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Diabetes management and complications

Diabetes management and complications. Dr. Louise Johnson-Loots Specialist physician and insulin pump centre Montana hospital, Pretoria. Diabetes types. Type 1 – auto immune Type 2 - insulin resistant Secondary – surgery, medication (i.e. steroids) GDM ( gestational diabetes).

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Diabetes management and complications

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  1. Diabetes management and complications Dr. Louise Johnson-Loots Specialist physician and insulin pump centre Montana hospital, Pretoria

  2. Diabetes types • Type 1 – auto immune • Type 2 - insulin resistant • Secondary – surgery, medication (i.e. steroids) • GDM ( gestational diabetes)

  3. Diabetes Type 1 • Younger than 30 yr • Thin • Auto-immune disease • 10-20% of Pt. Type 2 • Older than 30 yr • Obese – ♂ waist > 94 cm ♀ waist > 80 cm • Ass diseases i.e. HT,Dyslipiedemiae • 80% of Pt

  4. What you see is what you have… Type 1 Type 2

  5. Insulin resistance (metabolic syndrome) • First step on diabetes ladder • Waist circumference Male >94 cm Female >80cm • Associated disease –Hypertension - gout -abnormal cholesterol

  6. How to manage my metabolic abnormality? • Know your numbers • Set targets – keep to them • Know your bar stool (diet, exercise ,medication) • NO smoking!! • Test regularly

  7. Targets to achieve • Waist - 94 cm male, 80cm female • Blood pressure < 130/80mmHg • LDL cholesterol< 1.8 • HDL cholesterol > 1.0 • HbA1c < 7% • FPG < 5.5 , 2h PPG < 7.8

  8. How to get to target? • Diet • Exercise 30 min brisk walking/day • Correct medication – suit your life style • Regular blood glucose testing – 2x/day on insulin - wake up/2h PPG if on tablets • Test more if unwell

  9. Diabetic diet sign language • Fist – carbohydrate portion (tennis ball size) • Palm size – protein ( thickness of thumb ball ) • Two open hands – vegetables • Thumb tip – fat • 3 regular meals- don’t skip • Enough water - weight ( 84 kg = 8 glasses)

  10. Alcohol and diabetes • Female 1 unit/day • Male 2 units/day • Unit - single whiskey/brandy (spirits) - 200 ml dry white/red wine • Stay away from mixes, beer, sherry ,port liqueur

  11. Important pitfalls • Diabetic sweets - too much fat • Flavored water = Coke in calories!! • Fruit juice • Not what we eat but how much of it!

  12. Medication - Type 2 diabetes • Metformin basis of type 2 management • Incretin – tablets and injections (see second lecture after lunch break) • Sulphonylurea – hypoglycemia • TZD- pioglitazone – swelling of feet

  13. Medication Type 1 Diabetes • Insulin –to suit your lifestyle • Basal/bolus • Basal( long acting) Levemir, Lantus, • Bolus (short acting)– novorapid,apidra,humalog • Fixed mixes –novomix,humalog mix25 • Insulin pumps

  14. Time of diagnosis 100 ? 80 60 Pancreatic function = 50% of normal 40 20 0 ―10 ―8 ―6 ―4 ―2 0 2 4 6 Progression of type 2 diabetes -cell function (% of normal by HOMA) Time (years) HOMA=homeostasis model assessment. Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21―5.

  15. The first insulin 11/1/1922 Leonard Thompson 14yr 25 days on dog insulin

  16. Expectations today • Fast • Reliable • Smooth • Reproducible • Safe

  17. Complications • Preventable • Preventable! • Preventable!! • Know the rules of the metabolic abnormality to prevent the disease

  18. Rules for diabetes • Rule 1 – medical check 6 monthly with a specialist physician –Blood pressure, kidney ,heart,feet sensation and blood flow. • Rule 2 – eye check at an eye specialist (not the person giving the glasses) • Rule 3 – no bare foot walking

  19. More rules • Rule 4 – sin once every 14 days (ice cream ,chocolate ,cookies etc) • Rule 5 - if female and your baby weighed >4.0kg – get screened for diabetes yearly • Rule 6 – Become the captain of your own ship !

  20. Questions ??

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