Treatment of Diabetes Dr. Osama

Transcription

1 diabetes practical and type two Diabetes treatment diabetes treat << Objective Diabetes fasting blood sugar random post prandial Hemoglobin A 1 C glycated diabetic 6.5 diabetes controlled fasting P a g e 1

2 It is recommended fasting 180 post prandial glycated hemoglobin control target diabetes type two diabetes MODY P a g e 2

3 MODY 20 category 17 diabetes diabetes strong family history diabetes positive family history strong family history category diabetes islets cells antibodies positive family history MODY Maturity onset diabetes of young Monogenic diabetes Oral hypoglycemic MODY Oral hypoglycemic Oral hypoglycemic controlled MODY P a g e

4 positive Islets cells antibodies oral hypoglycemic response respond respond MODY never << 40 0 C peptide Investigations type two family history oral C peptide << type two diabetes LADA LADA latent auto immune diabetes in adults 20 auto immune process P a g e 4

5 late late oral hypoglycemic oral hypoglycemic MODY type two Type one Diabetes Type one diabetes diabetes aggressive 0.5 P a g e 5

6 hypoglycemia Low example unit NPH mixed insulin crystalline crystalline << 40 % 1/ intermediate 70 / 0 insulin mixtard insulin 0 10 twice daily P a g e 6

7 check provided 4 emergency Provided 500 Insulin infusion 0 cold case 5 units you cannot predict the response 5 4 check blood sugar stepwise controlled random controlled post prandial fasting 9 random post prandial fasting 24 P a g e 7

8 glycated hemoglobin secretion basal insulin secretion 24 blood sugar Long acting insulin crystalline insulin P a g e 8

9 type two 45 0 % say peak No Hypoglycemia at all % 0 % 0 % P a g e 9

10 controlled basal sliding scale sliding sliding scale basal above 50 crystalline insulin << P a g e 10

11 stable stabilized trial and errors P a g e 11

12 1/ 2/ twice per day << mixed insulin 70 / insulin mixtard 20 every few days << 5 Units << about 4 Optimum mixtard Mixtard crystalline insulin NPH action duration crystalline insulin 8 16 NPH NPH peak controlled P a g e 12

13 2 hypoglycemia Hypoglycemia Mixtard insulin analogue rapidly acting peak insulin analogue duration Mixed Mixed Novo mix << mixed 70 / 0 ) Mixtard insulin analogue << Novo mix Novo mix 0 % Mixtard sorry crystalline insulin mixtard crystalline insulin << 70 % Novo mix P a g e 1 crystalline insulin 70 %

14 twice insulin analogue mix Overlap duration Overlap aggressive aggressive physiological << crystalline insulin crystalline insulin overlap Insulin analogue Novo rapid analogue crystalline insulin short acting insulin analogue << Insulin Novo rapid crystalline insulin Novo rapid very short acting 4 P a g e 14 Mixtard Mixed insulin analogue

15 Novo rapid Mixtard 0 % 70 % Novo mix analogue novo mix mixtard Novo rapid Novo mix Novo rapid Hypoglycemia Novo rapid Long acting Insulin analogue errors trial Peak << divided crystalline novo rapid Insulin analogue trial and errors P a g e 15

16 sliding scale Hypoglycemia << traditional << Novo mix insulin analogue 0 % 70 % NPH duration 16 insulin analogue rapidly acting short duration P a g e 16

17 updated Novo rapid Novo rapid long acting insulin analogue long acting analogue short acting Novo rapid premixed Novo mix Novo rapid APIDRA Novo rapid Long acting short acting P a g e 17

18 novo mix Novo rapid mixed Novo rapid hypoglycemia emergency stepwise Type Two Diabetes release type two Oral Oral Secretagogues secretagogues secretagogues secretagogues Diamicron P a g e 18

19 amaryl Glimipride amaryl release Sulphonylurea << secretagogue exhaustion release on and off On and off release On and off One One << very common mistake P a g e 19

20 type two diabetes 5 type two diabetic 1 emergency << type two Obese insulin resistance 1 << amaryl 2 8 P a g e 20

21 6 << practically Insulin sensitizer Insulin sensitizer Biguanides P a g e 21

22 Exhaustion responding no way << definitely type two sort of insulin resistance You must add insulin sensitizer maximum of Off insulin sensitizer exhausted Insulin action to preserve P a g e 22

23 Diamicron Diamicron MR Diamicron MR Modified release Diamicron amaryl MR Modified release Modified release Diamicron one one Diamicron MR One 0 P a g e 2 two s better to be one

24 one 60 Diamicron MR Insulin sensitizer renal impairment hepatic COPD Renal impairment Kidney excreted lactic acidosis renal impairment diabetic side effects insulin sensitizer P a g e 24

25 Pioglitazones Pioglitazones Avandia Glustin X Cross Avandia Avandia cardio-toxic absolutely contraindicated coronary heart disease heart failure salt and water retention heart disease pain Avandia Avandia 0 Glustin 15 Glustin Glustin heart failure coronary 0 15 Glustin P a g e 25

26 24 Diamicron MR Glustin oral hypoglycemic 6 0 Oral hypoglycemic Diamicron insulin Glustin shift 120 Oral hypoglycemia combination P a g e 26

27 twice per day << insulin basal secretion Oral Oral release Novo norm Novo Norm normalized 0.5 Novo norm average Novo norm long acting << diet Mainly << Novo norm very short action Novo norm P a g e 27

28 insulin Novo norm diet basal insulin Novo norm Novo norm Novo norm satisfied Exhausted insulin << Up to 2 units per kg type two insulin resistance type two resistance P a g e 28

29 Mixtard insulin sensitizer type two insulin resistance incretin incretin effect incretins Oral intra venous oral IV IV Oral glucagon related peptide glucagon related peptide oral intestine oral P a g e 29

30 glucagon related peptide 500 oral glucagon related peptide intestine incretin effect incretin effect oral IV glucagon related peptide release glucagon related peptide release glucagon level appetite P a g e 0

31 incretins based therapy incretins based therapy glucagon related peptide enhance Oral glucagon related peptide << intestine glucagon related peptide << enhance << Ganuvia Glucagon related peptide Gulcagon related peptide enhance adjuvent therapy sorry effective P a g e 1

32 Diamicron incretin based therapy Novo rapid Long acting insulin Hypoglycemia << short acting insulin analogue overlap duration P a g e 2

33 Diabetes P a g e