2. Presented By Dr. Richard Nabhan M.B. Ch. B, D.T.M. & H., M.R.C.P (UK),FRCP(Lond) Senior Consultant Physician & Cardiologist, & Diabetologist The common Crippler & Killer of the Century Weapon Used,Complications & Regulation

3. Atherosclerosis (Hardening of the arteries) Thickening of the wall at the expense of the lumen Q. What Accelerates the Narrowing of the Lumen ? A. Diabetes. B. Hypertension C. Smoking D. High Lipids E. Family History F. Obesity G. Inactivity H. Stress Need to change the lifestyle Q. What happens if the lumen narrows ? Ischemic Pain. Q. What happens if this narrowed lumen ultimately closes ? Death of the tissue supplied. -Cholesterol -LDL -Triglycerides -HDL

4. Effects of Occlusion of a Vital Artery on a Vital Organ Hemiplegia Stroke ( Hemiplegia ) Myocardial infarction Heart-attack ( Myocardial infarction ) Brain Infarction

5. GANGRENEGANGRENEGANGRENEGANGRENE O cclusion of a P eripheral A rtery of the L ower L imbs

6. MicroVascular Complications MICROMICRO MACROMACRO Diabetic RetinopathyDiabetic Nephropathy

7. Diabetic Neuropathy 3 rd Nerve Palsy 7 th Nerve Palsy P eripheral N europathy:  Sensory.  Sensorimotor.  Proximal. Foot Drop Neuropathic Foot Ulcer Attacks more than 66% of Diabetics M ononeuropathy:  Wrist.  Foot.  Ocular.  Facial. A utonomic N europathy:  Postural hypotension.  Diarrhea.  Bladder dysfunction.  Sexual dysfunction.  Loss of sweating (LL), etc

8. Care of the Foot in Diabetes

9. Diabetic Retinopathy Diabetic Cataract A cataract causes light to scatter at the level of the lens causing blurry image. Successful removal of the cataract allows the image to be seen clearly.

10. - Hyperglycemia - Hypoglycemia Q. What happens if the Pancreas goes on strike ??? No Insulin AT ALL Little Insulin ± Insulin resistance  AGE  SYMPTOMS  TREATMENT: 1. Diet 2. Glucose control 3. Exercise 4. Medications Door Totally Closed Door Partially Closed Type I Diabetes Type II Diabetes Short-term Complications  Ketones: Ketonuria indicates no more insulin in the pancreas  Hb A1c: A marker of average glucose levels during the preceding 6-8 weeks  Microalbunminuria: A n early marker of diabetic nephropathy ON STRIKE

11. Criteria for the Diagnosis of Diabetes Mellitus!!!  Fasting blood sugar level ≥126 mg/dL OR  GTT 2-hour blood sugar level ≥ 200 mg/dL during a 75-g oral glucose tolerance test.  Symptoms (polyuria, polydipsia, weight loss with good appetite) plus random blood sugar level ≥ 200 mg/dL OR Our Goals for Glycemic Control Action SuggestedGoalNormal RangeBiochemical Index 14080-120<110Fasting/preprandial blood sugar level (mg/dL) 160100-140<120Bedtime blood sugar level (mg/dL) >8<74 - <6Hemoglobin A1c (%)

12. Glycated Hemoglobin(HBA 1 C) It’s an excellent Monitor of the behavior of Blood Glucose over the last three Months(age of the RBC). As the Hemoglobin in the RBCs moves in the Blood, it picks a Glucose coating

13. Quiz 2 Diabetic Patients have the same HBA 1 C of 7%. Patient No.1 did not develop any target organ damage, Patient No.2 developed accelerated Retinopathy. WHY???????????

14. The common Crippler & Killer of the Century Weapon Used,Complications & Regulation Presented By Dr. Richard Nabhan M.B. Ch. B, D.T.M. & H., M.R.C.P (UK),FRCP(Lond) Senior Consultant Physician & Cardiologist, & Diabetologist

15. ANSWER Patient No. 2 has high fluctuation of the daily Glucose Monitoring, thus Postprandial hyperglycemia triggers early microvascular complications HBA1C=7% Patient No. 1 has Minimal Glucose fluctuation specially Postprandial, thus is exempted from microvascular complications

16. Benefits of daily Glucose Monitoring 1.Regulator 2. Educator 3. Instructor 4. Psychological stimulator

17. THANK YOU FOR YOUR PATIENCE