1 / 30

Intro to Diabetes Mellitus

Intro to Diabetes Mellitus. Angela Venturelli MS II Chelsey Villanueva MS II. Types of DM. Type 1: Autoimmune destruction of pancreatic beta cells (insulin producing cells). Insufficient production of insulin. More common in young people. Types of DM. Type 2

thalia
Download Presentation

Intro to Diabetes Mellitus

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intro to Diabetes Mellitus Angela Venturelli MS II Chelsey Villanueva MS II

  2. Types of DM • Type 1: • Autoimmune destruction of pancreatic beta cells (insulin producing cells). • Insufficient production of insulin. • More common in young people.

  3. Types of DM • Type 2 • Insulin resistance and inability of beta cells in pancreas to produce enough insulin to meet the needs of the body. • No clear reason why it happens, but connected to lifestyle and genetics. • More common in older people, but patients are becoming younger.

  4. Diagnosis of Diabetes 2010 ADA Guidelines (need ONE): http://care.diabetesjournals.org/content/33/Supplement_1/S11.full.pdf+html • HbA1c reading 6.5% or higher. • Fasting serum glucose is ≥ 126mg/dl. (Fasting= no caloric intake for 8 hrs.) • 2-hour 75 g glucose challenge test yields blood sugar ≥ 200 mg/dl. • Random glucose ≥ 200 and pt. is experiencing symptoms (polydipsia, polyuria, unexplained wt. loss…) * If results from1-3 are unclear then retest.

  5. The History Chief Complaint: • Polyuria • Polydipsia • Polyphagia • Recurrent Blurred Vision • Irritability/Mood Changes • Yeast Infections • Numbness or tingling in hands and or feet • Weight Loss • Dark spots on skin (AcanthosisNigricans)

  6. The History Past Medical History: • Previous DM diagnosis • HTN • Hyperlipidemia • Heart Conditions

  7. The History Past Hospitalizations: • Diabetic Ketoacidosis (DKA): • Happens when body cannot access glucose and starts breaking down fat to ketoacids. Emergency • Hypoglycemic Episode: • shaking, weakness, palpitations, trouble speaking, anxiety, hunger Past Surgeries

  8. The History Family History: • DM • Hypertension • Hyperlipidemia • Kidney Problems • Heart Conditions

  9. The History Social History: • Smoking • Drinking • Drugs • Diet • Exercise

  10. Physical Exam • Vitals: BMI, BP • HEENT: Vision, Fundoscope, Thyroid • Cardio: RRR, Murmurs, Rubs, Gallops, Pedal pulses, peripheral edema • Respiratory: lung auscultation, crackles • Neuro: Sensitivity in hands and feet (filament test), patellar and Achilles reflex. • Skin: Special attention to legs and feet, dark skin in folds and creases

  11. AcanthosisNigricans

  12. Diabetic Retinopathy

  13. Medications Important Questions: • What medications are you taking? • Do you take insulin? • How long have you been on these meds? • Are you taking your meds? • How are you taking them? If different than prescribed, why? • Have you experienced any adverse reactions? • Do you have any drug allergies?

  14. Medications • Insulin • Long Acting: glargine (Lantus), detemir (Levemir) • Dose: 1 time per day • Intermediate Acting: NPH (Novolin N) • Dose: 2-3 times per day • Short Acting: Regular Insulin (Novolin R) • Dose: 30-45 min before a meal (Prandial) • Rapid Acting: lispro (Humalog), aspart (Novolog), glulisine(Apidra) • Dose: 15 min before a meal

  15. Medications • Biguanides • Oral • Inhibit liver glucose production and increase insulin action in muscle and fat • No risk of hypoglycemia • Side Effect: Diarrhea • metformin (Glucophage)

  16. Medications Hypoglycemics (Type II ONLY): • Sulfonylureas: • Oral • Stimulate insulin release • glyburide (DiabetaMicronase), glipizide (Glucotrol), glimeperide (Amaryl) • Meglitinides: • Oral • Stimulate insulin release • repaglinide (Prandin), nateglinide (Starlix) * Yellow medications on formulary.

  17. Medications • Incretins: • Injectible • increases insulin secretion, reduce glucagon secretion, slows gastric emptying, reduces appetite and induces weight loss • exenatide (Byetta), sitagliptin (Januvia), saxagliptin (Onglyza) • Amylin: • Injectible • suppress glucagon secretion, delay gastric emptying & suppress appetite • pramlintide (Symlin)

  18. Medication • Thiazolidinediones (Tzds) • Oral • Increases insulin sensitivity in peripheral tissue • pioglitaone (Actos), rosiglitazone (Avandia) • Alpha-Glucosidase Inhibitor • Oral • Reduces intestinal absorption of starch, dextrin and disaccharides • acarbose (Precose), miglitol (Glyset)

  19. Medications Other medications: • ACE Inhibitors- “-pril” • Oral • Start when pt. has microalbuminuria. • Side Effect: Cough • lisinopril, captopril, benazepril, enalapril • ARB- “-sartan” (Not on formulary) • Anti Hypertensives • Statins- “-statin”, Lipitor • Aspirin: • Pts. With cardiac risk. • Men > 50, Women > 60 with 1 major risk factor (famhx, CVD, HTN, smoking, dyslipidemia, albuminuria)

  20. Medications The clinics get most of their medications from the Target or Walmart $4 Formularies and PAPs. • Target: http://sites.target.com/site/en/health/page.jsp?contentId=WCMP04-040590 • Walmart: http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

  21. Treatment Goals 2010 ADA Recommendations: • HbA1c: < 7.0% • Preprandial capillary plasma glucose: • 70-130 mg/dl • Peak postprandial capillary plasma glucose: • < 180 mg/dl • BP: ≤ 130/80 • Lipids: • LDL < 100mg/dl • HDL >50 mg/dl • Trigs < 150 mg/dl

  22. Labs • HbA1c- Test sugar levels over last 3 months. • Draw= Every 3 months • Urinalysis- Kidney ftn. • 3 specimens in 3-6 month period should be taken to confirm abnormal urine protein results (also true for microalbumin) • MicroalbuminCreatinine Ratio- Kidney ftn. • Type 1: test 5 yrs after dx • Type 2: test immediately • Test annually thereafter.

  23. Labs • CMP- Kidney ftn., Electrolytes, Liver ftn. • Annually, especially Cr. • Fasting Lipid Panel- Cholesterol levels • Fasting lipids annually • Low risk can be done every 2 years • TSH • DM Type I Every 1-2 years

  24. Health Maintenance • Ophthalmology Referral • Every year • Screen for DM retinopathy • BP Control • Important for maintaining kidney ftn. • Cancer Screening • Potentially higher risk of: pancreatic, endometrial, melanoma, breast cancer

  25. Health Maintenance • Routine Vaccinations: • Yearly flu vaccine • Pneumococcal after age 65, if given before 55 (should be given every 10 years) • Tdap • Dental Care • Pregnancy: • Refer to county. Eligible for medical.

  26. Health Maintenance Lifestyle Modification aka: DIET and EXERCISE !!!

  27. Health Maintenance 2010 ADA Recommendations: • Exercise: • 150 min/week of moderate intensity exercise (50-70% of max HR) • In DM 2: Resistance Training 3x week. If not contraindicated. • Diet • Saturated Fats: <7% of total calories • Minimize trans fats • Monitor Carbohydrates with Carb counting: • http://www.diabetes.org/food-and-fitness/food/planning-meals/carb-counting/

  28. Thank You

  29. References • PPTs: • Type 2 Diabetes Mellitus, Dr. Roger K. Long • Type 1 Diabetes Mellitus and Diabetic Ketoacidosis, Dr. Nicole Glaser • Insulin and Oral Hypoglycemic Therapy, Heike Wulff, Ph.D.

  30. Medications Online: • Standards for Medical Care in Diabetes-2010, ADA: • http://care.diabetesjournals.org/content/33/Supplement_1/S11.full.pdf+html • Uptodate: “Overview of medical care in adults with diabetes mellitus”: • http://www.uptodate.com/online/content/topic.do?topicKey=diabetes/10339&selectedTitle=1%7E150&source=search_result#H22 • Mayo Clinic Website: • www.mayoclinic.com

More Related