Diabetes management and complications Dr Louise JohnsonLoots Specialist

Diabetes management and complications Dr. Louise Johnson-Loots Specialist physician and insulin pump centre Montana hospital, Pretoria

Diabetes types Ü Type 1 – auto immune Ü Type 2 - insulin resistant Ü Secondary – surgery, medication (i. e. steroids) Ü GDM ( gestational diabetes)

Diabetes Type 1 Type 2 Younger than 30 yr Older than 30 yr Thin Obese – Auto-immune disease ♂ waist > 94 cm 10 -20% of Pt. ♀ waist > 80 cm Ass diseases i. e. HT, Dyslipiedemiae 80% of Pt

What you see is what you have… Type 2 Type 1

Insulin resistance (metabolic syndrome) Ü First step on diabetes ladder Ü Waist circumference Male >94 cm Female >80 cm Ü Associated disease –Hypertension - gout -abnormal cholesterol

How to manage my metabolic abnormality? Ü Know your numbers Ü Set targets – keep to them Ü Know your bar stool (diet, exercise , medication) Ü NO smoking!! Ü Test regularly

Targets to achieve Ü Waist - 94 cm male, 80 cm female Ü Blood pressure < 130/80 mm. Hg Ü LDL cholesterol< 1. 8 Ü HDL cholesterol > 1. 0 Ü Hb. A 1 c < 7% Ü FPG < 5. 5 , 2 h PPG < 7. 8

How to get to target? Ü Diet Ü Exercise 30 min brisk walking/day Ü Correct medication – suit your life style Ü Regular blood glucose testing – 2 x/day on insulin - wake up/2 h PPG if on tablets Ü Test more if unwell

Diabetic diet sign language Ü Fist – carbohydrate portion (tennis ball size) Ü Palm size – protein ( thickness of thumb ball ) Ü Two open hands – vegetables Ü Thumb tip – fat Ü 3 regular meals- don’t skip Ü Enough water - weight ( 84 kg = 8 glasses)

Alcohol and diabetes Ü Female 1 unit/day Ü Male 2 units/day Ü Unit - single whiskey/brandy (spirits) - 200 ml dry white/red wine Ü Stay away from mixes, beer, sherry , port liqueur

Important pitfalls Ü Diabetic sweets - too much fat Ü Flavored water = Coke in calories!! Ü Fruit juice Ü Not what we eat but how much of it!

Medication - Type 2 diabetes Ü Metformin basis of type 2 management Ü Incretin – tablets and injections (see second lecture after lunch break) Ü Sulphonylurea – hypoglycemia Ü TZD- pioglitazone – swelling of feet

Medication Type 1 Diabetes Ü Insulin –to suit your lifestyle Ü Basal/bolus Ü Basal( long acting) Levemir, Lantus, Ü Bolus (short acting)– novorapid, apidra, humalog Ü Fixed mixes –novomix, humalog mix 25 Ü Insulin pumps

-cell function (% of normal by HOMA) Progression of type 2 diabetes 100 Time of diagnosis ? 80 60 Pancreatic function = 50% of normal 40 20 0 ― 10 ― 8 ― 6 ― 4 ― 2 Time (years) HOMA=homeostasis model assessment. Adapted from Holman RR. Diabetes Res Clin Pract 1998; 40(suppl 1): S 21― 5. 0 2 4 6

The first insulin § 11/1/1922 §Leonard Thompson § 14 yr § 25 days on dog insulin

Expectations today Fast Reliable Smooth Reproducible Safe

Complications Ü Preventable!! Ü Know the rules of the metabolic abnormality to prevent the disease

Rules for diabetes Ü Rule 1 – medical check 6 monthly with a specialist physician –Blood pressure, kidney , heart, feet sensation and blood flow. Ü Rule 2 – eye check at an eye specialist (not the person giving the glasses) Ü Rule 3 – no bare foot walking

More rules Ü Rule 4 – sin once every 14 days (ice cream , chocolate , cookies etc) Ü Rule 5 - if female and your baby weighed >4. 0 kg – get screened for diabetes yearly Ü Rule 6 – Become the captain of your own ship !

Questions ? ?