Diabetes From Zero PDF

DR/ MOAAZ HASSAN Welcome to Advanced Course …. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 1 Beta cells in (pancreatic islets) secrete insulin Insulin - break down glucose - Then ATP DR/ MOAAZ HASSAN...

DR/ MOAAZ HASSAN Welcome to Advanced Course …. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 1 Beta cells in (pancreatic islets) secrete insulin Insulin - break down glucose - Then ATP DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 2 Process Function Glycolysis Breakdown of glucose to ATP Glycogenesis Formation of Glycogen Gluconeogenesis Formation of Glucose Glycogenolysis Breakdown of Glycogen Insulin Stimulates Glucose and Potassium uptake in all cells. DR/ MOAAZ HASSAN Brain Cells can use and uptake glucose without being stimulated by insulin OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 3 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 4 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 5 Type 1 DM Destruction of (70 % B-cell in pancreases that produce insulin. C-peptide test to determine if there still insulin production or not If there is no sufficient amount of insulin to take glucose inside the cell to produce energy at the body will DR/ MOAAZ HASSAN break down the fats to produce ketone body as an alternative source of energy leads to Ketoacidosis Type 2 DM Insulin resistant and deficiency, insulin sensitivity in body cells risk factor. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 6 Risk Factors of DM :- Type 1 DM Type 2 DM Genetic Family history type 2 Decreased Vit D Age>35. DR/ MOAAZ HASSAN Cow milk Drugs BMI>25 HIN ,, lipid OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 7 Q- An adult female patient with weight 80 kg and 160 cm height how do you categorise this patient weight based on the following classification:- BMI Weight Category 30 Obese B. normal C. overweight D. underweight OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 8 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 9 Diagnosis of DM :- A1C > 6.5, FBG > 126, 2hrPG > 200 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 10 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 11 Complications of DM :- DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 12 Type of Diabetes When to first check When to follow up Type 1 DM Within 3-5 years after yearly diagnosis of diabetes once patient is aged ten years or older Type 2 DM At diagnosis yearly DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 13 Treatment of DM :- Insulin Sensitizers:- Biguanide (metformin) Thiazolidinediones: (pioglitazone, rosiglitazone) Dual PPar agonists (glitazar ) (saroglitazar) DR/ MOAAZ HASSAN Insulin Secretagogues :- First generation SU (Tolbutamide, Chlorpropamide) Second generation SU : (Glipizide, Glimepiride, Glyburide) Meglitinide (Repaglinide, Nateglinide) OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 14 SGLT-2 I :- Canagliflozin Dapagliflozin Empagliflozin Sotagliflozin GLP-1 :- DR/ MOAAZ HASSAN Lixisenatide Exenatide Liraglutide Dulaglutide Semaglutide OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 15 Insulin Sensitizers:- Increase insulin sensitivity. Metallic taste, take with food (Gl upset) Take vitB12 (schilling test) (monitor) Gestational DM (between 24 to 28 weeks) 1. Insulin (DOC) 2. Metformin DR/ MOAAZ HASSAN 3. Glyburide Metformin and heart? -------------------------------------------- Metallic taste:- Metformin Metronidazole Captopril. Iron OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 16 DR/ MOAAZ HASSAN Avoid: with iodinated contrast 48 hours. Drug interaction: topiramate. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 17 Thiazolidinediones: (pioglitazone, rosiglitazone) Contraindicated in 2H ( Heart, Hepatic ). DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 18 Insulin secretagogues: 1-Sulfonylurea: (Sulfa allergy) = 1st generation :- Tolbutamide,chlorpropamide = 2st generation :- Glipizide, Glimepiride safe in renal disease Glyburide can be used in Pregnancy. DR/ MOAAZ HASSAN 2-Meglitinides (Repaglinide, Nateglinide): (No Sulfa allergy) * High risk of hypoglycemia ? Insulin & SU. * Drugs that cause mask hypoglycemia symptoms ? Beta blockers non selective (propranolol, nadolol) OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 19 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 20 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 21 Peptide analogues:- GLP-1 ( incretin mimetics ): Injection :- Liraglutide - Dulaglutide - Have adverse effect on thyroid DR/ MOAAZ HASSAN Lixisenatide - Exenatide - safe in thyroid Semaglutide. Liraglutide(recombinant DNA) it an FDA approved to decrease weight. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 22 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 23 DPP-4I (DIPEPTIDYL PEPTIDASE 4 INHIBITORS):- Sitagliptin, Saxagliptin, Linagliptin Cause: Pancreatitis Saxagliptin » Not recommended in HF DR/ MOAAZ HASSAN Vildagliptin = hepatitis All require renal adjustment except linagliptin OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 24 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 25 Acarbose :- By delaying the digestion of carbohydrates, acarbose slows glucose absorption, reducing postprandial glucose blood concentrations. Alpha- glucosidase inhibitors (AGls) Taken with the first bite of a meal. DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 26 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 27 SGLT-2 I :- Canagliflozin(Risk of fractures, U.T.I) Dapagliflozin Empagliflozin Sotagliflozin. DR/ MOAAZ HASSAN New guidelines >>> this class of drug indicated to reduce risk of cardiovascular disease. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 28 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 29  Treatment Target A1C 6.5 - 7 Metformin 7 - 8.5 Increase dose 8.5 - 10 Dual therapy 10 and more Insulin DR/ MOAAZ HASSAN Insulin dose: T1 DM: 0.3-0.6 U/kg/day T2 DM: 0.1-0.2 U/kg/day OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 30 Example :- Blood glucose of patient 210 mg/dl and target 120, the correction factor is 30 What the correction dose for this patient ? DR/ MOAAZ HASSAN Correction dose= (blood glucose now-target blood glucose) / correction factors (210-120) /30 90/30 = 3 units Add to patient dose. OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 31 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 32 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 33  Insulin - High Risk Medication Zinc helps in insulin synthesis Cr helps in insulin action DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 34 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 35 DR/ MOAAZ HASSAN OTC COURSE FROM ZERO TO HERO - DR/ MOAAZ +201094718950 36