1 / 27

DIABETES MELLITUS

DIABETES MELLITUS. THOMAS MILLIGAN, DO OSU-COM FAMILY MEDICINE. Introduction. Types of DM Diagnosis Management Follow-up Complications. TYPES. Type 1 Type 2. TYPE 1. Pathophysiology Diagnosis Management. DIAGNOSIS. Random BS of 200 plus symptoms Polyuria Polydipsia

diamond
Download Presentation

DIABETES MELLITUS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. DIABETES MELLITUS THOMAS MILLIGAN, DO OSU-COM FAMILY MEDICINE

  2. Introduction • Types of DM • Diagnosis • Management • Follow-up • Complications

  3. TYPES • Type 1 • Type 2

  4. TYPE 1 • Pathophysiology • Diagnosis • Management

  5. DIAGNOSIS • Random BS of 200 plus symptoms • Polyuria • Polydipsia • Unexplained weight loss • Fasting BS 126 or Greater • NPO at Least 8 Hours • BS of 200, 2 Hours After 75g Glucose Challenge

  6. MANAGEMENT • Diet • Decrease Glucose • Pt Must Not Skip Meals • Exercise • Insulin

  7. PATHOPHYSIOLOGY • Immune related destruction of insulin producing cells • Loss of insulin • Insulin required to prevent DKA

  8. INSULIN • Begin with 20 - 40 u day • 2/3 am, 1/3 pm • Am 2/3 inter, 1/3 regular • Pm 1/2 inter, 1/2 regular • Timing • Must be given with respect to meals

  9. INSULIN • Adjustments • Average of 35 - 50 u day • 0.6 - 1.2 u/kg/day • Maintain FSBS 100 - 250 • Pt keeps log of FSBS to avoid hypoglycemia • Intermediate insulin • Change evening dose first • Beware of nocturnal hypoglycemia

  10. INSULIN • Regular insulin • Guided by pre-prandial FSBS • Avoid regular insulin at bedtime • More diet and activity sensitive • Multiple Daily Injections (MDI) • Better control • Very compliant pts

  11. INSULIN • ONSETPEAKDUR • LISPRO 15 - 30 m 1 - 3 h 3 - 6 h • REGULAR 15 - 60 m 2 - 6 h 4 - 12 h • NPH 1.5 - 4 h 6 - 16 h 14 -28 h • LENTE 1 - 4 h 6 - 16 h 14 -28 h

  12. TYPE 2 • Pathophysiology • Diagnosis • Management

  13. PATHOPHYSIOLOGY • Usually after age 30 • Usually obese • Insulin resistance • Insulin may be used, but not essential • Non ketotic hyperosmolar syndrome, not DKA

  14. DIAGNOSIS • Random bs of 200 plus symptoms • Polyuria • Polydipsia • Unexplained weight loss • Fasting BS 126 or greater • NPO at least 8 hours • BS of 200, 2 hours after 75g challenge

  15. MANAGEMENT • Diet • Exercise • Oral agents • Combination • Insulin

  16. ORAL AGENTS • Sulfonylureas • Metformin • Troglitazone • Acarbose

  17. SULFONYLUREAS • Diabinese, glucotrol, diabeta, micronase, prandin, amaryl • Increases insulin production • Hypoglycemia

  18. METFORMIN • Glucophage • Decreases hepatic glucose production • No hypoglycemia

  19. TROGLITAZONE • Rezulin • Increases peripheral glucose uptake • No hypoglycemia if used alone • Initial indication is for pts on insulin • Liver toxicity

  20. ACARBOSE • Precose • Alpha-glucosidase inhibitor • Decreases glucose uptake in the gut • GI intolerance • No hypoglycemia

  21. COMBINATION • Use one from each class • Reduce dose of other drugs by 1/2 if adding a sulfonylurea

  22. INSULIN • Max out oral agents • Start with intermediate acting insulin • Eventually will use one modality

  23. EVERY VISIT • FSBS • UA with microalbumin • Foot exam, including neuro

  24. EVERY 3 MONTHS • HGB A1C

  25. EVERY 6 MONTHS • Lipids • CHEM 8

  26. YEARLY • Ophthomology consult • EKG

  27. COMPLICATIONS • Retinopathy, neuropathy, cad, nephropathy, enteropathy, poor wound healing, impotence, depression • Hyperglycemia is better than no glycemia

More Related