8How to get to target? Diet Exercise 30 min brisk walking/day Correct medication – suit your life styleRegular blood glucose testing – 2x/day on insulin- wake up/2h PPG if on tabletsTest more if unwell
9Diabetic diet sign language Fist – carbohydrate portion (tennis ball size)Palm size – protein ( thickness of thumb ball )Two open hands – vegetablesThumb tip – fat3 regular meals- don’t skipEnough water - weight ( 84 kg = 8 glasses)
10Alcohol and diabetes Female 1 unit/day Male 2 units/day Unit - single whiskey/brandy (spirits)- 200 ml dry white/red wineStay away from mixes, beer, sherry ,port liqueur
11Important pitfalls Diabetic sweets - too much fat Flavored water = Coke in calories!!Fruit juiceNot what we eat but how much of it!
12Medication - Type 2 diabetes Metformin basis of type 2 managementIncretin – tablets and injections (see second lecture after lunch break)Sulphonylurea – hypoglycemiaTZD- pioglitazone – swelling of feet
13Medication Type 1 Diabetes Insulin –to suit your lifestyleBasal/bolusBasal( long acting) Levemir, Lantus,Bolus (short acting)– novorapid,apidra,humalogFixed mixes –novomix,humalog mix25Insulin pumps
14Progression of type 2 diabetes 20406080100―10―8―6―4―2246Time of diagnosis?Pancreatic function= 50% of normal-cell function (% of normal by HOMA)Type 2 diabetes mellitus (T2DM) develops because of a progressive decline in pancreatic -cell function, together with increasing insulin resistance, for which the -cells cannot compensate.The United Kingdom Prospective Diabetes Study (UKPDS) has demonstrated that by the time of diagnosis, patients may have already lost as much as 50% of their -cell function.Holman RR. Diabetes Res Clin Pract 1998;40(suppl):S215.Time (years)HOMA=homeostasis model assessment.Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21―5.
15The first insulin 11/1/1922 Leonard Thompson 14yr 25 days on dog insulin
17Complications Preventable Preventable! Preventable!! Know the rules of the metabolic abnormality to prevent the disease
18Rules for diabetesRule 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
19More rulesRule 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 yearlyRule 6 – Become the captain of your own ship !