diabetes practical 201 1 6 and type two Diabetes treatment diabetes treat << Objective 200 126 Diabetes fasting blood sugar random post prandial Hemoglobin A 1 C glycated 6.2 4 diabetic 6.5 diabetes controlled fasting P a g e 1
10 126 10 90 It is recommended fasting 180 post prandial glycated hemoglobin 7 6 7 control target diabetes type two diabetes MODY P a g e 2
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
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
late late oral hypoglycemic oral hypoglycemic MODY type two Type one Diabetes Type one diabetes diabetes 0.8 0. 60 aggressive 0.5 P a g e 5
hypoglycemia Low example 0.5 60 0 0 unit NPH mixed insulin crystalline crystalline << 40 % 1/ intermediate 70 / 0 insulin mixtard insulin 0 10 twice daily 20 20 10 0 20 1 12 20 7 P a g e 6
check provided 4 emergency Provided 500 Insulin infusion 0 cold case 5 units you cannot predict the response 5 4 check blood sugar 0 5 5 4 stepwise controlled random controlled post prandial fasting 9 random post prandial fasting 24 P a g e 7
glycated hemoglobin 60 40 secretion basal insulin secretion 24 blood sugar Long acting insulin crystalline insulin P a g e 8
45 40 15 0 type two 45 0 % say 15 45 peak No Hypoglycemia at all 15 0 10 10 10 40 % 0 % 0 % P a g e 9
15 10 10 10 controlled 12 15 12 12 20 basal sliding scale sliding sliding scale basal 8 200 above 50 crystalline insulin << 5 5 00 200 8 P a g e 10
200 100 10 50 200 150 15 10 15 10 stable stabilized 10 15 10 20 5 trial and errors 0.8 0. 60 0 P a g e 11
1/ 2/ twice per day << mixed insulin 70 / 0 10 0 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
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 %
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
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 20 15 60 60 << divided crystalline novo rapid Insulin analogue 12 15 10 trial and errors P a g e 15
10 10 200 50 sliding scale 150 50 5 170 Hypoglycemia 200 50 5 << traditional << Novo mix insulin analogue 0 % 70 % NPH duration 16 insulin analogue rapidly acting short duration P a g e 16
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
novo mix Novo rapid mixed Novo rapid 40 25 40 hypoglycemia emergency stepwise Type Two Diabetes release type two Oral Oral Secretagogues secretagogues secretagogues secretagogues Diamicron P a g e 18
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
type two diabetes 5 type two diabetic 1 emergency 5 4 2 << type two Obese insulin resistance 1 << amaryl 2 8 P a g e 20
6 << practically 6 2 1 2 1 Insulin sensitizer Insulin sensitizer Biguanides 1000 850 500 500 500 500 500 P a g e 21
1000 1000 4 1000 5 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
Diamicron Diamicron MR Diamicron MR Modified release 80 40 Diamicron amaryl MR Modified release 24 60 0 Modified release Diamicron 0 60 90 120 one one Diamicron MR One 0 P a g e 2 two s better to be one
one 60 Diamicron MR 120 0 Insulin sensitizer renal impairment hepatic COPD Renal impairment Kidney excreted lactic acidosis renal impairment diabetic side effects insulin sensitizer P a g e 24
Pioglitazones Pioglitazones Avandia Glustin X Cross Avandia Avandia cardio-toxic absolutely contraindicated coronary heart disease heart failure salt and water retention heart disease pain 12 10 Avandia Avandia 0 Glustin 15 Glustin Glustin heart failure coronary 0 15 Glustin P a g e 25
24 Diamicron MR Glustin oral hypoglycemic 6 0 Oral hypoglycemic Diamicron 1000 15 insulin Glustin shift 120 Oral hypoglycemia combination 10 2 12 48 P a g e 26
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
insulin Novo norm diet basal insulin Novo norm Novo norm Novo norm satisfied Exhausted insulin 0.8 0. << Up to 2 units per kg type two insulin resistance type two resistance P a g e 28
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
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
incretins based therapy incretins based therapy glucagon related peptide enhance Oral glucagon related peptide << intestine glucagon related peptide << enhance << Ganuvia 6 100 Glucagon related peptide Gulcagon related peptide enhance adjuvent therapy sorry effective P a g e 1
Diamicron incretin based therapy 100 0 200 Novo rapid Long acting insulin Hypoglycemia << short acting insulin analogue overlap duration P a g e 2
Diabetes 55 201 12 2 www.facebook.com/dr.tafreegh P a g e