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Management of Diabetes

The document discusses the management of diabetes. It covers goals of treatment, types of diabetes, lifestyle modifications, medications, and treatment approaches. For type 1 diabetes, insulin therapy is discussed. For type 2 diabetes, the focus is on lifestyle changes, oral medications that include biguanides, sulfonylureas, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones, incretin mimetics and SGLT2 inhibitors. Dietary management including macronutrient composition is also covered.

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48 views

Management of Diabetes

The document discusses the management of diabetes. It covers goals of treatment, types of diabetes, lifestyle modifications, medications, and treatment approaches. For type 1 diabetes, insulin therapy is discussed. For type 2 diabetes, the focus is on lifestyle changes, oral medications that include biguanides, sulfonylureas, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones, incretin mimetics and SGLT2 inhibitors. Dietary management including macronutrient composition is also covered.

Uploaded by

Godzilla555
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MANAGEMENT OF DIABETES

• Goals
• Improvement in symptoms
• Minimize Risk Of Complications
• Type 1 DM Insulin
• Type 2 DM dietry & life style modifications,
Antidiabetics
• Smoking
• Dyslipidemias
• Hypertension
Patient Education Self assessment of Blood Glucose
• Management
• Multidisciplinary approach
• Drugs
• Side effcts
• Stress situations
• Exercise
GOALS
Assessment After Diagnosis
Guidelines for Diabetic Patient Care
TYPE 1 DIABETES MELLITUS
INSULINS
• Types: Porcine, Recombinanat & Analogues
I. Rapid Acting(Analogues):
Lispro,Aspart,Glulisine
II. Short Acting [ Solouble(Regular)]
III. Intermediate Acting: Isophane(NPH), Lente
IV. Long Acting: Bovine Ultralente
V. Long Acting: Analogues (Glargine,Detemir)
• Site Of Injection:
Anterior Abdominal Wall, Outer Thighs, Buttocks
or IV/IM
• Rate Of Absorption:
Insulin Formulations,Site, Depth, Volume, Skin
Temp, local Massage & Exercise, Lipohypertrophy.
• Pharmacodynamics: Half life 30min,Metabolized
by Liver & kidneys
• Insulin Injection Devices:
Syringes, Pen Devices & Insulin
Pumps.
• Rapid Acting 15min before meal
• Reugular Insulin 30min before
meal
• Needle sited at right Angle to
skin
• Complications
i. Hypoglycemia
ii. Dawn Phenomenon
iii. Somogyi Effect
Insulin Dosing Regimens
• Depends on
I. Desired degree of glycemic
control
II. Severity of insulin deficiency
III. Patient lifestyle
IV. Patient ability to adjust Insulin
V. Once Daily
VI. Twice Daily
VII. Multiple Injection Regimens
(Intensive Insulin Therapy)
VIII.Open loop
Transplantation
• Whole pancrease in Patient with CKD
• Islets Cell Transplantation in Liver
• Stem Cells
TYPE 2 DIABETES MELLITUS
DIETRY MANAGEMENT
Aims Of Dietry Management
• Achieve good glycemic Control
• Reduce Hyeperglycemia & avoid Hypoglycemia
• Assist with Weight Management
Weight Maintenance for Type 1 & nonobese Type 2
Weight Reduction for Obese
• Reduce the Risk of Diabetic Complications
• Adequate Nutritional Intake
• Avoid Atherogenic Diet & those aggravating
Complications
Diet & Life Style
• Regular Physical Activity
• Healthy Diet
• No Alcohol
• Nutrition Advice
• Glycemic Index
• Dietry fiber ( Cellulose, Pectins & Gum)
Dietry Constituents & Recommended % of
energy Intake
• Carbohydrates: 45-60% , Sucrose upto 10%
• Fat: < 35%
n-6 ployunsaturated:<10%
n-3 polyunsaturated: one portion of 140gm 1-2
times/week
Monounsaturated:< 10-20%
Saturated: <10%
• Proteins: 10-15%(<1gm/kg)
• Fruits & Vegetables: 5 portions Daily
Plate Model

20%

40%
Fish, Meat,Eggs & Cheese
Rice, Pasta, Bread &
Potatoes
Vegetables & Fruits

40%
DRUG MANGEMENT
• Biguinides
• Sulphonylureas
• Meglitinides
• Alpha Glucosidase Inhibitors
• Thiazolinediones
• Incretin Based Therapies
• SGLT2 Inhibitors
• Insulins
Biguanides
• Metformin
• Insulin Sensitiser: Supress gluconeogenesis & glycogenolysis ,
improves peripheral Glucose uptake, decrease gut glucose
absorption. Mitochondrial respiration inhibition
• Reduces Hyperglycemia, weight neutral, beneficial in microvascular
disease
• 1st line therapy in tolerant patients.
• Start with 500mg and maintain with 1gm bd
• GI Side effects
• Lactic Acidosis in CKD half in GFR 30-45ml/min and stop in GFR <
30ml/min
• Vitamin B 12 Deficiency
Sulfonylureas
• Insulin Secretogouge
• Blocks ATP sens K Channel
• Glibenclamide, tolbutamide, Glimeperide,
Gliclazide, Glipizide.
• Alone Or Combined with Other Antidiabetics
• Weight Gain.
• Hypoglycemia.
Meglitinides
• Insulin Secretogouge
• Blocks ATP sens K Channel
• Repaglinide & Netiglinide
• Alone or Combined with Other Antidiabetics
• Weight Gain.
• Hypoglycemia.
Alpha Glucosidase Inhibitors
• Blocks Intestinal Disaccharidases
• Acarbose & Meglitol
• Alone Or Combined with Other Antidiabetics
• Faltulence
• Diarrhea
• Bloating
Thiazolidinediones
• PPAR γ
• Insulin Sensitivity in Adipose Tissue
• Alter release of Adipokines improving insulin sensitivity in liver
• Pioglitazone, Rosiglitazone
• Alone or In combination
• Weight Gain
• Myocardial Infarction
• Cardiac Failure Exacerbation
• Bone Fracture
• Bladder Cancer
Incretin Effect(Secretogouge) & Type 2
Diabetes Mellitus
Glucagon Like Peptide 1(GLP-1) & Gastric Inhibitory
PloyPeptide(GIP) metabolised by Dipeptidyl peptidase 4

Gliptins or DPP-4 inhibitors GLP-1 receptor agonists


• Prevents Metabolism of GLP • Decrease Gastric Emptying
1 & appetite
• Sitagliptin, Valdagliptin, • Weight Loss
Saxagliptin& linagliptin. • Exenatide,Albiglutide,Dulagl
• Upper Resp Tract Infection utide & liraglutide
due to • Nausea,Vomiting,Diarrhea.
• Anaphylaxis,angioedema & • Pancreatitis
steven Johnsons
• AKI
• Pancreatitis
• Medullary Thyroid Ca
• Heart Failure
SGLT2 Inhibitors
• SGLT2 in Renal Tubules.
• 25% of renal Tubular Glucose not reabsorbed &
resultant Renal Glycosuria.
• Dapagliflozin, Canagliflozin & Empagliflozin.
• Weight Loss.
• Genital Mycotic & Urinary Tract Infections.
• Dehydration & Hypotension.
• High LDL.
• Breast & Bladder Cancer.
Mechanism Of Various Antidiabetics
Effects Of Various Antidiabetics
Management Of Type 2 diabetes Mellitus
END

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