Conference Insight: Diabetes
Rawalpindi, Pakistan, 26/2/2011
Always give Metformin in Type 1 Diabetes.
If postprandial glues is high, give Sulfonylurea.
If patient is underweight- Start insulin.
If normal weight- Start Metformin.
Daonil (Glibenclamide) only Sulfonylurea to not cross placental barrier.
For starting Metformin : Check Creatinine and A.L.T. levels.
If Creatinine levels are greater than 3, discontinue A.C.E. inhibitor and Angiotensin receptor blockers. If stable Creatinine (which doesn’t rise), continue drugs.
If Glycosylated Hemoglobin can be reduced by 1%, 25% reductions in complications can occur.
If 184 mg/dl blood sugar level, advice Oral glucose tolerance test and blood glucose assessment.
Diabetics have fatty liver.
Acanthosis nigrican= Black spots on neck, indicator of insulin resistance, such patients are likely to develop Diabetes.
Metabolic Syndrome X= Cardiometabolic Syndrome= Syndrome X= Insulin resistance syndrome= Metabolic syndrome.
If fasting glucose level is greater than 126 mg/dl : Diabetic patient.
If blood glucose level between 100-125mg/dl: Pre-diabetic.
If HbA1C > 6.5% : Diabetic patient.
For pre-diabetic: Give Metformin (250mg) Once Daily for 5 days, then twice a day (850 mg) and keep increasing till 1250 mg. Maximum limit is 2500 mg.
When type 2 Diabetes diagnosed: 50% of B-pancreatic cells are already damaged.
If HbA1C > 9 (Fasting level :201-300 mg/dl or random level :301- 350 mg/dl) : Multi drug therapy needed.
If HbA1C > 11 (Fasting level >300 mg/dl or Random level > 350 mg/dl) : Start 3 line drug therapy or insulin and then revert to 2 line drug therapy within 6 weeks to 3 months because of ‘glucotoxicity’ (Greater glucose concentration in blood hinders Pancreatic B-cells)
Patient consultation: Constant monitoring, home glucometer, diet and exercise, eat everything but less (2-3 fruits everyday) can be taken. Similarly rice can be taken 1 cup a day.
Do not wear new shoes 24 hours a day, keep increasing time from 1 hour to 2 hour next day. Vigorously clean feet.
Every year have micro-albumin, lipid profile and dilated pupil fundus examination.
If well controlled Diabetic has sudden increase in glucose, check for any infection or steroids intake.
If pre-prandial glucose is high, post-prandial glucose will be high too.
Post-prandial glucose carries more mortality risk for diabetic patients.
Amylin (hormone) absent in Type 1 Diabetes while deficient in Type 2 Diabetes.
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