Presented By Dr. Richard Nabhan M.B. Ch. B, D.T.M. & H., M.R.C.P (UK),FRCP(Lond) Senior Consultant Physician & Cardiologist, & Diabetologist The common Crippler & Killer of the Century Weapon Used,Complications & Regulation Atherosclerosis (Hardening of the arteries) Thickening of the wall at the expense of the lumen Q. What Accelerates the Narrowing of the Lumen ? A. Diabetes. B. Hypertension C. Smoking D. High Lipids E. Family History F. Obesity G. Inactivity H. Stress Need to change the lifestyle Q. What happens if the lumen narrows ? Ischemic Pain. Q. What happens if this narrowed lumen ultimately closes ? Death of the tissue supplied. -Cholesterol -LDL -Triglycerides -HDL Effects of Occlusion of a Vital Artery on a Vital Organ Hemiplegia Stroke ( Hemiplegia ) Myocardial infarction Heart-attack ( Myocardial infarction ) Brain Infarction GANGRENEGANGRENEGANGRENEGANGRENE O cclusion of a P eripheral A rtery of the L ower L imbs MicroVascular Complications MICROMICRO MACROMACRO Diabetic RetinopathyDiabetic Nephropathy Diabetic Neuropathy 3 rd Nerve Palsy 7 th Nerve Palsy P eripheral N europathy: Sensory. Sensorimotor. Proximal. Foot Drop Neuropathic Foot Ulcer Attacks more than 66% of Diabetics M ononeuropathy: Wrist. Foot. Ocular. Facial. A utonomic N europathy: Postural hypotension. Diarrhea. Bladder dysfunction. Sexual dysfunction. Loss of sweating (LL), etc Care of the Foot in Diabetes Diabetic Retinopathy Diabetic Cataract A cataract causes light to scatter at the level of the lens causing blurry image. Successful removal of the cataract allows the image to be seen clearly. - Hyperglycemia - Hypoglycemia Q. What happens if the Pancreas goes on strike ??? No Insulin AT ALL Little Insulin Insulin resistance AGE SYMPTOMS TREATMENT: 1. Diet 2. Glucose control 3. Exercise 4. Medications Door Totally Closed Door Partially Closed Type I Diabetes Type II Diabetes Short-term Complications Ketones: Ketonuria indicates no more insulin in the pancreas Hb A1c: A marker of average glucose levels during the preceding 6-8 weeks Microalbunminuria: A n early marker of diabetic nephropathy ON STRIKE Criteria for the Diagnosis of Diabetes Mellitus!!! Fasting blood sugar level 126 mg/dL OR GTT 2-hour blood sugar level 200 mg/dL during a 75-g oral glucose tolerance test. Symptoms (polyuria, polydipsia, weight loss with good appetite) plus random blood sugar level 200 mg/dL OR Our Goals for Glycemic Control Action SuggestedGoalNormal RangeBiochemical Index