treatment & prevention 6
TRANSCRIPT
DIABETES
TREATMENT AND PREVENTION
LAVANYA.K ROLL NO.39
Goals of therapyGoals of therapyTo eliminate the symptoms
related to hyperglycemiaTo reduce or eliminate the long
term microvascular and macrovascular complications
To allow the patient to achieve as normal a lifestyle as
possible
Healthcare TeamHealthcare Team
Members of the team include1. Primary care provider2. Endocrinologist/ Diabetologist3. Certified diabetes educator4. Nutritionist5. Sub specialists
Treatment GoalsTreatment GoalsINDEX GOAL
Glycemic controlA1CPreprandial plasma glucosePeak post prandial plasma glucose
<7
90-130 mg/dl
<180 mg/dl
Blood pressure <130/80
LipidsLDLHDLTriglycerides
<100mg/dl
>40mg/dl
<150mg/dl
Diabetes educationDiabetes education
◦Diabetes educator is healthcare professional (nurse, dietician or pharmacist)
◦Education topics include diet • Self monitoring of blood glucose• Urine sugar monitoring• diet• Insulin administration• Management of hypoglycemia• Foot & skin care• Diabetes mgmt. before, during & after
exercise• Risk factor modifying activities
EXERCISEEXERCISEPositive benefits
◦Reduces cardiovascular risks, BP, body fat, weight
◦Maintenance of muscle mass◦Lowers blood glucose◦Increases insulin sensitivity
Time◦150 min per week ( 3 days)◦In type 2 DM, resistance training
Problems◦either hypo/ hyperglycemia
Guidelines to avoid these problems◦Monitor blood glucose before, during &
after exercise◦Delay exercise if bld. Glucose > 250 mg/
dl and Ketone bodies are present◦If bld. Glucose< 100 mg/ dl , ingest
carbohydrate before exercise
Assesment of long term Assesment of long term glycemic controlglycemic control
Glycated Hb/ A1CFructose amine acid1,5 anhydroglucitol
Treatment of type 1 Treatment of type 1 DiabetesDiabetes
Preparation Onset (hr) Peak (hr) Eff.duration(hr)
Short acting s.c.
•Lispro
•Aspart
•Glulisine
•Regular
<0.25
“
“
0.5- 1.0
0.5- 1.5
“
“
2-3
3-4
“
“
4-6
Short acting-inhaled
• Regular
<0.25 0.5-1.5 4-6
Long acting
• NPH
•Detemir
•Glargine
1-4
“
“
6-10
Dual peak
Dual peak
10-16
12-20
24
Insulin CombinationsInsulin Combinations
75 / 25 - Protamine lispro+ Lispro50 / 50 - “ + “70 / 30 - Protamine aspart +
Aspart70 / 30 - NPH + Reg. Insulin50 / 50 - “ + “
INSULIN REGIMENS
INSULIN PREPARATIONSINSULIN PREPARATIONS
AVAILABLE AS U-40 & U-100 REGULAR INSULIN U-500
GUIDELINES FOR MIXING OF GUIDELINES FOR MIXING OF INSULININSULIN
Mix the different insulin formulations in the syringe immediately before injection &inject within 2 min after mixing
Do not store insulin as mixtureStandardize the responseDo not mix insulin glargine or
detemir with other insulins
CALCULATION OF INSULIN CALCULATION OF INSULIN DOSEDOSEMeal component
Based on insulin carbohydrate ratio1 to 1.5 U/10gm of carbohydrate
Pre prandial blood glucose level- 1 U of insulin for every 50
mg/dl- (Body weight in kg)×
(blood glucose-desired glucose)/1500
Advantage of having long acting insulin before night meal
Dawn phenomenon
METHODS OF INSULIN DELIVEYMETHODS OF INSULIN DELIVEY Insulin syringe insulin pen injectors Insulin jet injectors Insulin pumps Insulin inhalers
INSULIN SYRINGEINSULIN SYRINGE
ROTATION SITESROTATION SITES
INULIN PENINULIN PEN
Has cartridge for insulin-dialContains needle & plungerMore convenient to use in schools,public places or at work
Insulin jet injectorsInsulin jet injectors
Sprays insulin→directly passes through the skin
CostlyBruishing→thin individuals
BLOOD GLUCOSE MONITORINGBLOOD GLUCOSE MONITORING
Visually read test strips ex.Betachek diabetes test strips pamphlet chemical test strips
TREATMENT OF TYPE II TREATMENT OF TYPE II DIABETESDIABETES
MANAGEMENT OF TYPE II DIABETES
GLYCEMIC CONTROL•Diet•Exercise•Medication
ASSOCIATED CONDITIONS•Dyslipidemia•Hypertension•Obesity•CHD
SCREENING•Retinopathy•Cardiovascular disease•Nephropathy•Neuropathy
Treatment of type 2 diabetes mellitusOral
Biguanides Metformin
Alpha glucosidase inhibitors
Acarbose , meglitol
DPP 4 inhibtors sitagliptin
Insulin secretagogues
sulfonyl ureas
first generation chlorpropamide,tolbutamide
second generation Glimepiride , glipizide
non sulfonyl ureas Repaglinide , nateglinide
–Thiazolidinedidones roseglitazone, pioglitazone
Parenteral
Insulin
GLP1 agonist exenatide
Amylin agonist pramlintide
drugs advantages Disadvantages
biguanides Weight loss Lactic acidosis,GI dysfunctions
Alpha glucosidase inhibitor
Reduce postprandial glycaemia
Liver & GI dysfunctions
DPP4 inhibitors No hypoglcaemia ---
sulfonylureas Lowers fasting blood glucose
Weight gain,hypoglyacemia
Nonsulfonylureas
thiazolidinediones
Shorter onset of actionLowers postprandial glycaemia
Lowera insulin requirements
Hypoglycaemia
CHF,weight gain ,fractures
Glycaemic management of type 2 diabetes mellitus patient with type 2 diabetes
medical, nutrition therapy,increased physical Activity and weight loss + metformin
Reasses A1CCombination therapy metformin+second agent
Reasses A1CCombination therapy metformin+2 agents metformin +insuln
Fall in insulin requirements Dialysis associated
complications -hypotension,progression
of retinopathy,atherosclerosis & hyperlipidemia
Treatment for diabetic nephropathy
• Transplantation-combined pancreas and kidney
TREATMENT FOR DIABETIC TREATMENT FOR DIABETIC NEUROPATHYNEUROPATHYRisk factors -> hypertension and
hypertriglyceridemiaAvoidance of neurotoxins -
>alcohol,smokingVit.supp(B12,folate)Symptomatic treatmentShould check their feet daily & take precaution
Chronic painful-antidepressants and anticonvulsants
Orthostatic hypotension-clonidine,fludrocortisone,ocreotide
TREATMENT FOR GI TREATMENT FOR GI DYSFUNCTIONDYSFUNCTION
Smaller and more frequent meals(liquids)
Low in fat contentDrugs metoclopramide 5-10 mg domperidone 10-20 mgDiabetic diarrhoea loperamide or ocreotide(50-70µg
TDS)Antibiotics
TREATMENT FOR GENITOURINARY TREATMENT FOR GENITOURINARY DYSFUNCTIONDYSFUNCTION
Diabetic cystopathy-timed voiding and self catheterisation
Erectile dysfunction-type 5 PDE inhibitors
Women-lubricants,treatment of infections & estrogen replacement(systemic/local)
TREATMENT FOR CARDIOVASCULAR TREATMENT FOR CARDIOVASCULAR DYSFUNCTIONDYSFUNCTION
Revascularisation procedures PCI & CABGProblem-restenosisImproved outcomes-stents/
GP 2b 3a platelet inhibitorsDrugs -ß blockers,ACE inh/ARBsSecondary prevention-Aspirin
New technologies in treatment of New technologies in treatment of diabetesdiabetesIslet cell transplantationGene therapyVaccine-peptideFoot ulcer-dermograftArtificial pancreas
PREVENTION•Primary prevention population strategy high risk strategy
•Secondary prevention glycosylated Hb self care home blood glucose monitoring
•Tertiary prevention
Thank
you