diabetes overview
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Diabetes Overview. Managing Diabetes in Primary Care. Diabetes Mellitus. Diabetes mellitus is a condition in which there is a chronically raised blood glucose concentration - PowerPoint PPT PresentationTRANSCRIPT
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Diabetes Overview
Managing Diabetes in Primary Care
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Diabetes Mellitus
Diabetes mellitus is a condition in which there is a chronically raised blood glucose concentration
It is caused by an absolute or relative lack of insulin i.e. insulin is not being produced from the pancreas or there is insufficient insulin or insulin action for the body’s needs
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Prevalence
1.3 million in UK 2.5% population
diagnosed “Missing Million”:
DUK reckon up to 2% more diabetics undiagnosed
Prevalence rises with age
1 in 20 over 65 1 in 5 over 85
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Sociology
European perspective Britain among worst rates of Diabetic complications in Europe
(renal failure, amputation, blindness)
Ethnicity T2DM up to 6* more common in people of South Asian descent T2DM up to 3* more common in people of African or Afro-
Caribbean descent
Social Class morbidity is up to 3.5* more in poorest than richest in our society
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Gender Variation
Prevalence higher in men than women
Risk of dying higher in women than men
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Definitions
World Health Organisation Diabetes
fasting plasma glucose >7.0 2-h post-glucose load >11.1
Impaired Glucose Tolerance fasting <7.0 and 2-h post-glucose load >7.8
Impaired Fasting Glucose fasting 6.1 – 7.0
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Classification
Type 1 insulin-dependent
Type 2 non-insulin-dependent
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Type 1 Diabetes
Presents in childhood or early adult life accounts for 15% cases in England pancreatic ß–islet cells destroyed autoimmune
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Type 2 Diabetes
Often presents after age 40 85% of cases in England insulin resistance gradual onset
tiredness, frequent urination, increased thirst, weight loss
may be detected routinely medical examination
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Complications
Microvascular Cardiovascular Other
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Microvascular
eye retinopathy maculopathy
nephropathy neuropathy
feet/ulceration postural hypotension abnormal sweating diarrhoea erectile dysfunction
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Cardiovascular
CHD angina myocardial infarction heart failure
Stroke/TIA PVD
claudication foot ulcers
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Other
cataract infections
UTI candidal skin
soft tissue problems frozen shoulder, trigger finger
skin problems necrobiosis lipoidica diabeticorum
mental health problems
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Management Options
Diet Oral Hypoglycaemics Insulin
T1DM T2DM
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Management of T1DM
Insulin Pre-mixed “biphasic” Basal Bolus Insulin Pump
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Management of T2DM
Diet low fat high (complex) carbohydrate
Lifestyle modification smoking cessation reduce alcohol reduce obesity exercise
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Management of T2DM (2)
Glycaemic control sulphonylureas biguanides (metformin) secretagogues (Repaglinide) thiazolidinediones
Hypertension control ACEI
Lipid control statins
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Organised Diabetic Care
Practice Clinic Nurse Specialist GP Specialist Call/Recall
Specialist Care Liaison Nurse
Screening Services Retinopathy Podiatry