Diabetes management and

complicationsDr. Louise Johnson-LootsSpecialist physician and insulin pump centreMontana hospital, Pretoria

Diabetes types

Type 1 – auto immune

Type 2 - insulin resistant

Secondary – surgery, medication (i.e. steroids)

GDM ( gestational 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

Type 2 Type 1

Insulin resistance (metabolic syndrome)

First step on diabetes ladder

Waist circumference Male >94 cm

Female >80cm

Associated disease –Hypertension

- gout

-abnormal cholesterol

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

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

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

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)

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

Important pitfalls

Diabetic sweets - too much fat

Flavored water = Coke in calories!!

Fruit juice

Not what we eat but how much of it!

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

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

HOMA=homeostasis model assessment.Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21―5.

-cell f

un

cti

on

(%

of

norm

al b

y

HO

MA

)

Time (years)

0

20

40

60

80

100

―10 ―8 ―6 ―4 ―2 0 2 4 6

Time of diagnosis

?

Pancreatic function= 50% of normal

11/1/1922

Leonard Thompson

14yr

25 days on dog insulin

Fast

Reliable

Smooth

Reproducible

Safe

Complications

Preventable

Preventable!

Preventable!!

Know the rules of the metabolic abnormality to prevent the disease

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

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 !

Questions ??