Dr Esther Tsang August 2011 Management of Diabetes Mellitus.

Slides:

Advertisements

Similar presentations

Diabetes and Self Monitoring

Advertisements

Clinical Case Presentation

Block 9 Board Review Endocrine/Rheum 14Feb14 Chauncey D. Tarrant, M.D. Chief of Residents

Dr. Esther Tsang August Case 1 50 year old lady presented with acute onset of shortness of breath this morning. This was preceded by one episode.

Dr Maeve Durkan & Dr Eoin O’Sullivan The Cork Diabetes & Endocrinology Group Bon Secours Hospital, Cork Maeve C. Durkan MBBS.FACP, Mmed.Ed Consultant.

Treatment in Cardiac disease The PNs Roll Dr. Sergio Diez Alvarez Staff Specialist Physician Armidale Hospital.

DIABETES AND THE KIDNEYS

Idara C.Eshiet. A 50 year old woman had a sudden onset of dizziness and vomiting. Her family noticed that her left eyelid appeared to be drooping.

Glucose Tolerance Test Diabetes Mellitus Dr. David Gee FCSN Nutrition Assessment Laboratory.

Dr Esther Tsang Sept Case 1 80 Chinese gentleman Brought in unconscious, found at the side of the road Appears dirty, unwashed; smelly No witnesses.

Characteristics and Treatment of Common Endocrine Disorders

ADVICE. Advice Strongly advise adherence to diet and medication Smoking cessation, exercise, weight reduction Ensure diabetes education and advise Diabetes.

BHS Guidelines for the management of hypertension BHS IV, 2004 and Update of the NICE Hypertension Guideline, 2006 Guidelines for management of hypertension:

Dr Kiran Sodha Patient Participation Group October 2014

Diabetes Exam Question Kieran Kitchener. Question 1 Amritpal, a 10 year old boy, has developed a flu-like illness over the last few months according to.

COMMON LIFESTYLE DISEASES

Type 2 Diabetes Type 2 is the most common form of diabetes, affecting 85-90% of all people with diabetes. While it usually affects older adults, more and.

Diabetic Nephropathy Case Presentations. UA (Urine Dipstick) Use as an initial screen for all patients Negative to trace proteinuria requires further.

Oromo Community Organization Diabetes Mellitus (Dhibee Sukkaara) By: Wandaye Deressa,

Hba1c for diagnosis Dr Karen Adamson. β-chain α-chain Glucose bound to N-terminal valine of β-chain.

Case Studies on Insulin Initiation

Health Screening. Should you go for health screening? Health screening helps to discover if a person is suffering from a particular disease or condition,

Clinical Biochemistry FAQ for GP Trainees Dr Mourad Labib Consultant Chemical Pathologist DGOH NHS Foundation Trust July 2009.

Source: Site Name and Year IHS Diabetes Audit Diabetes Health Status Report ______Site Name_________ Health Outcomes and Care Given to Patients with Diabetes.

METABOLIC SYNDROME Dr Gerhard Coetzer. Complaint Thirsty all the time Urinating more than usual Blurred vision Tiredness.

HDR Women’s Health 11 th April 2012 By Dr Mahya Mirfattahi GP ST3 POLYCYSTIC OVARY SYNDROME A SUMMARY OF RCOG GREEN-TOP GUIDELINE.

Criteria for Diagnosis of DM * Testing must be repeated on separate day. FPG is the preferred test ** Symptoms of DM IFG = Impaired fasting glucose IGT.

Illustrative Cases and Summary. A 50 year old European woman who is new to your practice comes to see you late on Friday afternoon with a sore throat.

Risk estimation and the prevention of cardiovascular disease SIGN 97.

Understanding Diabetes What is diabetes? Risk factors People without diabetes People with Type 1 diabetes People with Type 2 diabetes Signs and symptoms.

TREAT TO TARGET IN DIABETES: An Alternative pathway

Nutrition & Dietetic Service to Patients with Diabetes in West Berkshire Carolyn Jones Dietetic Team Lead.

Shadi Al-Ahmadi. The Presentation will include: Hypertension Dyslipidemia CVD Type 2 Diabetes-Associated Retinopathy Diabetic Periphral Neuropathy Diabetic.

Challenges in Diabetes Dr Philippa Feldman. Challenge 1 Increasing numbers.

Titrating Insulin to Glycemic Target Judy Bowen, MD CIM Rotation September, 2006.

Review Breast Cancer Screening Public Comment (CMS #125) and Discuss Controlling High Blood Pressure Measure Updates (CMS #165) Change Review Process Meeting.

DIABETES MELLITUS Current diagnostic criteria Diabetes symptoms (polyuria, polydipsia, unexplained weight loss) plus: – Random venous plasma glucose 200.

Blood pressure control in primary health care WORKSHOP

STROKE  WHAT IS IT?  WHAT CAUSES IT?  CAN I PREVENT IT?

The TRial Of Preventing HYpertension (TROPHY) TROPHY.

Dyslipidemia.  Dyslipidemia is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high- density lipoprotein level that contributes.

Cases Neuroscience. Case 4 A 45 year old woman with a history of hypertension experienced a brief "blackout". She had complained of severe headaches,

Comprehensive Diabetes Care. Comprehensive Diabetes Care: HbA1c Testing (Commercial) Source: National Committee for Quality Assurance, The State of Health.

PPAR  activation & lipid metabolism. Diabetic dyslipidaemia Lipid profiles and hyperinsulinaemia in newly diagnosed type 2 diabetic patients Niskanen.

LOGO A Diabetes Mellitus Case Shen Ji Contents 1. medical record 2. Physical examination and laboratory test 3. diagnosis 4. Treatment 5.

Diabetes. Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does.

Community Pharmacy Cheshire & Wirral (CPCW) Helen Murphy Chief Executive Officer Community Pharmacy Cheshire and Wirral.

Case I A 47 old male presents to your office for a yearly checkup. He smokes 40 cigarette/day, and examination detect wheezy chest and bronchospasm. His.

Diabetes – Diagnosis and assessment

Diabetes Mellitus Ch 13 ~ Endocrine System Med Term.

Oral Diabetes Medications Carol Cordy, MD. Goals Understand how type 2 diabetes affects many organs and how this changes over the course of the illness.

Dr Esther Tsang August 2011 Diabetic emergencies.

Laboratory Testing For Cardiovascular Risk

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Scott W. Rypkema, M.D.

Insulin Optimisation Workshop Theingi Aung & Claire Rowell.

Who is considered elderly? “Young old” years “Old, old” >75 years.

Case 2: Dyslipidaemia in Type 2 Diabetes Mellitus.

Diabetes. Objectives: Diabetes Mellitus (DM) Discuss the prevalence of diabetes in the U.S. Contrast the main types of diabetes. Describe the classic.

Case 1: Elevated LDL-C in a Young Adult. Page 2 of 10 *DALY; disability-adjusted life years Routine checkup:  Age:33 years  Sex: male  Status: Except.

DAKTARI ANNETTE BALONGO. DIABETES DEFINATION Its is a metabolic disorder characterized by increase in blood sugar 1.Insulin resistance 2.Deficiency in.

Dr John Cox Diabetes in Primary Care Conference Cork

Redefining Quality Care in T2DM Patients with CV Disease

Diabetes, Dyslipidemia, and Continuous Quality Improvement Using the Chronic Care Model in the Treatment of Patients Class of 2011, Family and Community.

Case studies In this presentation we will review hypoglycaemia – the causes, signs and symptoms, treatment, and prevention. We will also discuss unawareness.

HTN Cases Pharmacotherapy - 1.

Nutrition & Dietetic Service to Patients with Diabetes in West Berkshire Carolyn Jones Dietetic Team Lead.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors work by blocking the reabsorption of filtered glucose in the kidneys. This leads to glucosuria and improved.

Level of risk factor control in the overall sample and by gender

Hba1c for diagnosis Dr Karen Adamson.

Associations of body mass index (BMI) levels with achieving targets for glycated hemoglobin (HbA1c), blood pressure (BP), and lipids in the upper panels.

Presentation transcript:

Dr Esther Tsang August 2011 Management of Diabetes Mellitus

Case 1 50 year old lady presents to you with polyuria, polydipsia. You do a reflomet and it was 13.0mmol/L. Can you diagnose diabetes mellitus? How do you diagnose diabetes mellitus?

She complains of blurring of vision and cramping sensations in her legs whenever she walks. What are these symptoms of? What other questions do you ask to screen the patient for end-organ damage?

She weighs 80kgs and is 145cm tall. What is her BMI? What is the waist-hip ratio? How would you advise her with regards to her weight? What is the recommended amount of weight loss and how can this be achieved? What is the metabolic syndrome?

What particular physical signs do you want to look for in her physical examination? When should you examine her fundus? When should you refer her to the ophthalmologist?

What blood tests do you want to send? How would you screen for diabetic nephropathy?

Her HbA1c was 11.0% FBS was 14.6 mmol/L Renal function was normal. Which OHA would you start and why? What are the side effects of metformin? What are the contraindications of metformin. Name the classes of OHAs.

You start her on Metformin 1g BD and Gliclazide 160mg BD. 1 month later, she is here to see you. She has a FBS of 8.0mmol/L; BP of 140/90 mm Hg; and HbA1c of 10.9%. Her FLP is as follows : TC 7.0 mmol/L LDL 4.0mmol/L TG 2.0 mmol/L Is she adequately managed? What should be the targets? How do you interpret the HbA1c now?

Can you continue her tablets and see her 4 months later with a repeat blood test? How would you then treat her diabetes mellitus?

She comes back during her next follow up with a fasting blood sugar of 15.0mmol/L despite your treatment. HbA1c 10.0%. She confesses that she did not take her metformin at all due to severe diarrhoea. What can you offer her? What is a diabetic diet?

How would you treat her dyslipidaemia? How would you treat her blood pressure?

Then she complains of severe pains over her lower limbs, so much so that she is unable to tolerate blankets over her legs. What can you offer?

Finally during her next visit, she has reduced her weight to 75kgs, FBS of 7.5mmol/L and HbA1c of 8.0%. Are you satisfied? She says that she has a niece aged 21 whom she thinks should be screened for diabetes mellitus. Do you agree? Who should be screened for diabetes mellitus?