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Overview of Diabetes Mellitus

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A syndrome caused by a decrease or total lack of insulin or diminished ... Acromegaly. MODY. DIDMOAD. Symptoms. Polyuria. Polydypsia. Weight loss. Lethargy. Tiredness ... – PowerPoint PPT presentation

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Title: Overview of Diabetes Mellitus


1
Overview of Diabetes Mellitus
  • Dr F Dunne
  • Dept of Medicine

2
Layout
  • Definition
  • Diagnosis
  • Classification
  • Symptoms
  • Annual Assessment
  • Treatment options
  • Metabolic complications
  • Macrovascular complications
  • Microvascular complications

3
Definition
  • A syndrome caused by a decrease or total lack of
    insulin or diminished effectiveness of
    circulating insulin (insulin resistance)
  • Characterised by hyperglycaemia

4
Insulin
  • Enhances peripheral glucose uptake
  • Inhibits breakdown of liver glycogen
  • Enhances storage of glucose as glycogen
  • Increases protein synthesis
  • Increases triglyceride storage

5
Diagnosis
  • Fasting blood glucose gt 7mmol/l
  • Random blood glucose gt11.1mmol/l
  • 75g OGTT

6
75g OGTT
  • Diabetic FBGgt7 2h gt11.1 mmol/l
  • IGT FBG lt7 2h 7.8-11.1 mmol/l
  • IFG FBG 6.1-6.9 mmol/l

7
Classification
  • Type 1 diabetes
  • Type 2 diabetes
  • Secondary diabetes

8
Type 1 diabetesType 2 diabetes
  • Juvenille
  • Abrupt onset
  • Family history
  • Autoimmune
  • Ketones
  • Total insulin def,
  • Islet cell AB pos
  • HLA DR3 DR4
  • Insulin dependent
  • Older age
  • Slow onset
  • Family history
  • Not autoimmune
  • No ketones
  • Partial Insulin def/Resistance
  • Insulin requiring
  • Diet/OHA

9
Secondary Diabetes
  • Steroids
  • Thiazide Diuretics
  • Drugs for HIV
  • Pancreatectomy
  • Acute pancreatitis
  • Chronic Pancreatitis
  • Haemachromatosis
  • Cystic Fibrosis
  • Cushings Disease
  • Acromegaly
  • MODY
  • DIDMOAD

10
Symptoms
  • Polyuria
  • Polydypsia
  • Weight loss
  • Lethargy
  • Tiredness
  • Blurred Vision
  • Boils/abscesses
  • Pruritus Vulvae
  • DKA
  • Retinopathy
  • Nephropathy
  • Neuropathy
  • Foot ulcers/gangrene
  • Angina/MI/CVA

11
Annual Assessment
  • Osmotic symptoms
  • Hypoglycaemia
  • Injection sites
  • Treatment
  • Diabetes nurse specialist
  • Dietitian
  • Blood pressure
  • VAs Fundoscopy
  • Pulses/CFT
  • Neurology of Legs
  • Urinalysis
  • HbA1C
  • Lipids
  • Renal function

12
Treatment
  • Relief of osmotic symptoms
  • Avoid complications
  • Choice of treatments dependent on type, age,
    family support etc.

13
Treatments of Glucose
  • Diet
  • Metformin
  • Sulphonylureas
  • Acarbose
  • Thiazolidinediones
  • Netaglinide/Repag.
  • Regular Insulin
  • Long acting Insulin
  • Analogue insulins
  • Mixed insulins

14
Other treatments
  • Anti-hypertensives
  • Statins/fibrates
  • Aspirin
  • ACE inhibitors
  • ARBs

15
Treat to Target
  • HbA1C lt 7
  • BP lt 140/80
  • Cholesterol lt5 mmol/l
  • HDL-C gt1mmol/l
  • Triglycerides lt1.5mmol/l

16
Neuropathy
  • Peripheral Neurop
  • Femoral Amyotrophy
  • Mononeuritis multiplex
  • Autonomic Neuropathy
  • Postural hypotension
  • Diarrhoea
  • Impotence
  • Atonic bladder
  • Sweating
  • Loss of hypo. awarenes

17
Vascular Disease
  • PVD
  • CVD
  • CAD
  • Diabetes
  • Hypertension
  • Proteinuria
  • Lipids
  • Cigarettes
  • Obesity

18
PVD
  • Intermittent Claudication
  • Cold Legs
  • Pulseless Leg
  • Foot Ulcers
  • Gangrene
  • Doppler Studies
  • Duplex Scanning
  • Angiography
  • Angioplasty
  • Treat risk factors

19
CVD
  • TIAs
  • CVAs
  • Dementia
  • CT scan
  • Carotid Dopplers
  • Treat risk factors
  • Carotid bypass surgery

20
CAD
  • Angina
  • MI
  • Silent infarct
  • CCF
  • ECG
  • Cardiac enzymes
  • Troponin I
  • Exercise stress test
  • Echocardiography
  • Angiography
  • Angioplasty/CABG

21
Diabetic Foot
  • Neuropathy
  • PVD
  • Charcot Arthropathy
  • Ulceration
  • MRI
  • Angiography

22
Retinopathy
  • Background DR
  • Pre-proliferative DR
  • Proliferative DR
  • Maculopathy
  • Fluroscein angiography
  • Laser
  • Blood Pressure
  • Lipids
  • Glucose

23
Nephropathy
  • Diabetic glomerulosclerosis
  • Microalbuminuria lt300mg/l
  • Proteinuria gt300mg/l
  • Nephrotic gt3g/l
  • Abnormal creatinine
  • Glycaemic control
  • BP control
  • CAPD
  • Transplantation

24
Screening
  • BMIgt30
  • Age gt50
  • Ethnic minorities
  • Family history
  • GDM
  • Urinalysis
  • FBG
  • Random glucose
  • OGTT
  • Cost/benefit analysis

25
Economic/Social facts
  • 114 adults
  • 18 40-75
  • 15 gt75
  • 13 Unaware of diag.
  • T1 Life 20yrs less
  • T2 Life 10yrs less
  • By 2025 more people worldwide will have diabetes
    than now live in N.America
  • 2-4 fold greater risk of stroke and heart disease
  • 65 of deaths from CVS disease
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