Outline of Diabetes Mellitus

0
0
2015 days ago, 737 views
PowerPoint PPT Presentation

Presentation Transcript

Slide 1

Outline of Diabetes Mellitus Dr F Dunne Dept of Medicine

Slide 2

Definition Diagnosis Classification Symptoms Annual Assessment Treatment alternatives Metabolic difficulties Macrovascular intricacies Microvascular entanglements Layout

Slide 3

Definition A disorder brought about by a reduction or aggregate absence of insulin or lessened viability of circling (insulin resistance) Characterized by hyperglycaemia

Slide 4

Insulin Enhances fringe glucose take-up Inhibits breakdown of liver glycogen Enhances stockpiling of glucose as glycogen Increases protein combination Increases triglyceride stockpiling

Slide 5

Fasting blood glucose > 7mmol/l Random blood glucose >11.1mmol/l 75g OGTT Diagnosis

Slide 6

75g OGTT Diabetic: FBG>7; 2h >11.1 mmol/l IGT : FBG <7; 2h 7.8-11.1 mmol/l IFG: FBG 6.1-6.9 mmol/l

Slide 7

Classification Type 1 diabetes Type 2 diabetes Secondary diabetes

Slide 8

Older age Slow onset Family history Not immune system No ketones Partial Insulin def/Resistance Insulin requiring Diet/OHA Type 1 diabetes;Type 2 diabetes Juvenille Abrupt onset Family history Autoimmune Ketones Total insulin def, Islet cell AB pos HLA DR3 DR4 Insulin subordinate

Slide 9

Steroids Thiazide Diuretics Drugs for HIV Pancreatectomy Acute pancreatitis Chronic Pancreatitis Haemachromatosis Cystic Fibrosis Cushings Disease Acromegaly MODY DIDMOAD Secondary Diabetes

Slide 10

Polyuria Polydypsia Weight misfortune Lethargy Tiredness Blurred Vision Boils/abscesses Pruritus Vulvae DKA Retinopathy Nephropathy Neuropathy Foot ulcers/gangrene Angina/MI/CVA Symptoms

Slide 11

Osmotic side effects Hypoglycaemia Injection destinations Treatment Diabetes nurture pro Dietitian Blood weight VAs Fundoscopy Pulses/CFT Neurology of Legs Urinalysis HbA1C Lipids Renal capacity Annual Assessment

Slide 12

Treatment Relief of osmotic indications Avoid complexities Choice of medications subject to sort, age, family bolster and so on

Slide 13

Rapid acting Insulin Long acting Insulin Mixed Insulins Short acting analogues Long acting analogues Treatments of Glucose Diet Metformin Sulphonylureas Acarbose Thiazolidinediones Netaglinide/Repag.

Slide 14

Other medications Anti-hypertensives Statins/fibrates Aspirin ACE inhibitors ARBs

Slide 15

Treat to Target HbA1C < 7% BP < 140/80 Cholesterol <5 mmol/l HDL-C >1mmol/l LDL-C < 2mmol/l Triglycerides <1.5mmol/l

Slide 16

Too much insulin Food exclusion Sulphonylureas Renal impairement Hypoglycaemia <2.5mmol/l Autonomic Neuroglycopenic LOC Cerebral Oedema

Slide 17

Treatment Food Dextrose tablets Hypostop Glucose implantation Glucagon

Slide 18

Infection Omits insulin Dehydration Ketotic Hyperventilating Hypotensive Tachycardia Coma Glucose/ketones/ acidotic on ABG IV Fluids Insulin Potassium Antibiotics DKA – Serious/Life debilitating

Slide 19

Type 2 Unwell for a considerable length of time Not acidotic No ketones Very high glucose Risk of coagulating Fluids Insulin Potassium Heparin HONK

Slide 20

Peripheral Neurop Femoral Amyotrophy Mononeuritis multiplex Autonomic Neuropathy Postural hypotension Diarrhea Impotence Atonic bladder Sweating Loss of hypo. awarenes Neuropathy

Slide 21

PVD CVD CAD Diabetes Hypertension Proteinuria Lipids Cigarettes Obesity Vascular Disease

Slide 22

Intermittent Claudication Cold Legs Pulseless Leg Foot Ulcers Gangrene Doppler Studies Duplex Scanning Angiography Angioplasty Treat chance elements PVD

Slide 23

TIAs CVAs Dementia CT examine Carotid Dopplers Treat chance components Carotid sidestep surgery CVD

Slide 24

Angina MI Silent infarct CCF ECG Cardiac compounds Troponin I Exercise stretch test Echocardiography Angiography Angioplasty/CABG CAD

Slide 25

Neuropathy PVD Charcot Arthropathy Ulceration MRI Angiography Diabetic Foot

Slide 26

Background DR Pre-proliferative DR Proliferative DR Maculopathy Fluroscein angiography Laser Blood Pressure Lipids Glucose Retinopathy

Slide 27

Diabetic glomerulosclerosis Microalbuminuria <300mg/l Proteinuria >300mg/l Nephrotic >3g/l Abnormal creatinine Glycaemic control BP control CAPD Transplantation Nephropathy

Slide 28

BMI>30 Age >50 Ethnic minorities Family history GDM Urinalysis FBG Random glucose OGTT Cost/advantage examination Screening

Slide 29

Diabetes is preventable by way of life adjustment Da Quing (Chinnese)31-46% diminishment Finnish (Europeans)58% decrease DPP (North Americans) 58% lessening STOP –NIDDM Trial Acarbose Lancet 2002;359: 2072-2077. JAMA 2003;290: 486-494 TRIPOD Study Pioglitazone

Slide 30

DCCT Trial(Type1) Diabetes 1996;45: 1289-1298 NEJM 1993;329;977 UKPDS study (Type 2) Lancet 1998;352:837-853 DIGAMI (CCU) BMJ 1997;314:1512-1515 Lancet 2002:259; Lancet 2000; 355: 733-777 ICU patients NEJM 2001;345:1359-1367 WOSCOPS; 4S; ASCOT Lancet 2003;361;1149-1158 (Statin) HOPE (ACE-I) NEJM 2000;342:145-153 ALL-HAT (ACE-I) JAMA 2002;288:2981-2997 LIFE SCOPE (ARB) CARDS Study (Lancet August 2004) DIGAMI 2 ponder (in press). Writing

SPONSORS