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Presented by: Dr. Emad HamedPracticing Physician, Naga- Hammady
Standardization
in
Diabetes
Standardization in Diabetes
In Prevention.In Screening for early detection.In Diagnosis.In Management
In Routine Investigations In Management Protocols Life Style Modification
Diet Physical Activity
Medications Oral Hypoglycemic Drugs Insulin
Standardization in Diagnosis
Plasma level / Blood level (Laboratory / Glucometers)
The difference is that plasma numbers read about 10 - 12% higher than the older
whole blood numbers. So if your fasting and pre-meal blood glucose target is 90
- 130 mg/dl plasma glucose, it would be 80 - 120 mg/dl if your meter reads
whole blood.(Joslin Diabetes Center)
Blood Pressure Measurement.
Waist Circumference Measurement.
Standardization in DiagnosisBlood Pressure Measurement
A waist measurement of greater than 94cm for men or 80cm for women is an indicator of internal fat deposits, which can coat the heart, kidneys, liver and pancreas, and increase the risk of chronic disease.
Waist circumference should only be used for adults to check the risk of developing a chronic disease. Measurements that indicate increased risks for children and teenagers have not been developed.
Why is waist measurement important?
Standardization in DiagnosisWaist Circumference Measurement
Measuring Waist Circumference
The tape measure should be placed directly on your skin, or on
no more than one layer of light clothing.
The correct place to measure your waist is horizontally halfway
between your lowest rib and the top of your hipbone. This is
roughly in line with your belly button.
Breathe out normally and take the measure.
Make sure the tape is snug, without squeezing the skin.
Standardization in DiagnosisWaist Circumference Measurement
Mode of Action & Dose of Oral Anti-Diabetic Drugs
( Accordinf to the British National Formulary BNF March 2010)
Active Principle Mode of Action Dose Details
MetforminDecreasing gluconeogenesis & increasing peripheral
utilization of glucose. Only if there is residual pancreatic function
Adult and Child over 10 years 500 mg with breakfast > one week > 500 mg with breakfast & dinner > one week > 500 mg with 3 meals
Glibenclamide
Augmentig Insulin secreation. During long term adminestration they have extrapanceatic action
Initially 5 rng daily with or immediately after break fast, dose adjusted according to response ; max. 15 mg daily
Gliclazide(MR)Initially 30 mg daily with breakfast, adjusted according to response every 4 weeks ;
max. 120 mg daily
GlipizideInitially 2.5—5 mg daily shortly before breakfast or lunch, adjusted according to
response; max. 20 mg daily.Up to 15 mg (Sigle dose), higher doses divided.
GlimerprideInitially 1 mg daily, adjusted according to response at 1-2 week intervals; max. 4 mg
daily taken shortly before or with first main meal
RepaglinideStimulate insulin release. Both drugs have a rapid onset of
action and short duration of activity
> 18 years, initially 500 micrograms within 30 minutes before main meals ; up to 4 mg may be given as a single dose, max. 16 mg daily
Natiglinide> 18 years, initially 60 mg 3 times daily within 30 minutes before main meals, up to
max. 180 mg 3 times daily
AcarboseInhibits intestinal glucosidase , delays the digestion &
absorption of starch & sucrose
> 18 years, initially 50 mg daily increased to 50 mg 3 times daily, max. 200 mg 3 times daily Tablets should be chewed with first mouthful of food or swallowed whole
with a little liquid immediately before food
PioglitazoneReduce peripheral insulin resistance, leading to a reduction
of blood-glucose concentration> 18 years, initially 15-30 mg once daily increased to 45 mg once daily according to
response
Vildagliptin Inhibits dipeptidylpeptidase-4 so increases insulin secreation and lowers glucagon secretion
>18 years, in combination with metformin or pioglitazone, 50 mg twice/D in combination with a sulfonylurea, 50 mg daily in the morning
Sitagliptin > 18 years, 100 mg once daily
Standardization in ManagementOral Hypoglycemic Drugs
Transporting Insulin.
Cooling Insulin.
Injecting Insulin.
100 U/ml / 40 U/ml.
Sites of Injection.
Technique (Flash Movies) If insulin leaks from the pen or from your skin after you remove the needle from
the injection site, you may not be leaving the needle under the skin long enough.
It is a good practice to count slowly to 10 before withdrawing the needle.
Standardization in ManagementInsulin
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