Diabetes and Thyroid Lecture Notes PDF

Diabetes and Thyroid Kristy Tian ASSOCIATE CONSULTANT, DEPARTMENT OF ENDOCRINOLOGY SINGAPORE GENERAL HOSPITAL  Role of the Endocrinologist Hormonal imbalance Diabetes mellitus Obesity Thyroid Osteoporosis 2  Outline: Diabetes What i...

Diabetes and Thyroid Kristy Tian ASSOCIATE CONSULTANT, DEPARTMENT OF ENDOCRINOLOGY SINGAPORE GENERAL HOSPITAL  Role of the Endocrinologist Hormonal imbalance Diabetes mellitus Obesity Thyroid Osteoporosis 2  Outline: Diabetes What is it? Diagnosis and classification Pathophysiology Complications of diabetes Outpatient Management Clinical features How to treat? Follow u Inpatient Management Hyperglycemic emergencies Hypoglycemia 3 4 5  What is diabetes? 6  How to diagnose diabetes? ADA MOH Fasting plasma ≥7.0 mmol/L ≥7.0mmol/L glucose 2-hour plasma glucose ≥11.1mmol/L ≥11.1mmol/L after 75g OGTT Random plasma ≥11.1mmol/L ≥11.1mmol/L glucose HbA1c ≥6.5% Results should be confirmed by repeat testing unless there is unequivocal hyperglycemia 7  HbA1c approved as a screening test for DM 8  Natural History of Type 2 Diabetes 17.5 (mmol/L) 15.0 Post Meal Glucose 12.5 Relative function Glucose 10.0 Fasting Glucose 7.5 5.0 2.5 250 200 Insulin Resistance 150 100 50 Pre Diabetes (IFG, IGT) Clinical diagnosis Insulin secretion CVD - Metabolic Syndrome 0 -15 -10 -5 0 5 10 15 20 25 30 Years Adapted 9 from International Diabetes Center. Minneapolis, Minnesota.  Natural History of Type 2 Diabetes 17.5 (mmol/L) 15.0 Post Meal Glucose 12.5 Relative function Glucose 10.0 Fasting Glucose 7.5 5.0 2.5 250 200 Insulin Resistance 150 100 50 Pre Diabetes (IFG, IGT) Clinical diagnosis Insulin secretion CVD - Metabolic Syndrome 0 -15 -10 -5 0 5 10 15 20 25 30 Adapted from International Diabetes Center. Minneapolis, Minnesota. Years 10  My sugar level is high but I feel well. What’s the big deal? 11  These complications are not reversible but progressive 12  Good diabetes control preserves beta-cell function 17.5 (mmol/L) 15.0 Post Meal Glucose 12.5 Relative function Glucose 10.0 Fasting Glucose 7.5 5.0 2.5 250 200 Insulin Resistance 150 100 50 Pre Diabetes (IFG, IGT) Clinical diagnosis Insulin secretion CVD - Metabolic Syndrome 0 -15 -10 -5 0 5 10 15 20 25 30 Adapted from International Diabetes Center. Minneapolis, Minnesota. Years 13  Diabetes – taking a history Diagnosis and type of diabetes How was it diagnosed? Age at diagnosis? Health screening? Admission for DKA? Family history of diabetes Duration of disease Diabetes control: HbA1c levels, self monitoring of blood glucose Treatment Lifestyle: diet, exercise, weight loss Pharmacologic: oral glucose lowering drugs, insulin injections Adherence to above measures 14  Diabetes – taking a history Acute diabetes-related complications Diabetic emergencies Hypoglycemia Infections Chronic diabetes-related complications Macrovascular: ischemic heart disease, stroke, peripheral arterial disease Microvascular: retinopathy, nephropathy, neuropathy Other past medical history Hypertension Hyperlipidemia Chronic kidney disease Cardiovascular disease 15  Physical examination Height, weight, BMI Blood pressure Skin examination: acanthosis nigricans, review insulin injection sites Foot examination – Inspect for foot ulcers – Palpation of pedal pulses – Sensation 16  Aims of Treatment To relieve symptoms related to hyperglycemia and achieve good metabolic control (short-term) To prevent development of diabetes related complications, both microvascular and microvascular (long-term) 17  Management of Diabetes Assess diabetes Look for Consider control and set complications treatment goals options 18  Management of Diabetes Assess diabetes Look for Consider control and set complications treatment goals options 19  1. Assess diabetes control and set goals Image result for hba1c HbA1c: glycated hemoglobin Self monitoring of blood glucose 20  Establish HbA1c targets with patients, taking into account various patient and disease factors Determine how far patients’ current HbA1c levels are from the target 21  Can we just use HbA1c? 22  Self monitoring of blood glucose Pre-meal glucose target 4.4-7.2mmol/L 2H post-meal target