Diabetes Overview Managing Diabetes in Primary Care Diabetes
Diabetes Overview Managing Diabetes in Primary Care
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 James Street Family Practice, Louth GP Registrar Tutorial
Prevalence w 1. 3 million in UK n 2. 5% population diagnosed w “Missing Million”: n DUK reckon up to 2% more diabetics undiagnosed w Prevalence rises with age n n James Street Family Practice, Louth GP Registrar Tutorial 1 in 20 over 65 1 in 5 over 85
Sociology w European perspective n Britain among worst rates of Diabetic complications in Europe (renal failure, amputation, blindness) w Ethnicity n n T 2 DM up to 6* more common in people of South Asian descent T 2 DM up to 3* more common in people of African or Afro. Caribbean descent w Social Class n morbidity is up to 3. 5* more in poorest than richest in our society James Street Family Practice, Louth GP Registrar Tutorial
Gender Variation w Prevalence higher in men than women w Risk of dying higher in women than men James Street Family Practice, Louth GP Registrar Tutorial
Definitions w World Health Organisation n Diabetes l l n Impaired Glucose Tolerance l l n fasting plasma glucose >7. 0 2 -h post-glucose load >11. 1 fasting <7. 0 and 2 -h post-glucose load >7. 8 Impaired Fasting Glucose l James Street Family Practice, Louth GP Registrar Tutorial fasting 6. 1 – 7. 0
Classification w Type 1 n insulin-dependent w Type 2 n non-insulin-dependent James Street Family Practice, Louth GP Registrar Tutorial
Type 1 Diabetes w Presents in childhood or early adult life w accounts for 15% cases in England w pancreatic ß–islet cells destroyed autoimmune James Street Family Practice, Louth GP Registrar Tutorial
Type 2 Diabetes w w Often presents after age 40 85% of cases in England insulin resistance gradual onset n tiredness, frequent urination, increased thirst, weight loss w may be detected routinely n medical examination James Street Family Practice, Louth GP Registrar Tutorial
Complications w Microvascular w Cardiovascular w Other James Street Family Practice, Louth GP Registrar Tutorial
Microvascular n eye l l n n retinopathy maculopathy nephropathy neuropathy l l l feet/ulceration postural hypotension abnormal sweating diarrhoea erectile dysfunction James Street Family Practice, Louth GP Registrar Tutorial
Cardiovascular n CHD l l l n n angina myocardial infarction heart failure Stroke/TIA PVD l l claudication foot ulcers James Street Family Practice, Louth GP Registrar Tutorial
Other n n cataract infections l l l n soft tissue problems l n frozen shoulder, trigger finger skin problems l n UTI candidal skin necrobiosis lipoidica diabeticorum mental health problems James Street Family Practice, Louth GP Registrar Tutorial
Management Options w Diet w Oral Hypoglycaemics w Insulin w T 1 DM w T 2 DM James Street Family Practice, Louth GP Registrar Tutorial
Management of T 1 DM w Insulin n Pre-mixed “biphasic” Basal Bolus Insulin Pump James Street Family Practice, Louth GP Registrar Tutorial
Management of T 2 DM w Diet n n low fat high (complex) carbohydrate w Lifestyle modification n n smoking cessation reduce alcohol reduce obesity exercise James Street Family Practice, Louth GP Registrar Tutorial
Management of T 2 DM (2) w Glycaemic control n n sulphonylureas biguanides (metformin) secretagogues (Repaglinide) thiazolidinediones w Hypertension control n ACEI w Lipid control n statins James Street Family Practice, Louth GP Registrar Tutorial
Organised Diabetic Care w Practice Clinic n n n Nurse Specialist GP Specialist Call/Recall w Specialist Care n Liaison Nurse w Screening Services n n Retinopathy Podiatry James Street Family Practice, Louth GP Registrar Tutorial
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