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Question 1

1. Question 1. What is our Global Ranking for DM ? What is our current estimated burden? Why is T2DM so important ?. Question 1. What is our Global Ranking for DM ? What is our current estimated burden? Why is T2DM so important ? Numero Uno – RANK ONE Globally About 36 million (in 2003)

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Question 1

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  2. Question 1 • What is our Global Ranking for DM ? • What is our current estimated burden? • Why is T2DM so important ?

  3. Question 1 • What is our Global Ranking for DM ? • What is our current estimated burden? • Why is T2DM so important ? • Numero Uno – RANK ONE Globally • About 36 million (in 2003) • DM = CAD + Its major complications !! • Shortens longevity by 10-15 years

  4. Question 2 • What are the TWO major defects in Type 2 Diabetes ?

  5. Question 2 • What are the TWO major defects in Type 2 Diabetes ? • Insulin Resistance (IR) • Insulin Deficiency (ID)

  6. Question 3 • What is  cell apoptosis ? •  cell apoptosis occurs in how many years ?

  7. Question 3 • What is  cell apoptosis ? •  cell apoptosis occurs in how many years ? • Progressive programmed  cell death • 10 to 15 years after the onset of DM • Today’s approach is save the  cell

  8. Question 4 • What are the core defects of Insulin Secretion in T2DM ?

  9. Question 4 • What are the core defects of Insulin Secretion in T2DM ? • Loss or delay of first phase of Insulin secretion • Blunting or flattening of second phase

  10. Question 5 • What is Gold Standard Test to Diagnose DM ? • Should we use Plasma Sugar or Whole blood Sugar for Diagnosis ?

  11. Question 5 • What is Gold Standard Test to Diagnose DM ? • Should we use Plasma Sugar or Whole blood Sugar for Diagnosis ? • O-GTT – Fasting sample and 2 hours Post Glucose (75g) sample • Obviously Plasma (venous sample)

  12. Question 6 • What is Normal FBG & What is IFG ? • What is Normal PPBG & What is IGT ? • Is it essential two have TWO readings ?

  13. Question 6 • What is Normal FBG & What is IFG ? • What is Normal PPBG & What is IGT ? • Is it essential two have TWO readings ? • N =100 mg FBG; 101-125 is IFG • N =140 mg PPBG; 141-199 is IGT • YES – Two readings are a must for Dx. • FBG  126 or PPBG  200 is DM

  14. Question 7 • Can we use urine sugar for Dx. or F/u ? • Can we use HbA1c for Diagnosis ? • What is important in urine exam in DM ?

  15. Question 7 • Can we use urine sugar for Dx. or F/u ? • Can we use HbA1c for Diagnosis ? • What is important in urine exam in DM ? • No. Urine sugar is not all useful • No. HbA1c is not for Diagnosis; only F/u • Albumin, MAU, Ketones are very imp.

  16. Question 8 • What is the cause of Fasting Hyperglycemia ? • What is the defect that causes it ?

  17. Question 8 • What is the cause of Fasting Hyperglycemia ? • What is the defect that causes it ? • Increase in Hepatic Glucose Output – Called HGO • Decrease in Basal Insulin secretion

  18. Question 9 • What is the cause of Postprandial Hyperglycemia ? • What is the defect that causes it ?

  19. Question 9 • What is the cause of Postprandial Hyperglycemia ? • What is the defect that causes it ? • Decrease in peripheral utilization – removal of glucose by muscle & adipose tissue • Excess CHO meal load • Delay or absence of 1st Phase Insulin

  20. Question 10 • What are the four mechanisms which contribute to ↑ plasma glucose ?

  21. Question 10 • What are the four mechanisms which contribute to ↑ plasma glucose ? • Hepatic Glucose Output (HGO) Basal In • Lack of peripheral utilization (IR) • Decrease in insulin secretion (ID) • Increase in absorption from GIT

  22. Question 11 • What is HbA1c ? • What is its normal value ? • What does it reflect ?

  23. Question 11 • What is HbA1c ? • What is its normal value ? • What does it reflect ? • It is a Glycated hemoglobin • Normal HbA1c is around 6% • It represents the mean plasma glucose over the previous 120 days

  24. Question 12 • What is the best measure to monitor glycemic control for follow up ? • What is its target value ?

  25. Question 12 • What is the best measure to monitor glycemic control for follow up ? • What is its target value ? • HbA1c is the measure for monitoring • It must be kept below 7, preferably 6

  26. Question 13 • What is IDRS ? • What are its components ?

  27. Question 13 • What is IDRS ? • What are its components ? • Indian Diabetic Risk Score is used to assess ones risk for DM • Age, WC, family h/o, physical activity

  28. Question 14 • Can we prevent Diabetes ? • If so, How ?

  29. Question 14 • Can we prevent Diabetes ? • If so, How ? Yes. 3 international studied confirmed it • Identifying people in stage 1- IR • Total Lifestyle Change – MNT, PA • If necessary Metformin, Acarbose

  30. Question 15 • Where can we find all info on TLC ?

  31. Question 15 • Where can we find all info on TLC ? • www.mypyramid.gov

  32. Question 16 • What is the ‘Old Paradigm’ of Diabetes management ?

  33. Question 16 • What is the ‘Old Paradigm’ of Diabetes management ? • It is called the ‘Step Care’ approach • It envisages Diet  OAD  Insulin

  34. Question 17 • What is the ‘New Paradigm’ of Diabetes management ?

  35. Question 17 • What is the ‘New Paradigm’ of Diabetes management ? • It is the ‘Stage Management’ approach • Stage 1 – Insulin Resistance (IR) • Stage 2 – IR + Insulin Deficiency (ID) • Stage 3 – Insulin Deficiency (ID)

  36. Question 18 • What is total metabolic control ?

  37. Question 18 • What is total metabolic control ? • Glycemic control is essential but we also need to control all components • We must maintain the B.P <130/80 • The lipids under target values • See that pt. avoids smoking • Reduce his weight and waist • This is total METABOLIC CONTROL

  38. Question 19 • List the microvascular complications

  39. Question 19 • List the microvascular complications • Diabetic Retinopathy (DR) • Diabetic Kidney Disease (DKD) – Nephropathy • Diabetic Neuropathy – DPN, DAN These start right at the onset of ↑ BG We must screen for and prevent them

  40. Question 20 • List the macrovascular complications

  41. Question 20 • List the macrovascular complications • Coronary Artery Disease - CAD • Cerebro Vascular Disease, TIA • Peripheral Vascular Disease PVD These start right at the onset of IR We must screen for and prevent them

  42. Question 21 • How do we identify persons with IR ?

  43. Question 21 • How do we identify persons with IR ? • IGT or IFG • WC > 36 (32) BMI > 23 • B.P > 140/90 • Dyslipidemia –TG>150, HDL<40(50) • Acanthosis Nigricans • Fasting C-Peptide levels increased

  44. Question 22 • What is C-Peptide ?

  45. Question 22 • What is C-Peptide ? • When proinsulin is cleaved into active Insulin, C-peptide is formed • It is measured in the fasting serum • It reflects the endogenous insulin secretion by  cells • It is used in HOMA IR model

  46. Question 23 • What are the ABC of Diabetes ?

  47. Question 23 • What are the ABC of Diabetes ? • A1c target of < 7% • B.P  130/80 • Cholesterols • TG <150, HDL> 40(50), Lp(a) <25

  48. Question 24 • What are the 4 major classes of OAD ?

  49. Question 24 • What are the 4 major classes of OAD ? Those • That decrease HGO - Metformin • Improve insulin Resistance - Met, TZD • Stimulate  cell – SU, Repaglinide • Slow absorption of CHO - Acarbose

  50. Question 25 • Which OAD is the sheet anchor of Diabetes treatment ?

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