Management of Diabetes Bharatha Ambadasu
Management of Diabetes
Bharatha Ambadasu
What is Diabetes?
• Body cannot properly store/use food for fuel• Insulin
• hormone • Produced by beta cells in the pancreas• Allows glucose to move from blood stream into
muscles to be used in energy production
• In diabetes, insulin is produced in insufficient
amounts, or it is produced but cannot be used
properly
Diabetes mellitus (DM)• 5-8% of the population• Large number of individuals are asymptomatic
Classified into:
Type 1 (IDDM) –autoimmune (10%)
• Juvenile onset DM
Type 2 (NIDDM) –genetic (90%)
• Adult onset DM, often obese
Type 3 (MODY) –genetic (1-5%)• Occurs before 25 years of age• No insulin resistance, not obese
Type 4 (gestational)
• Glucose intolerance
Macrovascular Microvascular
Stroke
Heart disease and hypertension
2-4 X increased risk
Foot problems
Diabetic eye disease(retinopathy and cataracts)
Renal disease
Peripheral Neuropathy
Peripheral vascular disease
Diabetes: Complications
Complications
Erectile Dysfunction
Treatment
Unfortunately,
THERE IS NO CURE!
Aims of the treatment
• To alleviate symptomatic hyperglycemia
• Reduce overall blood glucose & minimise fluctuations
• To reduce insulin resistance, hyperglycemia &
dislipidemias
• Avoid hypoglycemia
• (insuln & sulfonylureas)
• Avoid weight gain
• (insulin, sulfonylureas, thiozolidinediones)
• Cardiovascular risk factors should be corrected
Treatment
• PATIENT EDUCATION, understanding, and participation is vital
Treatment
Physical Activity• Regular physical activity helps your body lower blood
glucose levels, promotes weight loss, reduces stress and enhances overall fitness.
Treatment
Diet• What, when and how much you eat
Treatment
Weight Management• Maintaining a healthy weight is especially important
in the management of type 2 diabetes.
Treatment
Lifestyle Management• Learning to reduce stress levels in day-to-day life
can help people with diabetes better manage their disease.
Treatment
Blood Pressure
• High blood pressure can lead to eye disease, heart
disease, stroke and kidney disease, so people with
diabetes should try to maintain a blood pressure at
or below 130/80.
• To do this, you may need to change your eating and
physical activity habits and/or take medication.
Treatment
Medication
• Type 1 diabetes is always treated with insulin. Type
2 diabetes is managed through physical activity and
meal planning and may require medications and/or
insulin to assist your body in making or using insulin
more effectively.
Treatment: Type 1
• Diet + Insulin
Insulin requirement
• Increased during:
• Infections, severe illness, trauma, surgery,
thyrotoxicosis, hyperparathyroidism, acromegaly,
hypokalemia and pregnancy
• Decreased during:
• Dieting, weight loss, exercise, hypothyroidism, renal
insufficiency and old age
Treatment: Type 1 Diabetes Cont…
Insulin regimens:
• Choice of regimen depends on the desired degree of
glycemic control, the patients life style & his/her ability
to adjust the insulin dose
Treatment: Type 1 Diabetes Cont…
i. Three doses of soluble insulin (before the main
meals) plus an intermediate acting insulin at bedtime
ii. A biphasic or intermediate acting insulin twice a day
before morning and evening meals
iii. A single morning dose of a biphasic or intermediate
acting insulin before breakfast
Treatment: Type 2 Diabetes
• 80% are obese• 10% non-obese• 10% unstable: may
look more like a Type 1 Diabetic
• Diet and weight reduction (mild diabetics)
• Diet plus an oral antidiabetic agent
• Insulin (suboptimal doses) with oral antidiabetics
• Insulin
Treatment: Type 2 Diabetes Cont…
<40yrs Most Type I Insulin
Non obese
Obese
Weight maintenance diet
Low energy diet
>40yrs Most Type II
Non obese
Obese
Low energy dietExcersise
Weight maintenance dietSulfonylurea
+Metformin
Or addGlitazones
Alpha glucosidase Inhibitor
PGR Bedtime isophane insulin
Insulin
Insulin
Diet
Sulfonylureas
Metformin
Monotherapy Combined therpy
Low calorie sweetener
• Replace sugar with low calorie sweetener Aspartame
(1 tab of 18mg =sweetness of 1 ts sugar, gives 2
calories)
• Sucralose
Management of MODY
• Any child or young adult who had persistent,
asymptomatic hyperglycemia without progression to
diabetic ketosis or ketoacidosis
• MODY is often referred to as "monogenic diabetes“
• MODY 1 - 6
• Defects are mutations of transcription factor genes
• Changes in diet, physical exercise, oral hypoglycemic
agents, and insulin injections
Management of Gestational diabetes
• Most common medical complication of Pregnancy
• affects 2-3% of pregnancies
• Gestational DM 90%
• Preexisting DM 10%
• To avoid fetal loss at all stages, and in the first trimester
to reduce fetal malformations
Management of Gestational diabetes Cont…
• Human Placental Lactogen (HPL) –”Anti-insulin”
• Estrogen and Progesterone
• Insulinase (Minor role)
• Typically controlled with INSULIN but oral
hypoglycemic agents like glyburide are also showing
promise.
Diabetic Ketoacidosis
Treatment for DKA
• Correct fluid volume deficit
1. 1 liter of isotonic saline over 1 hour
2. 1 liter of hypotonic saline over 6 to 8 hrs
3. 1 liter of hypertonic solution (D5/2NS)
over 8 to 12 hrs.
Drug therapy for DKA Cont…
• Insulin therapy: lower BG by 75-150mg/dl/hr
1. Regular insulin IV bolus dose of 0.1 - 0.2 U/kg
followed by IV drip of 0.1 U/kg/hr.
• Electrolyte replacement
1. Potassium
2. Bicarbonate
Answer these questions
1. A 50year old women has just been diagnosed as a Type 2 diabetic and given a prescription for Metformin. Which one of the following statements is characteristic of this medication?
A. Hypoglycemia
B. Undergoes metabolism to an active compound
C. Many Drug –Drug interactions
D. Increases peripheral glucose uptake & utilisation
E. Pt often gains weight
2. A 64yr old women with a history of Type 2 diabetes is diagnosed with heart failure. Which one of the following drugs would be a poor choice in controlling her diabetes?
A. Exenatide
B. Glyburide
C. Glipizide
D. Pioglitazone
Answer these questions
3. A 75 ys diabetic female on an oral hypoglycemic agent becomes light headed and profuse sweating. Blood glucose is below normal. Which of the following agents are responsible for this?
A. Pioglitazone
B. Glipizide
C. Acarbose
D. Metformin
Answer these questions
4. A 60yr old diabetic male on an oral diabetic agent develops abnormal LFT. Which one of the following agent agent can cause this finding?
A. Glyburide
B. Metformin
C. Troglitazone
D. Acarbose
Answer these questions
THE END!!!!