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 2 Diabetes 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. What you see is what you have…
Type 2
Type 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)
- 200 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. Progression of type 2 diabetes20 40 60 80
100
―10 ―8 ―6 ―4 ―2 2 4 6
Time 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):S215.
Time (years)
HOMA=homeostasis model assessment.
Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21―5.

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

16. Expectations today
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 ??