2. DIAGNOSIS OF DIABETES
1. With symptoms:11.1mmol/l (198mg/dl)
2.Without symptoms:
WHO 1985 ADA 1997
FBS =or >7.8(140) =or >7(126)
PGBS >11.1(198)
(IGT: FBS<7.8 and PGBS 7.8-11.1)
(IFG: 6.1-6.9)
3. TYPES OF DIABETES
Type 1:immune or idiopathic
Type 2: insulin resistance/deficiency
Type 3:genetic defects,MRDM etc.
Type 4:gestational diabetes mellitus
11. Alpha glucosidase inhibitors (ex. Acarbose)
Alpha glucosidases located in brush border
of enterocytes
Cleavage of sucrose, maltose, maltotriose to
glucose,galactose and fructose
Marked reduction of digestion
Postprandial rise evenly distributed
12. Indications for use of acarbose
- Primary therapy for mild or moderate
diabetes
- adjunct therapy with insulin or SUs
-adjunct therapy with insulin in type 1
diabetes
19. CLINICAL SIGNIFICANCE OF PGR
Coronary risk associated with
postprandial glycaemia rather than
fasting glycaemia
PP glycaemia due to a defect in PP
insulin release
PP insulin release should be restored
SUs reduce 24 hour glucose levels but
do not correct abnormal insulin
secretion pattern. And therefore have
no effect on PP glycaemia
20. PRANDIAL GLUCOSE
REGULATORS
acts on pancreas at the time of the
meal
mimics physiological insulin release
regulates prandial glycaemia
hypoglycaemia rare
23. Indications for insulin use in type 2
diabetes
Regular use:
lean type 2 diabetes(?LADA,LWDM)
oral hypoglycaemic failure (primary or
secondary)
allergy to SUs
renal and hepatic disease
severe complications
29. TREATMENT OF COMPLICATIONS
Diabetes and hypertension
Diabetic nephropathy
Diabetes and coronary heart disease
Diabetes and dyslipidaemia
Diabetic foot disease
35. Definitions of abnormalities in
albumin excretion
Category 24hr Timed Spot (ug/mg
(mg/24hrs) (ug/mt) creatinine)
normal <30 <20 <30
microalbuminuria 30-299 20-199 30-299
clinical albumiuria = or >300 = or >200 = or >300
38. Diabetes and CHD
Risk stratification in those
with established CHD
Testing for CHD in those
without symptoms
39. Testing for CHD in those without
symptoms
atypical cardiac symptoms
abnormal ECG
PVD or carotid disease
sedentary lifestyle
dyslipidaemia
smokers
FH of CHD
BP>140/90
micro or macroalbuminuria
45. Order of priorities for
treatment of dyslipidaemia
LDL lowering: first choice-statins
:second choice-fibrates
HDL raising: nicotinic acid or fibrates
TG lowering:fibrates
:statins if LDL is high
46. Targets for control of
diabetic dyslipidaemia
LDL <100mg/dl
Triglycerides < 200mg/dl
HDL >45mg/dl in men
>55mg/dl in women
48. High risk foot
peripheral neuropathy
altered biomechanics due to PN
evidence of increased pressure
(callus,haemorrhage)
PVD
fissures
ulcers
nail pathology
50. Aspirin in diabetes
secondary prevention of CHD,CVD,PVD
primary prevention in: FH of CHD
smokers
hypertension
albuminuria
obesity
dyslipidaemia
age >30 years
51. Aspirin in diabetes
Aspirin safe in diabetic
patients with hypertension
Aspirin lessens the beneficial
effect of ACE inhibitors in
those with CVD
