This document discusses how diabetes differs and is managed for women at various life stages including puberty, pregnancy, and menopause. It notes that diabetes has more severe health impacts and higher mortality for women compared to men. During puberty, diabetes can delay menarche and cause menstrual disturbances. Gestational diabetes requires screening and treatment during pregnancy to prevent complications for mother and baby. Women with a history of gestational diabetes have a high risk of developing type 2 diabetes later in life. The document provides guidance on managing diabetes throughout these various stages.
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
This is a presentation on the management of diabetes mellitus in children and adolescents. This presentation is based primarily on the ADA guidelines 2015.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
This is a presentation on the management of diabetes mellitus in children and adolescents. This presentation is based primarily on the ADA guidelines 2015.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Does the diabetes presentations and treatment differs in the different stages of women's life. What is the interplay between diabetes and both puberty and menopause
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The Primary Care Physician's guide to management of Pregnancy DiabetesHanifullah Khan
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Similar to Ueda2016 woman’s health & diabetes - lobna el toony (20)
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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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
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- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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ASA GUIDELINE
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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!
8. How Diabetes Differs for Men and Women
• Women with diabetes have it worse, on average,
than men with diabetes.
• while men with diabetes live 7.5 years less on
average than those who don't have the disease,
among women the difference is even greater:
8.2 years
• The risk for heart disease is six times higher
for women with diabetes than those without .
9. • Type 2 diabetes is more prevalent
in woman than men, making
prevention and early detection of
particular importance
10. 10
Diabetes has a higher incidence in women, is associated with
hormonal disturbances and is a stronger risk factor in women –
why?
Lundberg et al, Arch Int Med, 1997
10
12
14
16
0
2
4
6
8
Diabetics Risk for MI Lethality from MI MI due to
Diabetes
PCOS
Women
Men
Women with Polyc.ovarian syndr.
Diabetes as risk factor in women and men
11.
12. 12
Sex-related differences in glucose metabolism
0
5
10
15
20
25
30
35
40
45
50
Known D Unkn D IGT IFG all
%ofpopulation
women
men
W Rathmann et al, Diabetologica 2003
Mechanisms?
Fasting glucose
F-GIGT
Women have higher 2 h glucose for
each fasting glucose level
Williams et al., Diab Med. 2003
men
women
Relation between FG and OGT
13. Stages and Plateaus
Age
0 10 20 30 40 50 60 70 80 90 100
Menarche:
The Beginning
Menopause:
Menses “Pause”
Perimenopause:
Variable
Teen years:
+/- Rough
Fertile Years:
Fairly Predictable
14.
15.
16. Menarche & Menstrual Cycle
Disturbances in Type 1 Diabetes
• T1DM prior to menarche, particularly before 10
years of age, caused a delay in menarchial age of
approximately 1 year
• Women with younger than age at menarche are
more likely to develop type 2 diabetes, and this
association is only partially explained by higher
adult BMI.athttp://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc13-0446/-/DC1. ,
2013.
• Persistent menstrual disorders remaining in the
third and forth decade in 30% of those women ,
mainly secondary amenorrhea and
oligomenorrhea.
17.
18. The Menstrual Cycle And T1DM
• Fluctuations in hormone levels occur through
the menstrual cycle can affect blood sugar
control leading to high blood sugar 3-5 days
before, during or after their periods.
• Premenstrual symptoms (PMS) can be worsened
by poor blood sugar .Food cravings during
PMS are triggered by an increase in
progesterone and can make it more difficult to
control blood sugar
• The extra insulin are needed to overcome insulin
resistance during this with frequent measuring SBG
19. • 1-Hypothalamic Anovulatory leading to
disruption in hypothalamic pulsetile secretion of
gonadotrophin-releasing hormone (GnRH),
with a lower basal levels of luteinizing
hormone (LH) in Type 1 diabetic patients with
amenorrhea.
Menstrual disturbances in T1DM
20.
21. Menstrual disturbances in T1DM
• 2-Neuroendocrine control
• Increased central dopaminergic activity , which
in turn inhibits GnRH secretion.
• 3-Polycystic ovary syndrome (PCOS) is
especially prominent among women with the
onset of Type 1 diabetes before menarche.
PCOS prevalence of 31 and 40%
• 4- Young women with spontaneous premature
ovarian failure are at increased risk of
autoimmune hypothyroidism
22. Correlation between Type 2
Diabetes & Fertility
• Alterations in the length of the menstrual cycle,
and the premature age of onset of menopause
with resultant shortening of the reproductive
period .
• PCOS is a leading cause of infertility due to
insulin resistance and obesity
• Obesity is common in both PCOS and Type 2
diabetes and experience longer times to
conception.
Fertility Issues in Women with Diabetes Women's Healt 2009;
24. Diabetic complications and
fertility
• Diabetic microvascular or cardiovascular
complications is associated with particularly low
fertility that is improved after glycemic control
25.
26.
27.
28. Diabetes in Pregnancy: 2
Categories
Pregestational diabetes Gestational diabetes
Pregnancy in
pre-existing diabetes
• Type 1 diabetes
• Type 2 diabetes
Diabetes diagnosed in
pregnancy
29. Dysglycemia in Pregnancy can
Result in Adverse Pregnancy
Outcome
• Elevated glucose levels can have
adverse effects on the fetus
– 1st trimester ↑ fetal malformations
– 2nd and 3rd trimester: ↑ risk of macrosomia and
metabolic complications
30. Risk of Fetal Anomaly Relative to
Periconceptional A1C
Guerin A et al. Diabetes Care 2007;30:1-6.
Glycemic control pre-conception = essential
31. We Currently Intervene Too Late
4 5 6 7 8 9 10 11 12
Central Nervous SystemCentral Nervous System
HeartHeart
ArmsArms
EyesEyes
LegsLegs
TeethTeeth
PalatePalate
External genitaliaExternal genitalia
EarEar
Missed Period Mean Entry into Prenatal Care
Critical Periods of Fetal DevelopmentCritical Periods of Fetal Development
32.
33. Diabetes in Pregnancy:
Consider Phases
Pregestational diabetes Gestational diabetes
1. Preconception counseling 1. Screening
2. Glycemic control during
pregnancy
2. Glycemic control during
pregnancy
3. Management in labour 3. Management in labour
4. Postpartum considerations 4. Postpartum considerations
34.
35.
36.
37.
38.
39. Diabetes in Pregnancy:
Avoiding Complications
• Advances in diagnosis and treatment have dramatically
reduced morbidity and mortality in both mothers and infants1,2Preconception care
• Renal impairment, cardiac disease, neuropathy3
Careful evaluations
at each visit
• 1st trimester through 1st year postpartum
• Examine active lesions more frequently1
Regular
ophthalmologic exams
• Target: systolic BP 110-129 mmHg; diastolic BP 65-79 mmHg
• Lifestyle changes, behavior therapy, and pregnancy-safe
medications (ACE inhibitors and ARBs contraindicated in
pregnancy)3
Hypertension
management
1. AACE. Endocr Pract. 2011;17(2):1-53. 2. Jovanovic L, et al. Diabetes Care.
2011;34(1):53-54.
3. Jovanovic L, et al. Mt Sinai J Med. 2009;76(3):269-80. 4. ADA. Diabetes Care.
40.
41. Insulin Delivery Throughout Pregnancy
Calculating Daily Insulin Dose for Pregnancy
With Preexisting Diabetes
Gestational
week
4–12
12–24
24–38
38–42
0.7 U
0.8 U
0.9 U
1.0 U
Insulin dose
Multiplied by
current
pregnant
weight in kg
Jovanovic L. In: Leahy JL, Cefalu WT, eds. Insulin Therapy. New York, NY:
Marcel Dekker Inc; 2002:139-151
50. Gestational Diabetes (GDM)
Diagnosis
• Universal screening for GDM @ 24-28 weeks
Gestational Age (GA)
• Screen earlier if risk factors for GDM:
Previous GDM BMI ≥30 kg/m2
Prediabetes Polycystic ovarian
syndrome
High risk population
(Aboriginal, Hispanic,
South Asian, Asian, African)
Current fetal macrosomia
or polyhydramnios
Age ≥35 years History of macrosomic
infant
Corticosteroid use Acanthosis nigricans
51. Screening and Diagnostic Criteria for GDM:
Glucose
Level
Reference Diagnostic Test -- Glucose Tolerance Test:
Cut points in Milligrams per deciliter (mg/dL)
Screening
National Diabetes
Data Group*
100 g
American Diabetes
Association*
100 g/75 g
World Health
Organization †
75 g
Glucose Challenge
Test
50 g
Fasting 105 95 >126 --
1hour 190 180 -- 130/140
2 hours 165 155
> 140 --
3 hours 145 140 -- --
* Two or more criteria must be met or exceeded for a positive diagnosis.
† One or more criteria must be met or exceeded for a positive diagnosis.
-- Indicates glucose levels not used for the test indicated.
65. Perimenopause – 6 months
• This person does not feel well!
• Her partner is hanging out with his/her friends a lot lately!
• And she’s thinking about selling her kids.
Hormones are out of balance.
72. 72
Interaction of hyperglycaemia and diabetes with
CAD is sex dependent
0
1
2
3
4
5
6
F, Diab M, Diab F, HyGly M, HyGly
Pan, Am J Epidem, 1986, Chicago H S
Increase in Relative Risik for death from CAD in female and male patients with
diabetes and Hyperglycemia
73. 73
Incidence of CAD and HF in Diabetics
Diabetic men
CAD - 24.9% per 1000 person-years
HF – 7.75% per 1000 person-years
Diabetic women
CAD – 17% per 1000 person-years
HF – 11.5% per 1000 person-years
Beuters et al. Cardiovascular Diabetology 2003;1:1-16.
74.
75. Diabetes and menopause:
What to expect
• Changes in blood sugar level
• Weight gain :This can increase the need for insulin or oral
diabetes medication.
• Infections urinary and vaginal infections.
• Sleep problems
• Additional health problems: Atherosclerosis which leads
to stroke and heart attack
• .Osteoporosis
•
• Sexual problems
76.
77.
78.
79.
80.
81. Medications for Sexual
Dysfunctions
For Men:
• ED
o Generic Viagra (Sildenafil
Citrate)
o Generic Cialis (Tadalafil)
o Generic Levitra
(Vardenafil)
• PE
o Generic Priligy
(Dapoxetine)
o Duloxetine
o Fluoxetine
• Loss of libido
Women:
• Arousal Disorder
oLovegra
oLadygra
83. Take Home Message
• At all stages of life, women’s bodies
present obstacles for managing
diabetes. Challenges may occur
because:
• The fluctuating hormones associated
with the menstrual cycle, childbearing,
and menopause make it more difficult to
maintain proper blood glucose levels.
84. Take Home Message
• Diabetes can cause difficulties during
pregnancy such as a miscarriage or a baby
born with birth defects. In addition to fertility
disorders .
• Older Women with diabetes are also more
likely to have a heart attack, and at a younger
age, with decreased life expectancy more
than men . Vaginal and UTI Infection ,
• Sleep disorders, sexual dysfunctions that
exaggerate menopausal syndromes .
85. Take Home Message
• Fortunately , all these stages in women 's
life can pass safely by increasing in the
awareness , frequent monitoring of BG and
follow up to reach target glycemic control
that delay or even prevent diabetes
complications in women.