Presentation on theme: "Objective At the end of this session, students will be able to:"— Presentation transcript:
1Done by: Ayana - sara qhatani – sara dhahry – elham Lama – alaa – kholud - eilaf
2Objective At the end of this session, students will be able to: Identify differential diagnosis of a case presented with the symptoms of polyuria and polydipsia.Identify the prevalence of diabetes mellitus (DM) in the Saudi community.Discuss the classification of DM .Discuss briefly about the diagnostic criteria for DM.Identify the patho-physiological changes in a diabetic patient.Enumerate and discuss the importance presenting signs & symptoms of DM.Investigate appropriately a patient with DM.Advice initial management plan for a patient diagnosed first with DM.Discuss different medication used in DM management .Identify importance of life style changes in diabetic patients.Discuss screening criteria for DM.
3Case StudyA 25-year-old man, who works as a clerk in a company, has presented to the clinic today with the complaint of increased thirst, and increased urination . These complaints initiated for last few weeks. He admitted that he was in Makkah for Omra and started to have these symptoms, but he assumed that these symptoms were due to hard works and running from here to there in Makkah. But he is worried that the symptoms are continuing even he is back home and having usual sedentary life.He also complaint of generalized weakness, otherwise on other complaint. He is not known to have any other chronic illness.
4On examination:Look well. His height is 160 cm and hisweight is 98 kg.Systematic examination revealed normal findings,apart from being obese.
5Differential diagnosis of a case presented with the symptoms of poluria and polydipsia DM DI Psychological Polydipsia check blood check ADH ask about sugar level level water intake NEED TO BE TESTED
6Diabetes Insipidus :It is a condition characterized by excessive thirst and polyuria secondary todeficiency of ADH (cranial DI)or kidney does not respond to ADH (nephrogenic DI) .- No hyperglycemia or glucose in urine in case of diabetes insipidus.
7Diabetes mellitus :causes poluria via a process called osmotic diuresis due to the high blood sugar leaking into the urine and taking excess water along with it.
8DM MORE LIKELY DI LESS LIKELY Pt complain of poluria ,polydipsia ,weaknesshave 2 risk factor : obesity & sedentary lifestyleDM more common than DI.DI LESS LIKELYPt Systematic examination is normalusually come with other symptom( dehydration, fever , vomiting ,diarrhea)DI less common than DM
9is a group of metabolic disorders characterized by hyperglycemia and abnormalities in carbohydrate, fat, and protein metabolism. It results from defects in insulin secretion, insulin sensitivity, or both.
10points to be included in history taking 1) C .O : How can I help you? 2) HPI : When did the symptoms start? Associated symptoms? e.g. loss of appetite , decrease vision
113) Past medical history: Social Hx : Occupation, education , smoking , alcohol , marital state , living condition . Family Hx : Dm , hypertension , Tb , asthma Any other diseases ? Surgical Hx .
12MAIN THINGS1_ family history of DM 2_ sex and age 3_ life style include diet & physical activity. 4_ Symptoms & when did they start. 5_ complication
13prevalence of (DM) in the KSA Study of WHO in 2004 : 23.7 % From Ann Saudi Med Jan:Age12_1920_2930_3940_4950_5960_69Above 70Male1,1%4,4%14,3 %29,9 %60,2%71,8%%65,7Female%2,6%4,7%10,8%3357,1%64,9%61,7 %
18account for 5% to 10% of all cases. Occur in childhood or early adulthood.develops when the body’s immune system destroys pancreatic beta cells, causing absolute insulin deficiency.Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors.
19There is a long preclinical period (up to 9 to 13 years) marked by the presence of immune markers. Hyperglycemia occurs when 80% to 90% of β- cells are destroyed. Individuals with type 1 DM are often thin and are prone to develop diabetic ketoacidosis if insulin is withheld or under conditions of severe stress.
20LADALatent Autoimmune Diabetes in Adults (LADA) is a form of autoimmune (type 1 diabetes) which is diagnosed in individuals who are older than the usual age of onset of type 1 diabetes ( > 25 year ) . Often, patients with LADA are mistakenly thought to have type 2 diabetes, based on their age at the time of diagnosis
21MODYcaused by mutations in a number of different genes defects of insulin secretion.Occur in late childhood, adolescence, or early adulthood.diagnosis of MODY is based on presence of :- non-ketotic hyperglycemiain conjunction with a family history of diabetes. -
22DM accounts for as many as 90% of DM cases This is the most common form of diabetes mellitus and is highly associated with a family history of diabetes, older age, obesity and lack of exercise, history of gestational diabetes, impaired glucose metabolism. It usually begins as insulin resistance, where the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.
24Form of glucose intolerance diagnosed in pregnant women.occurs more frequently among African Americans, obese women and women with a family history of diabetes.requires treatment >>> normalize maternal blood glucose levels to avoid complications in the fetus.Women who had GDM have a 20% to 50% chance of developing diabetes
25Other specific types of DM Uncommon causes of diabetes (1% to 2% of cases) include:- Endocrine disorders (e.g. acromegaly, Cushing’s(syndrome- Exocrine pancreas (e.g. pancreatitis)- medications (e.g. glucocorticoids, pentamidine, niacin, and α- interferon).
28Urine test: Detect glucose Detect proteinuria For ketone determination - For Pregnant diabetic woman to check adequate nutrition and glycemic control
29Pre- diabeticIt’s a state of abnormal glucose homeostasis characterized by the presence ofimpaired FPG, GTT , or both.It is often described as the “gray area” between normal blood sugar and diabetic levels
31important clinically because: When lifestyle changes such as- eating healthy foods- physical activity in daily routine- maintaining a healthy weightmay be able to bring your blood sugar level back to normal and prevent development DM 2 .
32important lab investigation for a patient who is presenting with DM as follow up : HbA1c at least twice a year in patients meeting treatment goals on a stable therapeutic regimen.
33Screening for DMScreening for type 2 DM should be performed every 3 years beginning at the age of 45.But considered at an earlier age and more frequently in individuals with risk factors .Pregnant women should be assessed for GDM at their first prenatal visit and proceed with glucose testing if at high risk.
34The recommended screening test is : fasting plasma glucose (FPG) Normal FPG is less than 100 mg/dL Or less than (5.6 mmol/L).
36Initial TreatmentAdvice on diet and exercise recommendations for people with diabetes.Check for risk factor :stop smoking.blood pressure control.cholesterol-lowering.
37Type 1Regular insulin given subcutaneously, requiring injection 30 minutes prior to meals. Lispro, aspart, and glulisine insulins have shorter durations of action than regular insulin, injection 10 minutes prior to meals.
38Neutral protamine hagedorn (NPH) is intermediate-acting Neutral protamine hagedorn (NPH) is intermediate-acting. contribute to a labile glucose response, nocturnal hypoglycemia, and fasting hyperglycemia. Glargine and Detemir are long-acting “peakless” human insulin analogs that result in less nocturnal hypoglycemia than NPH insulin when given at bedtime
40Type 2Symptomatic patients may initially require insulin or combination oral therapy to reduce glucose toxicity (which may reduce β-cell insulin secretion and worsen insulin resistance).
41Sulfonylureas : stimulating insulin secretion Sulfonylureas : stimulating insulin secretion . Meglitinides : stimulating insulin secretion in presence of glucose. Biguanides (metformin) : enhances insulin sensitivity of both hepatic and peripheral (muscle) tissues. Thiazolidinediones (Glitazones) : enhance insulin sensitivity in muscle, liver, and fat tissues indirectly. Insulin must be present in significant quantities for these actions to occur. Insulin for patient who doesn't maintain good control of blood sugar with drugs.
43Life style modification studies included people with IGT and other high-risk characteristics for developing diabetes.They found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults.In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, the development of diabetes was reduced 58% over 3 years .
45Complication & How to prevent it The major organs and body systems involved in diabetes complications are the:eyeskidneysnervesheart and blood vesselsgums
46Eye Problems: To prevent : Cataracts, Retinopathy, glucoma Keep blood pressure and blood sugar levels in check .make sure the eyes are examined on the schedule prescribed by the doctor
47Kidney Disease (Diabetic Nephropathy) High blood sugar can damage the blood vessels in the kidneys.To preventmaintain good blood sugar control by following the diabetes treatment plan.regular blood pressure and urine albumin tests checks up.
48Nerve Damage (Diabetic Neuropathy) can involve nerves in many different parts of the body. The most common early symptoms are numbness, tingling, or sharp pains in the feet or lower legs.To preventcontrolling blood sugar levels with diet, exercise, and diabetes medications will help reduce risk.
49Heart and Blood Vessel Diseases heart attack ,stroke and blockage of blood vessels in the legs and feet, which can lead to foot ulcers.To preventmaintain a healthy weight.check blood lipid and blood pressure regularly to be sure they're in a healthy range.
50Reference -Davidson's Principles and Practice of Medicine - Kumar & Clark's Clinical Medicine (Saunders, 2009).-Pharmacotherapy: A Pathophysiologic Approach, 8th Edition [Joseph DiPiro]-Davidson's Principles and Practice of Medicine