My efforts for diabetes care & approach to diabetes patient

1. APPROACH TO A
DIABETIC PATIENT
By Dr. Pushpendra Vyas.
Guided by Dr. Rakesh Gupta sir.

2. DIABETES
INITIAL MEDICAL EVALUATION
1. Classify diabetes
2. Detect complication
3. Review previous treatment & risk factor
control in established case
4. Assist in formulating a management plan
5. Provide a basis for continuing care

3. COMPONENT OF MEDICAL EVALUATION
 Medical history
 Physical examination- Weight , Blood
pressure, Foot examination .
 Lab evaluation- FBG, HbA1c, Lipid profile,
Renal function, Urinalysis, Microalbuminuria
 Referrals- Retinopathy, Neuropathy,
Nephropathy,

4. DIABETES MANAGEMENT
WHAT IS OUR AIM :-
1. ACHIEVE HBA1C GOAL OR FBS OR
OGTT OR PPG GOAL
2. PREVENT & DELAY LONGTERM
MACRO & MICRO - VASCULAR
COMPLICATION
3.INCREASE LIFE EXPECTANCY

5. TWO TYPE OF APPROACH
1. NON PHARMACOLOGICAL .
2. PHARMACOLOGICAL .

6. 1. NON-PHARMACOLOGICAL .
It contain all action except drugs
therapy
1. Diabetes patient education
2. Medical nutrition therapy
3. Exercise or workout
4. Reduce risk factors like smoking,
obesity , alcohol ,sodium
(2300mg/day)

7. DIABETES PATIENT EDUCATION
 First demonstrated by miller & Goldstein in 1972
 Objective is to make patient understand & handle
acute & chronic complication which are 50-80%
preventable . It Significantly reduce hypoglycemic
event , ketoacidosis , leg amputation & improve
diabetes control .
 Impossible to manage diabetes without good
awareness .
 No diabetes educators in india .
 At community level promotion
 Teaching a teacher - In India even physicians doesn’t
receive education program . There should be a
curriculum to train teacher includes nutritional &
physical advice , home based method of monitoring
blood glucose , injection techniques, all acute &
chronic complications .

8. MEDICAL NUTRITION THERAPY
Basic principles are –
1. Decrease in saturated fat
2. Decrease in simple carbohydrates
3. Substitute with complex carb.
4. Increase in dietary fibers.
5. limiting alcohol consumption
6. 2 gm of protein/kg bw to minimize nitrogen loss
7. Consumption of high calorie snacks or sugar rich
beverages should be discontinued .
8. Consumption of three main meals a day with 1 or 2
snacks .

9. BROCA’S INDEX & BMI
 Ideal body weight of a pt may be assessed
using broca’s index
 Height in cms -100 = desirable body wt in kg
. Maintaining wt at 90% of desirable wt may
be preferred in pt with diabetes .
 BMI = (wt in kgs )/(ht in mtr)^2

10. HOW WE DETERMINE DIET PRESCRIPTION

11. DETERMINE EXERCISE PRESCRIPTION
 Normal prediabetic patient ADA recommond
150min/week aerobic or jogging activity
 Diabetes with obesity more than 30 BMI
recommondation of 300min/week aerobic
with some vigorous exercises .

12. SMOKING CESSATION
 One of the most cost effective interventions
in pt with DM .
 Ask history about duration, frequency &
types of smoking & tobacco .
 Regardless of patient’s willingness , offer
advice & information about the effects &
complications related to smoking .
 Once pt prepare for quitting give them a
favourable environment .

13. CONTROL OBESITY
 BMI should be less than 23 kg/m2 in indians
 Diet & food based therapy
 Exercise
 Behavioral therapy
 Pharmacotherapy drugs like orlistat(decrease
fat absorption),phenteremine (appetite
suppressant) lorcaserin(satiety)
,naltrexone(reduce foodintake) ( USFDA
approved ) others are metformin , glp-1 agonist ,
dpp-4 inhibitors .
 Bariatric surgery

14. OTHERS INCLUDES :-
Alcohol cessation
Psychological assessment
Immunization

15. 2. PHARMACOLOGICAL APPROACH
 Type 1 DM
 Type 2 DM

16. TYPE 1 DM PHARMACOTHERAPY
1. Insulin insulin & insulin .
Insulin must be prescribed in basal bolus
regimens
There is no other drug use in type 1 dm
2. Pramlintide – USFDA approved
delayed gastric emptying , blunt pancreatic
secretion of glucagon & enhance satiety .
Induce wt loss & lower insulin dose . Only
indicated in adult .

17. TYPE 2 DM PHARMACOTHERAPY
 These includes OHA in monotherapy or in
combination with other OHA or INSULIN .