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Des study talk

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Des study talk

  1. 1. Diabetes Mellitus By Pete Kelly Diabetes Specialist Nurse Diabetes Education Services
  2. 2. Any burning questions? Diabetes Education Services
  3. 3. Definition‘Diabetes Mellitus is a chronic disease caused bydeficiency in production of insulin by the pancreas,or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 Diabetes Education Services
  4. 4. Definition‘Diabetes Mellitus is a chronic disease caused bydeficiency in production of insulin by the pancreas,or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON Diabetes Education Services
  5. 5. Definition‘Diabetes Mellitus is a chronic disease caused bydeficiency in production of insulin by the pancreas,or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON Diabetes Education Services
  6. 6. Definition‘Diabetes Mellitus is a chronic disease caused bydeficiency in production of insulin by the pancreas,or by the ineffectiveness of the insulin produced’ World Health Organisation 2002 DIABETES = COMES FROM THE GREEK MEANING TO PASS THROUGH OR SYPHON MELLITUS = MEANS SUGAR, SWEET OR HONEY Diabetes Education Services
  7. 7. UK Prevalence• Currently 2.8 million people are diagnosed with diabetes• Further 850,000 who don’t know they have diabetes• By 2010 it is anticipated there will be 3 million diagnosed Diabetes UK 2009• Within EU ~ estimated to be 25 million people with diabetes and the same amount Diabetes undiagnosed Education Services
  8. 8. Diagnosis of Diabetes Diabetes symptoms (polyuria, polydipsia) Random Laboratory venous plasma glucose > 11.1 mmol/l. Random Laboratory fasting venous plasma glucose > 7.0 mmol/l. Advisable to have two tests results to confirm diagnosis, or one oral glucose tolerance test.  Oral glucose tolerance test (OGTT). Patient takes 75g oral glucose and two hours later has bloods taken, if venous plasma glucose >11.1 mmol/l, Diabetes is diagnosed. More recently the WHO have agreed to use the HbA1c as a method of diagnosis Diabetes Education Services
  9. 9. • Types of diabetes Type One• Type Two• Mature onset of diabetes in young (MODY)• Gestational diabetes mellitus• Secondary to genetic conditions Diabetes Education Services
  10. 10. The physiology of normal • The pancreas controls blood glucose levels. • It lies behind the stomach. • The pancreas does two jobs: 1. Produces pancreatic juices which aids food digestion.Alpha cells release Glucagons, which increases blood glucoseby prompting the release of glucose (from the Liver) into theblood.Beta cells release Insulin, a hormone which encouragesthe absorption of glucose into muscle cells, fat cells, and Diabetesconnective tissue cells etc, this reduces blood sugars. Education Services
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  23. 23. Causes and Risk FactorsType 1 Type 2 Diabetes Education Services
  24. 24. Causes and Risk FactorsType 1 Type 2 Diabetes Education Services
  25. 25. Causes and Risk FactorsType 1 Type 2 • Being overweight •Close member of the family has type 2 diabetes •Waist measurement •Hypertension •POS and being overweight •Impaired glucose tolerance •Gestational diabetes •Mental health problems Diabetes Education Services
  26. 26. Complications of all types Diabetes Education Services
  27. 27. Complications of all types Vascular disease Ischaemic heart disease Gangrene / amputations Nerve Damage (Neuropathy) Eye Disease (Retinopathy) Cataracts Diabetes Blindness Education Services Renal disease (Nephropathy)
  28. 28. Newly diagnosedType 1Diet, exercise + InsulinType 2Diet and exercise for 3 months ↓Oral hyperglycaemic agent:Sulphonylurea for those not overweight (eg. Gliclazide, Glibenclamide)Biguanide for those overweight (eg. Metformin)Can use together if not individually effective ↓Newer agents – Glitazones, Gliptins and GLP-1 ↓ Diabetes Education Insulin Metformin can also be added if patient is overweight Services
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  30. 30. Diabetes diet Diabetes Education Services
  31. 31. Hypoglycaemia Diabetes Education Services
  32. 32. HypoglycaemiaClassed as a blood sugar below 4mmols/l.Symptoms of a hypoglycaemic event. Sweating Shaking Drowsiness Vagueness Mood changes Diabetes Education Services
  33. 33. Treatment of a Hypoglycaemic Episode. Diabetes Education Services
  34. 34. Treatment of a Hypoglycaemic Episode.• If the patient is conscious provide 4 dextrose tablets or 20mls of polycal or 50mls of lucozade.• If the patient is conscious but confused or uncooperative treat with Glucogel (Hypostop).• Provide a carbohydrate snack when the patient is alert again. (ie sandwiches, toast or bowl of cereal.• Continue to test the blood sugar every 20 minutes until stable. Diabetes• Expect higher blood sugars that day Education Services• Remember do not omit the next insulin dose a

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