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DIABETES mANAgemENT , BEYONDNUMBERS!

Dr. SYED SULAIMAN;M.D. (GEN.MED) PHYSICIAN & DIABETOLOGIST. DIABETES mANAgemENT , BEYONDNUMBERS!. Goals in diabetes management. KNOW YOUR NUMBERS. ARE WE JUSTIFIED ??. Justify yourself!. YES. Give me reason to negate!. no. Management of the disease

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DIABETES mANAgemENT , BEYONDNUMBERS!

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  1. Dr. SYED SULAIMAN;M.D. (GEN.MED) PHYSICIAN & DIABETOLOGIST DIABETES mANAgemENT, BEYONDNUMBERS!

  2. Goals in diabetes management

  3. KNOW YOUR NUMBERS

  4. ARE WE JUSTIFIED ??

  5. Justify yourself! YES

  6. Give me reason to negate! no

  7. Management of the disease Management of the co morbid conditions TWO SIDES OF A COIN

  8. Depression Erectile Dysfunction Skin diseases Endocrine disorders Comorbid conditions

  9. Effect of depression on all-cause mortality in people with diabetes

  10. At least five symptoms present nearly every day for 2 weeks, including: • Depressed mood • Diminished interest in daily activities • Significant weight loss/gain or decreased appetite • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness/guilt • Diminished ability to concentrate/make decisions • Recurrent thoughts of death or suicide Criteria for diagnosing depression

  11. Feeling sad/depressed mood Inability to sleep Early waking Lack of interest/enjoyment Tiredness/lack of energy Loss of appetite Feelings of guilt/worthlessness Recurrent thoughts about death/suicide Depressive symptoms – often measured using self-report instruments

  12. Depression and Diabetes share many common threads: Chronic history Multifactorial pathogenesis Poorly understood etiology Multifaceted clinical picture Frequent exacerbations Need for patients active participation in management Ability to be controlled but difficulty in getting cured DEADLY DUO

  13. Poor adherence to treatment Poor glycemic control Frequent complications Sexual dysfunction Poor Quality of life Less interest in exercise Lack of physical fitness EFFECTS OF DEPRESSION ON DIABETES

  14. Life time prevalence of major depression in diabetes is 28.5% DEPRESSION IS TWICE COMMON IN DIABETICS More frequent in women (28%) than in men(18%) More in uncontrolled group(30%)than in controlled group(21%) More in clinical(32%) than in community samples(20%) PREVALeNCE OF DEPRESSION IN DIABETES

  15. 18% 36% Normal population Female > Male Depression Female > Male Life Time Prevalence of Depression in Diabetic Patients

  16. DM AND DEPRESSIONTHE MYTH & THE REALITY REALITY  Depression disorders are overlapping, hardly expressed by the patient and constitute a major problem in symptom exaggeration MYTH  Depression is obvious and easily recognized and expressed by the patient

  17. While depression is significantly more common in people with diabetes compared to those without diabetes, it can be treated effectively. Depression increases the risk of developing diabetes, Impacts on blood glucose control, and increases the risk of developing diabetes complications. It is associated with increased body weight or obesity, and poorer diabetes self-management. It is important to recognize that although diabetes and depression are separate conditions they often co-exist and any treatment offered must reflect this in order to maximize the benefits to the person with diabetes. Summary

  18. “The consistent inability to achieve or sustain an erection of sufficient rigidity to permit sexual intercourse “ ERECTILE DYSFUNCTION

  19. Many men with diabetes also have erectile dysfunction: • ED can be an early sign of diabetes. • A diabetic man is two to five times more likely to develop ED than a man who is not a diabetic. • Men with diabetes tend to develop ED 10-15 years earlier than men • without diabetes. • More than 50% of men develop diabetic ED within 10 years of getting diabetes.¹ • 50%-60% percent of diabetic men over age 50 have some problem with ED.¹ • 50%-75% of men with diabetes will experience some degree of ED during their lives. • 9% of men with diabetes age 20-29 experience ED. 95% of men with diabetes experience ED by age 70.¹ Diabetes & ERECTILE DYSFUNCTION

  20. Prevalence of e.d

  21. Genetics: A family disposition for the disease • Diet: High in fat and processed foods • Lack of exercise: Getting off the couch Causes

  22. Neurogenic: Penile autonomic neuropathy Vasculogenic: Diabetic microangiopathy Endocrinologic: PATHOPHYSIOLOGY OF DIABETES RELATED E.D

  23. Lesions of medial preoptic nucleus, paraventicular nucleus, hippocampus • Spinal trauma • Myelodisplasia (spina bifida) • Pelvic surgery/radiotherapy • Multiple sclerosis • Intervertebral disc lesion • Peripheral neuropathies • Alcohol • Diabetes • HIV Neurogenic causes of ED

  24. Hypertension Smoking Diabetes Hyperlipidaemia Peripheral vascular disease Blunt perineal or pelvic trauma Pelvic irradiation Arteriogenic Cause of ED

  25. Hypogonadism • Low testosterone • Raised SHBG • Raised Prolactin • Thyroid disease Endocrine causes of ED

  26. Antihypertensives • Thiazides • B blockers • Centrally acting drugs • Antidepressants • Tricyclics • MAO inhibitors • SSRI • Anticholinergics • Atropine Drugs associated with ED • Antipsychotics • Phenothiazines • Anxiolytics • Benzodiazepines • Psychotropic drugs • Alcohol • Opiates • Amphetamines • Cocaine

  27. Generalised atherosclerosis Penile arteries smaller than coronary arteries ED pre-dates coronary artery disease Man with ED and no cardiac symptoms is a cardiac patient until proven otherwise ED and Coronary Artery Disease

  28. Sexual Medical Psychosocial history EVALUATION OF E.D

  29. DIABETES & SKIN

  30. SKIN MANIFESTATIONS OF DIABETES

  31. CUTANEOUS INFECTIONS ONYCHOMYCOSIS TAENIA PEDIS

  32. NEUROLOGIC LESIONS CHARCOT FOOT NEUROPATHIC ULCER

  33. COLLAGEN DISORDERS NECROBIOSIS LIPOIDICA GRANULOMA ANNULARE SCLERODERMA DIABETICORUM

  34. SKIN CONDITIONS STRONGLY ASSOCIATED WITH DM ACANTHOSIS NIGRICANS BULLAE DIABETIC DERMOPATHY

  35. Metabolic diseases Porphyria cutaneatarda xanthomatosis Haemochromatosis

  36. SKIN REACTIONSTO DIABETIC THERAPY LIPODYSTROPHY LIPOHYPERTROPHY

  37. ACANTHOSIS NIGRICANS

  38. BULLAE

  39. CELLULITIS

  40. DIABETIC DERMOPATHY

  41. FOLLICULITIS

  42. GRANULOMA ANNULARE

  43. TAENIA PEDIS

  44. PARONYCHIA

  45. ONYCHOMYCOSIS

  46. NEUROPATHIC ULCER

  47. Type 1 DM ,Hypothyroidism & Graves disease– autoimmune association Girls > Boys Subclinical hypothyroidism (SCH):TSH, normal FT4 & FT3. Frequently seen in adults with Type 1 & Type 2 DM ENDOCRINE DISORDERS

  48. The good physician treats the disease; the great physician treats the patient who has the disease. William Osler

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