dm trends

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Trends in Diabetes

Care Management

Ann Margarett Lapuz

Cathy Roxas

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Trends in Diabetes Care

Management

Healthcare workers primarily focus on

prevention of DM thru lifestyle modification

DIET EXERCISE

It reveals 58% decrease in developing

DM and slows the rate of the disease in pt.

with DM.

ABCs of DM

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Management

A = A1c ( 1.1

Women > 1.3 mmol/ l - > 1.3

Triglycerides < 1.7 mmol/ l < 1.5

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Management

Prevent complications of DM

Patient CenteredApproach

early DM Dx; effective control of glycaemia,BP, etc.

Prevention of severe sequel of DMcomplications

Cx screening & its management

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Management

Emphasis on patient self-care

Empowerment / patient education

Education on self management of diabetes

mellitus is important since more than 95% of

diabetes care is self-care.

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Pharmacological Treatment

New Emerging Theraphies

Incretin-Based Hormones (Exenatide, Liraglutide)

Regulates blood glucose, and to a lesser extent, insulinand glucagon secretion.

Usually given SQ

Amylin Agonist

Pramlintide - inhibit postprandial glucagon secretion,slow the rate of gastric emptying, enhance satiety, and

reduce food intake

Given pre-meals SQ

Highly associated with hypoglycaemia if used with other

drugs

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New Diabetes Indication for

EstablishedDrugs

Colesevelamused for the treatment of hyperlipidemia, is thought

to delay or alter absorption of glucose from the

intestines

shown to provide an A1C reduction of 0.41% andan LDL reduction of 12.8%

SE: constipation, dyspepsia, nausea

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Bromocriptineshown in a 1-year study to reduce A1C level by

approximately 0.6% as monotherapy and 1.2% in

combination with insulin or a sulfonylurea.

lowered plasma triglycerides and free fatty acids

by approximately 30%

Decreased cardiovascular events

SE: nausea, vomiting, fatigue, dizziness, and

hypotension.

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Sodium -Glucose Transpo rter 2

Blockers

Dapagliflozin - prevent renal glucose reabsorptionand lower serum glucose by increasing urinary

excretion of glucose.

shown to lower A1C by 0.58% to 0.89%

SE: may lead to cancer, hepatoxicity

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New modes of Insulin Delivery

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Journal

Neonatal Diabetes: Current Trends in

Diagnosis and Management

Abstract The purpose of this article is to describe diabetes

diagnosed during the first 6 months of life

also known as congenital diabetes

Neonatal diabetes is not type 1 diabetes. While theetiology of type 1 diabetes is multifactorial and

includes genetic and environmental factors,

neonatal diabetes is strictly a genetic condition.

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Neonatal Diabetes defined as uncontrolled hyperglycemia that requires

treatment with insulin and has an onset in the first 6

months of life. occurs in approximately 1 in 300,000 to 500,000 live

births

can be either permanent or transient.

term as "congenital diabetes" because some of these

cases occur after the 4-week neonatal period.

majority of cases of neonatal diabetes are genetically

determined by a gene mutation and are, therefore, not

autoimmune.



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Diagnosis of Diabetes in Infancy small for gestational age (SGA)

increased thirst

polyuria ( soaking the diaper suddenly )

dehydration

failure to thrive

rarely suspected, misdiagnosed which may lead to

diabetic ketoacidosis Presence of ketones in the urine

Persistent elevated blood sugar of >150 200mg/dl



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Neonatal Diabetes Type 1 Diabetes Mellitus

Genetic Condition Autoimmune disorder

Diagnosed during neonatal period Diagnosed after neonatal period

In children and young adults

Caused by gene mutationMonogenic

Polygenic Genetic predisposition butassociated with environmental factors

( viruses, cows milk nitrosamines )

No presence of antibodies With autoantibodies, insulin antibodies

etc.



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Transient Neonatal Diabetes Permanent Neonatal Diabetes

Result from mutation of chromosome 6 Mutation in the potassium (KATP)

channel of the insulin-producing cells

early onset but normalized by 18

months of age

Diagnosed during 1st 6mos and does not

resolve

SGA but can catch up later on have neurological complications such

as Developmental delay mild to severe,

Epilepsy, etc

Decrease C-peptide levels (not enough

secretion of insulin)

Absence of C-peptide levels

Resolves during Infancy but possible

relapse during adolescence, pregnancy

and stressful events.

Requires insulin daily in increasing dosage

Insulin management Insulin management and oral

sulfonylureas



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Treatment Options for Neonatal Diabetes

Insulin

Treatment begins immediately after diabetes isdiagnosed by an elevated hemoglobin A1c or persistent

hyperglycemia

Insulin is often delivered initially by an insulin infusion

that gives healthcare providers the ability to titrate doses

depending on blood glucose levels. Once transitioned from the initial insulin infusion,

injections of a basal insulin may be started

often divided into twice-daily dosing in young children

and infants to provide an adequate basal effect



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Dilute insulin utilized to ease measurement of insulin doses for small

children

usual dilution used for insulin is a 1unit/10ml

concentration

Insulin usually given in 0.2 units

allowing for more specificity with measurement

should be prepared by a pharmacist who is familiar withthe dilution technique

should be discarded 30 days after preparation



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Feeding and insulin important that insulin boluses be paired with feedings

Counting carbohydrates and planning dietary intake must be

carefully managed by healthcare team

a common rule for evaluating the insulin-to-carbohydrate ratiois to divide 500 by the total daily insulin dose. If the infant is

requiring about 3 units of insulin in a 24-hour period, divide 500

by 3. This results in 166-the insulin-to-carbohydrate ratio would

be 1 unit of insulin for 166 g of carbohydrate. U-10 dilution of

insulin, each 0.1 unit of insulin would then cover 16 g of

carbohydrate-the total carbohydrate in 10 oz of milk.

For blood glucose correction, the 1,800 rule is applied: divide

1,800 by the total daily insulin dose. In this case, divide 1,800

by 3 and get 600. Each unit of insulin would decrease the blood

glucose by 600 mg/dl. Using U-10 dilute insulin, each 0.1 unit

would decrease the blood glucose by 60 mg/dl.



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Assessment of Blood Glucose Control safe target range for glucose levels for infants is 100 to

180 mg/dl before feeding and 110 to 200 mg/dl at sleep

times ( ADA ) Trends can be seen at specific times of the day, after

specific meals or feeding times or in relation to illness or

other change in the daily activity

Monitor accordingly

Hemoglobin A1c measures long-term glucose controland should be measured every 3 months. (ADA) 7.5%

and 8.5% to optimize good blood glucose control

Always watch out for episodes of hypoglycaemia



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Oral Sulfonylureas Sulfonylurea drugs bind to the channel, resulting in

closure and release of endogenous insulin

Given if after 4-8 weeks infant is confirmed to have PND

Substitution of insulin with the sulfonylurea should take

place gradually under the direction of a experienced

medical team

sulfonylureas in infancy is currently off-label, and parents

should be fully informed and sign consent for the changein treatment



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Clinical Implications great deal for nurses to learn about diagnosis and management

of neonatal diabetes

Nurses play a significant role in supporting families as theylearn about the disease, and struggle to manage the stress,

which accompanies having a sick infant.

Educate parents in handling their sick infant, (giving insulin as

needed and monitoring blood glucose throughout the day and

night )

dangers of hypoglycemia and hyperglycemia in their infants

Infants have varying sleep/wake and eating schedules, adding

to the complications of trying to achieve consistently safe blood

glucose levels



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Fussiness can be correctly interpreted as normal in the

infant, but it may also be caused by hypoglycemia or

hyperglycemia, requiring more frequent blood glucose

testing than might be necessary in an older child.

Managing infants with diabetes requires a skilled

pediatric endocrine team with experience in diagnosis

and management of diabetes in this young age group,

with professional nurses who are both learned and

compassionate in their care.



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