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Diabetes management and complications Dr. Louise Johnson-Loots Specialist physician and insulin pump centre Montana hospital, Pretoria.

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Presentation on theme: "Diabetes management and complications Dr. Louise Johnson-Loots Specialist physician and insulin pump centre Montana hospital, Pretoria."— Presentation transcript:

1 Diabetes management and complications Dr. Louise Johnson-Loots Specialist physician and insulin pump centre Montana hospital, Pretoria

2 Diabetes types  Type 1 – auto immune  Type 2 - insulin resistant  Secondary – surgery, medication (i.e. steroids)  GDM ( gestational diabetes)

3 Type 1 Younger than 30 yr Thin Auto-immune disease 10-20% of Pt. Type 2 Older than 30 yr Obese – ♂ waist > 94 cm ♀ waist > 80 cm Ass diseases i.e. HT,Dyslipiedemiae 80% of Pt

4 Type 2Type 1

5 Insulin resistance (metabolic syndrome)  First step on diabetes ladder  Waist circumference Male >94 cm Female >80cm  Associated disease –Hypertension - gout -abnormal cholesterol

6 How to manage my metabolic abnormality?  Know your numbers  Set targets – keep to them  Know your bar stool (diet, exercise,medication)  NO smoking!!  Test regularly

7 Targets to achieve  Waist - 94 cm male, 80cm female  Blood pressure < 130/80mmHg  LDL cholesterol< 1.8  HDL cholesterol > 1.0  HbA1c < 7%  FPG < 5.5, 2h PPG < 7.8

8 How to get to target?  Diet  Exercise 30 min brisk walking/day  Correct medication – suit your life style  Regular blood glucose testing – 2x/day on insulin - wake up/2h PPG if on tablets  Test more if unwell

9 Diabetic diet sign language  Fist – carbohydrate portion (tennis ball size)  Palm size – protein ( thickness of thumb ball )  Two open hands – vegetables  Thumb tip – fat  3 regular meals- don’t skip  Enough water - weight ( 84 kg = 8 glasses)

10 Alcohol and diabetes  Female 1 unit/day  Male 2 units/day  Unit - single whiskey/brandy (spirits) ml dry white/red wine  Stay away from mixes, beer, sherry,port liqueur

11 Important pitfalls  Diabetic sweets - too much fat  Flavored water = Coke in calories!!  Fruit juice  Not what we eat but how much of it!

12 Medication - Type 2 diabetes  Metformin basis of type 2 management  Incretin – tablets and injections (see second lecture after lunch break)  Sulphonylurea – hypoglycemia  TZD- pioglitazone – swelling of feet

13 Medication Type 1 Diabetes  Insulin –to suit your lifestyle  Basal/bolus  Basal( long acting) Levemir, Lantus,  Bolus (short acting)– novorapid,apidra,humalog  Fixed mixes –novomix,humalog mix25  Insulin pumps

14 HOMA=homeostasis model assessment. Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21 ― 5.  -cell function (% of normal by HOMA) Time (years) ― 10 ―8―8―6―6―4―4―2―20246 Time of diagnosis ? Pancreatic function = 50% of normal

15 The first insulin  11/1/1922  Leonard Thompson  14yr  25 days on dog insulin

16 Fast Reliable Smooth Reproducible Safe

17 Complications  Preventable  Preventable!  Preventable!!  Know the rules of the metabolic abnormality to prevent the disease

18 Rules for diabetes  Rule 1 – medical check 6 monthly with a specialist physician –Blood pressure, kidney,heart,feet sensation and blood flow.  Rule 2 – eye check at an eye specialist (not the person giving the glasses)  Rule 3 – no bare foot walking

19 More rules  Rule 4 – sin once every 14 days (ice cream,chocolate,cookies etc)  Rule 5 - if female and your baby weighed >4.0kg – get screened for diabetes yearly  Rule 6 – Become the captain of your own ship !

20 Questions ??


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