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Clinical Pharmacology 5 th year section. Diabetes mellitus:.

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Clinical Pharmacology 5 th year section

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Clinical pharmacology 5 th year section l.jpg

Clinical Pharmacology5th yearsection


Diabetes mellitus l.jpg

Diabetes mellitus:

  • It is a condition in which the body either does not produce enough, or does not properly respond to, insulin, ahormoneproduced in thepancreas. Insulin enables cells to absorb glucose in order to turn it into energy. In diabetes, the body either fails to properly respond to its own insulin, does not make enough insulin, or both. This causes glucose to accumulate in the blood, often leading to various complications.

  • Many types of diabetes are recognized The principal three are:

  • Type 1: Results from the body's failure to produce insulin.

  • Type 2: Results from Insulin resistance.

  • Gestational diabetes


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Laboratory tests for diabetes

  • Fasting blood glucose >120 mg\dl

  • Oral glucose tolerance test >200 mg\dl

  • Glycolated HB >8%


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Diabetic complications

  • Diabetic vascular complications (heart, blood vessels)

  • Diabetic nephropathy

  • Diabetic retinopathy

  • Diabetic neuropathy

  • Diabetic foot complications


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Clinical case 1

  • Mrs PH is a 62-year-old lady who has hypertension, for which she takes bendroflumethiazide 2.5 mg daily.

  • She has smoked for over 40 years

    and is overweight.

  • This morning she had a ‘funny turn’

    and fell to the floor.

  • Her husband called an ambulance and

    she was taken to hospital.

  • She said that she felt generally unwell but couldn’t specify any particular symptoms other than nausea.


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Clinical case 1

  • In the accident and emergency department of the hospital an ECG showed acute ST elevation.

  • blood tests showed that she had: 1)raised creatinine kinase-MB and troponins. 2) A venous blood glucose level of 23.6 mmol/L was reported and confirmed.


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Clinical case 1

Question:

  • What is her diagnosis?

  • What are her risk factors for cardiac diseases?

  • How should she be treated acutely?

  • What important lifestyle changes should she make?

  • What targets for glycaemic control would be appropriate?


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Answer to case 1

  • - Silent acute myocardial infarction

  • Type 2 D.M.

  • - hyperglycemia, obesity, hypertension and smoking

  • - Thrombolytic

  • Aspirin

  • I.V. Insulin and Glucose

  • β-blockers

  • ACE inhibitors

  • Stop smoking and reduce weight

  • HbA1c below 6.5%


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Clinical case 2

  • Mrs DB is a 55-year-old lady with type 2 diabetes, which she has had for 4 years.

  • She presented for her primary care clinician complaining of tiredness and lethargy.

  • Her normal medication includes:

  • Metformin 500 mg three times a day,

  • Mixtard 30 insulin (18 units in the morning and 12 in the evening)

  • Aspirin 75 mg daily

  • Simvastatin 40 mg daily

  • Lisinopril 5 mg daily.


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Clinical case 2

  • Her primary care clinician did blood tests and discovered:

  • Serum creatinine of 207 µmol/L

  • eGRF of 24mL/min

  • Haemoglobin (Hb) of 8.4 g/dL.

  • Her HbA1c was 9.2 %

  • Random blood glucose test was 14.2 mmol/L.

  • Her blood pressure was 170/95 mmHg and

  • Urine dipstick was positive for protein


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Clinical case 2

Question:

  • What might be the cause of her tiredness and lethargy?

  • What immediate interventions should be made by her primary care clinician?

  • How might the rate of renal decline be further slowed?


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Answer to case 2

  • - poorly controlled diabetes

  • Anemia which occur with diabetic nephropathy

    2. - metformin stopped (lactic acidosis)

  • ↑lisinopril dose to 20 mg/day to ↓B.P. ˂130/80, but serum creatinine must be checked

  • ↑insulin dose

    3.- Control hypertension and glycaemic control

    - Administer exogenous erythropoeitin and parentral iron therapy


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