Diabetes management and complications

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Diabetes management and complications

• Dr. Louise Johnson-Loots
• Specialist physician and insulin pump centre
• Montana hospital, Pretoria

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Diabetes types

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

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Diabetes

• Type 1
• Younger than 30 yr
• Thin
• Auto-immune disease
• 10-20 of Pt.

• Type 2
• Older than 30 yr
• Obese
• ? waist gt 94 cm
• ? waist gt 80 cm
• Ass diseases i.e. HT,Dyslipiedemiae
• 80 of Pt

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What you see is what you have

• Type 2

• Type 1

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Insulin resistance (metabolic syndrome)

• First step on diabetes ladder
• Waist circumference Male gt94 cm
• Female
  gt80cm
• Associated disease Hypertension
• - gout
• -abnormal
  cholesterol

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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

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Targets to achieve

• Waist - 94 cm male, 80cm female
• Blood pressure lt 130/80mmHg
• LDL cholesterollt 1.8
• HDL cholesterol gt 1.0
• HbA1c lt 7
• FPG lt 5.5 , 2h PPG lt 7.8

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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

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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- dont skip
• Enough water - weight ( 84 kg 8 glasses)

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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

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Important pitfalls

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

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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

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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

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Progression of type 2 diabetes
?-cell function ( of normal by HOMA)
Time (years)
HOMAhomeostasis model assessment. Adapted from
Holman RR. Diabetes Res Clin Pract 199840(suppl
1)S21?5.
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The first insulin

• 11/1/1922
• Leonard Thompson
• 14yr
• 25 days on dog insulin

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Expectations today

• Fast
• Reliable
• Smooth
• Reproducible
• Safe

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Complications

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

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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

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More rules

• Rule 4 sin once every 14 days (ice cream
  ,chocolate ,cookies etc)
• Rule 5 - if female and your baby weighed gt4.0kg
  get screened for diabetes yearly
• Rule 6 Become the captain of your own ship !

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Questions ??