of DM.
(3) allow the patient to achieve as normal a lifestyle as
possible. To reach these goals, the physician should
identify a target level of glycemic control for each
patient.
Index Goal
Glycemic control <11.1 mmol/L (200 mg/dL)
Hb A1C <7.0
Blood pressure <130/80
Lipids LDL <2.6 mmol/L (<100mg/dL)
HDL >1.1 mmol/L (>40 mg/dL)
TG <1.7 mmol/L (<150 mg/dL)
6. The care of an individual with either type 1 or type 2
DM requires a multidisciplinary team.
Central to the success of this team are the patient's
participation, which is essential for optimal diabetes
management.
Members of the health care team include the
primary care provider and/or the endocrinologist or
diabetologist, a certified diabetes educator, and a
nutritionist.
In addition, when the complications of DM arise,
subspecialists (including neurologists,nephrologists,
vascular surgeons, cardiologists, ophthalmologists,
and pediatrics) with experience in DM-related
complications are essential.
7. Diet & exercise :
Adherence to nutrition and meal-planning principles is a challenging but
essential component of successful diabetes management. Diet planning
should include lifestyle and nutrition goals as well as specific biochemical and
other physiologic parameters for the individual. Insulin requirements are then
matched to the patient's diet, not vice versa.
If type 2 diabetes is diagnosed and the patient is overweight. a diet that is
prudently low fat and low cholesterol should be started and an exercise
routine initiated but even a modest weight loss of 10- 20 pounds may
ameliorate the diabetes or cause its remission.
Before an exercise program is prescribed for anyone older than age 35. a
determination must be made that the heart is normal and that there are no
contraindications.
Bariatric surgery-surgery that promotes weight loss-is a popular option for
very obese individuals who are unresponsive to other forms of therapy. There
are 3 general techniques for bariatric surgery: restrictive surgery. which
restricts stomach volume; malabsorptive surgery. which minimizes the ability
of the gastrointestinal tract to absorb nutrients; and a combination of
restrictive and malabsorptive approaches.
8. Insulin therapy :
This therapy usually involves use of a longer-acting
insulin to maintain a baseline level and then use of a
rapid-acting insulin to cover meals.
Current insulin preparations are generated by
recombinant DNA technology and consist of the amino
acid sequence of human insulin. Animal insulin (beef or
pork) is no longer used. In the United States, most
insulin is formulated as U-100 (100 units/mL)
Regular insulin is the traditional rapid-acting agent used
for short-term coverage; however, the development of
very rapid-acting insulins allows diabetic patients the
convenience of timing injections just a few minutes
before meals.
9. Very rapid-acting insulins include
insulin lispro (Humalog),
insulin aspart (NovoLog),
and insulin glulisine (Apidra).
Isophane insulin suspension (NPH insulin) is an intermediate-acting insulin.
The newer long-acting insulins with very stable absorption
characteristics that result in a constant level of basal insulin include
Glargine (Lantus)
and detemir (Levemir)
Insulin zinc suspension (Lente insulin) and extended insulin zinc
(Ultralente insulin) are no longer available.
Premixed combinations of various insulins are also available for
patients less able to work with all these variables.
One commonly used regimen consists of twice-daily injections of a
long-acting insulin like NPH (detemir could be used instead) mixed
with a short-acting insulin before the morning and evening meal.
Such regimens usually prescribe two-thirds of the total daily insulin
dose in the morning (with about two-thirds given as long-acting
insulin and one-third as short-acting) and one-third before the
evening meal (with approximately one-half given as long-acting
insulin and one-half as short-acting).
10. Pharmacokinetics of Insulin Preparations
Time of Action
Preparation Onset, h Peak, h Effective Duration, h
Short-acting
Lispro <0.25 0.5–1.5 3–4
Aspart <0.25 0.5–1.5 3–4
Glulisine <0.25 0.5–1.5 3–4
Regular 0.5–1.0 2–3 4–6
Long-acting
NPH 1–4 6–10 10–16
Detemir 1–4 — 12–20
Glargine 1–4 — 24
Insulin Combinations
75/25– 75% protamine lispro, 25% lispro Up to 10–16
70/30– 70% protamine aspart, 30% aspart Up to 10–16
50/50– 50% protamine lispro, 50% lispro Up to 10–16
70/30– 70% NPH, 30% regular insulin 10–16
50/50– 50% NPH, 50% regular insulin 10–16
11. Continuous subcutaneous insulin infusion (CSII)
pumps allow even more physiologic levels of insulin
than do traditional injections. The pump tends to be
used when multiple-injection therapy fails.
Disadvantages include a higher cost, infection at
the infusion site, and infusion failure.
Complications of insulin therapy
• Hypoglycemia
• Lipodystrophy
• Local insulin allergy
• Generalized anaphylaxis, hives, and angioedema
may also develop.
• Immunologic insulin resistance may occur because
of production of insulin-neutralizing antibodies
12. Oral agents:
* Sulfonylureas:
The sulfonylureas have been widely used in the United States
and Canada since 1967 for treatment of type 2 diabetes. Their
major mechanism of action is stimulation of pancreatic insulin
secretion, although some studies have suggested a peripheral
augmentation of insulin action.
The most significant adverse effect of this drug is hypoglycemia,
which, though infrequent, may be severe and prolonged,
depending on the half-life of the specific drug.
Second-generation sulfonylurea are approximately 50-100 times
more potent than first-generation agents, and these drugs
generally need to be given only once daily.
13. *Biguanides
A major advance occurred with the development of metformin
(Glucophage. Glucophage XR). currently the only available
biguanide. Metformin improves insulin sensitivity. it may also
lead to modest weight loss or at least stabilization (in contrast to
the weight gain that may occur with use of insulin or
sulfonylureas).
In addition it is less likely to cause hypoglycemia and can be used
in nonobese patients.
Metformin is generally the first agent used in patients whose
hyperglycemia cannot be controlled with lifestyle changes alone.
Although metformin is generally very safe, patients may
complain of gastrointestinal tract symptoms, including a metallic
taste, nausea, and diarrhea. A more severe potential problem is
lactic acidosis. Although rare, this problem is more likely to occur
in patients with renal insufficiency.
14. * a-Glucosidase inhibitors
Acarbose (Precose) and miglitol (Glyset) are administered with meals to delay
digestion and absorption of carbohydrates by inhibiting the enzymes that
convert complex carbohydrates into monosaccharides.
Although relatively safe, these agents often cause flatulence, which limits
patient compliance, and they are to be avoided in patients with intestinal
disorders.
* Thiazolidinediones
This new class of orally active drugs, represented by rosiglitazone (Avandia)
and pioglitazone (Actos), is thought to increase insulin sensitivity in muscle and
adipose tissue and to inhibit hepatic gluconeogenesis, thereby increasing
glycemic control while reducing circulating insulin levels. These drugs also act
to increase insulin secretion.
The first available agent of this class, troglitazone (Rezulin), was withdrawn
from the market in 2000, when the FDA noted that this drug had a higher rate
of liver toxicity than did the other drugs. In 2010, the FDA significantly
restricted the use of rosiglitazone because of an increased risk of
cardiovascular complications in patients using this drug.
Both rosiglitazone and pioglitazone can cause weight gain, in part owing to
the proliferation of new adipocytes. Another problem is fluid retention, which
has been associated with cases of macular edema.
15. *Meglitinides
Repaglinide (Prandin) and nateglinide (Starlix) are meglitinides, whose
mechanism of action and side effect profile are similar to those of the
sulfonylureas. However, they are more expensive and generally no
more efficacious than the sulfonylureas.
Because of their rapid onset of action and short duration, these agents are
taken daily with meals. They can be used as Single agents or in
combination therapy with other oral hypoglycemic agents.
* Other therapies
Incretins are gut-derived factors that are released when nutrients
enter the stomach; they help to stimulate postprandial insulin
release. Incretin mimetics improve glycemic control by enhancing
pancreatic secretion of insulin in response to nutrient intake,
Inhibiting glucagon secretion and promoting early satiety. Two
recently approved injectable incretin mimetics are exenatide
(Byetta). used as adjunctive therapy for patients with type 2
diabetes who are inadequately controlled by oral agents. and
pramlintide (Symlin). a synthetic analogue of amylin. used in
patients treated with mealtime insulin.
16. Dipeptidyl peptidase IV (DPP-IV) is an enzyme that
deactivates bioactive peptides including incretins;
therefore inhibiting this enzyme can enhance glucose
regulation. Sitagliptin (Januvia) is an oral DPP-IV
inhibitor that requires only once a day dosing. But it is
expensive. only modestly effective. and not commonly
used.
Glucose transport inhibitors are a new class of drugs.
Glucose is filtered in the renal glomerulus and
reabsorbed in the proximal tubule. Beyond a certain
threshold (usually 160- 180 mgldL). it is excreted in the
urine. Glucose transport inhibitors prevent the
reabsorption and thereby increase the loss of glucose in
the urine. The lost calories then cause weight loss and
improved blood glucose values.
17. Pharmacokinetics of Oral Hypoglycemic Drugs
Drug Usual Daily Dose, mg Dosing per Day
First-generation sulfonylureas
Acetohexamide 500-750 Once or divided
Chlorpropamide (Dabinese) 250-500 Once
Tolbutamide (Orinase) 1000-2000 Once or divided
Second-generation sulfonylureas
Glipizide (Glucotrol) 2.5-10 Once or divided
(Glueotrol XL) 5-10 Once
Glyburide (DiaBeta, Micronase, 2.5-10 Once or divided
Glynase)
Glimepiride (Amaryl) 2-4 Once
Biguanides
Metformin (Glucophage, 1500-2550 Twice to 3 times
Glueophage XR)
a-Glucosidase inhibitors
Acarbose (Precose) 150-300 3 times
Miglitol (Glyset) 150-300 3 times
Thiazolidinediones
Rosiglitazone (Avandia) 4-8 Once or divided
Pioglitazone (Actos) 15-45 Once
Meglitinides
Repaglinide (Prandin) 2-16 3 times w/meals
Nateglinide (Starlix) 360 3 times w/meals
Other
Sitagliptin (Januvia) 100 Once
19. Pancreatic transplantation
For type I diabetic patients, pancreas transplantation
can be performed in conjunction with renal
transplantation.
With modern techniques and immunosuppression,
there is a high transplant survival rate, and the
majority of patients become euglycemic without the
need for insulin.
Islet cells can be injected directly into the liver
without the need for formal transplantation. This
procedure has been attempted in humans, but
rejection leads to a high failure rate. Studies are under
way to identify effective immunosuppressive regimens
as well as other sites for cell placement. Islet cell-
producing stem cell research is still at a basic stage.
20. The Importance of Glucose Control
³ The Diabetes Control and Complications Trial showed that
intensive therapy aimed at maintaining near-normal glucose
levels had a large and beneficial effect on delaying the
development and retarding the progression of long-term
complications for type 1 diabetic patients. Intensive therapy
decreased the risk of the development and progression of
retinopathy, nephropathy, and neuropathy by 40%-76%..
³ A related study, the United Kingdom Prospective Diabetes Study
(UKPDS), was designed to assess the effect of intensive control
on patients with type 2 diabetes. The UKPDS showed a reduction
in complications. the risk of retinopathy progression rises almost
exponentially as the HbA1c increases. However, patients who
decrease their HbAjc by 1 percentage point (eg, from 8% to 7%)
decrease the risk of retinopathy approximately 30%, and this
benefit holds for other diabetic complications, such as
nephropathy and neuropathy.
21. ³ For patients with type 1 diabetes, intensive control also
provides protection against macrovascular
complications, such as cardiovascular disease. For
patients with type 2 diabetes, A recent study,
suggested that intensive glycemic control in patients
with type 2 diabetes might actually increase the risk of
cardiovascular mortality.
³ Studies have shown that poor control can increase the
rate of retinopathy progression after cataract surgery
and blunt the treatment response to laser for diabetic
macular edema.
22. Guidelines for Ongoing Medical Care for Patients with
Diabetes:
† Self-monitoring of blood glucose (individualized frequency)
† HbA1C testing (2–4 times/year)
† Patient education in diabetes management (annual)
† Medical nutrition therapy and education (annual)
† Eye examination (annual)
† Foot examination (1–2 times/year by physician; daily by
patient)
† Screening for diabetic nephropathy (annual)
† Blood pressure measurement (quarterly)
† Lipid profile and serum creatinine (estimate GFR) (annual)
† Influenza/pneumococcal immunizations
† Consider antiplatelet therapy