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
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)
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
Important pitfalls Diabetic sweets - too much fat Flavored water = Coke in calories!! Fruit juice Not what we eat but how much of it!
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
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
The first insulin 11/1/1922 Leonard Thompson 14yr 25 days on dog insulin
Fast Reliable Smooth Reproducible Safe
Complications Preventable Preventable! Preventable!! Know the rules of the metabolic abnormality to prevent the disease
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
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 !