Download - Diabetes management and complications
Diabetes management and
complicationsDr. Louise Johnson-LootsSpecialist physician and insulin pump centreMontana hospital, Pretoria
Diabetes types
Type 1 – auto immune
Type 2 - insulin resistant
Secondary – surgery, medication (i.e. steroids)
GDM ( gestational diabetes)
Type 1
Younger than 30 yr
Thin
Auto-immune disease
10-20% of Pt.
Type 2
Older than 30 yr
Obese –
♂ waist > 94 cm
♀ waist > 80 cm
Ass diseases i.e. HT,Dyslipiedemiae
80% of Pt
Type 2 Type 1
Insulin resistance (metabolic syndrome)
First step on diabetes ladder
Waist circumference Male >94 cm
Female >80cm
Associated disease –Hypertension
- gout
-abnormal cholesterol
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
Targets to achieve
Waist - 94 cm male, 80cm female
Blood pressure < 130/80mmHg
LDL cholesterol< 1.8
HDL cholesterol > 1.0
HbA1c < 7%
FPG < 5.5 , 2h PPG < 7.8
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
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- don’t skip
Enough water - weight ( 84 kg = 8 glasses)
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
Important pitfalls
Diabetic sweets - too much fat
Flavored water = Coke in calories!!
Fruit juice
Not what we eat but how much of it!
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
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
HOMA=homeostasis model assessment.Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21―5.
-cell f
un
cti
on
(%
of
norm
al b
y
HO
MA
)
Time (years)
0
20
40
60
80
100
―10 ―8 ―6 ―4 ―2 0 2 4 6
Time of diagnosis
?
Pancreatic function= 50% of normal
11/1/1922
Leonard Thompson
14yr
25 days on dog insulin
Fast
Reliable
Smooth
Reproducible
Safe
Complications
Preventable
Preventable!
Preventable!!
Know the rules of the metabolic abnormality to prevent the disease
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
More rules
Rule 4 – sin once every 14 days (ice cream ,chocolate ,cookies etc)
Rule 5 - if female and your baby weighed >4.0kg – get screened for diabetes yearly
Rule 6 – Become the captain of your own ship !
Questions ??