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Diabetes Mellitus AnnaGolovko
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object]
Classification of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG) ,[object Object],[object Object],1 Give 75 g of glucose dissolved in 300 mL of water after an overnight fast in subjects who have been receiving at least 150-200 g of carbohydrate daily for 3 days before the test. 2 A fasting plasma glucose ≥ 126 mg/dL is diagnostic of diabetes if confirmed on a subsequent day. ≥  200 ≥  140 but < 200 < 140 Two hours after glucose load (mg/dL) ≥  126 110-125 < 110 Fasting plasma glucose (mg/dL) Diabetes Mellitus 2 Impaired Glucose Tolerance Normal Glucose Tolerance   Table 27-5.  The Diabetes Expert Committee criteria for evaluating the standard oral glucose tolerance test. 1
Pathophysiology of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Type 2 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Type 2 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Type 2 DM ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Type 2 DM ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Type 2 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pathophysiology of Type 2 DM
Symptoms of diabetes and a casual plasma glucose  ≥  200 mg/dl The symptoms of diabetes include polyuria, polydipsia, polyphagia, ketoacidosis, and unexplained weight loss. OR FPG  ≥ 126 mg/dl OR 2-h plasma glucose  ≥200 mg/dl after an OGTT  (using a glucose  load  containing the equivalent of 75-g anhydrous glucose dissolved in water). Criteria for the diagnosis of diabetes These criteria should be confirmed by repeat testing on a different day
Screening for Type 2 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acanthosis Nigricans   A skin disorder characterized by velvety, light-brown-to-black, markings usually on the neck, under the arms or in the groin. Acanthosis nigricans is most often associated with hyperinsulimea http://www.aocd.org/skin/dermatologic_diseases/acanthosis_nigrica.html http://dermatology.cdlib.org/DOJvol6num1/original/acanthosis/katz.html
Treatment  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Specific Desired Endpoints http://guidelines.gov/summary/summary.aspx?doc_id=7212&nbr=004306&string=diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],>40 mg/dL (>1.1 mmol/L)**** High-density lipoprotein (HDL) <150 mg/dL (<1.7 mmol/L) Triglycerides <100 mg/dL (<2.6 mmol/L) Low-density lipoprotein (LDL) Lipids*** <130/80 mmHg Blood pressure <180 mg/dL (<10.0 mmol/L) Peak postprandial capillary plasma glucose** 90-130 mg/dL (5.0-7.2 mmol/L) Preprandial capillary plasma glucose <7.0%* Hemoglobin A 1C Glycemic Control
Non- pharmacological treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Composition of diet ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Composition of diet ,[object Object],[object Object],[object Object],[object Object]
Composition of diet ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Activity ,[object Object],[object Object]
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object]
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of Insulins http://www.clevelandclinic.org/health/health-info/docs/3300/3376.asp?index=11452 16-20 hrs 30 min.-2½hrs  15 min. Humalog mix 75/25 18-24 hours 2-5 hours 30 min. Humulin 50/50 Up to 24 1-4 hours 10-20 min. Novolog 70/30 Up to24 hours 2-12 hours 30 min. Novolin 70/30 14-24 hours  2-4 hours  30 min Humulin 70/30       Pre-Mixed* 20-24 hours No peak time; insulin is delivered at a steady level 1-1½ hour Lantus 20-36 hours 10-20 hours  30 min.-3 hours  Ultralente (U)       Long Acting 18-24 hours 3-10 hours 1-2½ hours Lente (L) 18-24 hours 4-12 hours 1-2 hours NPH (N)       Intermediate Acting 5-8 hours 2-5 hours 30 min. -1 hour Regular (R)       Short Acting 3-5 hours 1-3 hours 10-20 min. Novolog 3-5 hours 30 min to 2½ hours 15-30 min. Humalog       Rapid Acting Duration Peak Onset Type of Insulin & Brand Names
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object]
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Treatment of Type 1 DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diabetic Ketoacidosis (DKA) ,[object Object],[object Object]
Diabetic Ketoacidosis (DKA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Treatment of Type 2 DM ,[object Object]
Pharmacologic Treatment of Type 2 DM ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sulfonylureas ,[object Object],[object Object],[object Object]
Meglitinides ,[object Object],[object Object],[object Object],[object Object],[object Object]
Meglitinides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Meglitinides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Meglitinides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alpha-Glucosidase Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alpha-Glucosidase Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alpha-Glucosidase Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biguanides  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biguanides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biguanides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biguanides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biguanides ,[object Object]
Thiazolidinediones  ,[object Object],[object Object],[object Object],[object Object]
Thiazolidinediones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thiazolidinediones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thiazolidinediones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thiazolidinediones ,[object Object],[object Object],[object Object],[object Object]
Exenatide (Byetta) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exenatide (Byetta) ,[object Object],[object Object],[object Object]
Medications that all diabetic patients should be on ,[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring /Counseling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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  • 17. Symptoms of diabetes and a casual plasma glucose ≥ 200 mg/dl The symptoms of diabetes include polyuria, polydipsia, polyphagia, ketoacidosis, and unexplained weight loss. OR FPG ≥ 126 mg/dl OR 2-h plasma glucose ≥200 mg/dl after an OGTT (using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water). Criteria for the diagnosis of diabetes These criteria should be confirmed by repeat testing on a different day
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  • 19. Acanthosis Nigricans A skin disorder characterized by velvety, light-brown-to-black, markings usually on the neck, under the arms or in the groin. Acanthosis nigricans is most often associated with hyperinsulimea http://www.aocd.org/skin/dermatologic_diseases/acanthosis_nigrica.html http://dermatology.cdlib.org/DOJvol6num1/original/acanthosis/katz.html
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  • 32. Types of Insulins http://www.clevelandclinic.org/health/health-info/docs/3300/3376.asp?index=11452 16-20 hrs 30 min.-2½hrs  15 min. Humalog mix 75/25 18-24 hours 2-5 hours 30 min. Humulin 50/50 Up to 24 1-4 hours 10-20 min. Novolog 70/30 Up to24 hours 2-12 hours 30 min. Novolin 70/30 14-24 hours 2-4 hours 30 min Humulin 70/30       Pre-Mixed* 20-24 hours No peak time; insulin is delivered at a steady level 1-1½ hour Lantus 20-36 hours 10-20 hours 30 min.-3 hours Ultralente (U)       Long Acting 18-24 hours 3-10 hours 1-2½ hours Lente (L) 18-24 hours 4-12 hours 1-2 hours NPH (N)       Intermediate Acting 5-8 hours 2-5 hours 30 min. -1 hour Regular (R)       Short Acting 3-5 hours 1-3 hours 10-20 min. Novolog 3-5 hours 30 min to 2½ hours 15-30 min. Humalog       Rapid Acting Duration Peak Onset Type of Insulin & Brand Names
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