DR.V.SEKAR COIMBATORE DIABETES FOUNDATION. HYPERGLYCEMIA IS THE HALLMARKOF DIABETES HYPERGLYCEMIA IS...
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Transcript of DR.V.SEKAR COIMBATORE DIABETES FOUNDATION. HYPERGLYCEMIA IS THE HALLMARKOF DIABETES HYPERGLYCEMIA IS...
DR.V.SEKARDR.V.SEKAR
COIMBATORE COIMBATORE DIABETES DIABETES
FOUNDATIONFOUNDATION
HYPERGLYCEMIA IS THEHYPERGLYCEMIA IS THE
HALLMARK HALLMARK OF DIABETESOF DIABETESHYPERGLYCEMIA IS THE HYPERGLYCEMIA IS THE
HALLMARK OF DIABETESHALLMARK OF DIABETES
HYPERGLYCEMIA IS THEHYPERGLYCEMIA IS THE
HALLMARK HALLMARK OF DIABETESOF DIABETES
DIABETES TREATMENT IS DIABETES TREATMENT IS BASED ON THE BASED ON THE
NUMBER IN MILLIGRAMSNUMBER IN MILLIGRAMS
BEFORE WE DECIDE WHETHER BEFORE WE DECIDE WHETHER BLOOD SUGAR IS BLOOD SUGAR IS
NORMAL , HIGH OR LOWNORMAL , HIGH OR LOW
HYPERGLYCEMIA IS THEHYPERGLYCEMIA IS THE
HALLMARK HALLMARK OF DIABETESOF DIABETES
HOW THE BOOLD SUGAR IS HOW THE BOOLD SUGAR IS
DERIVED FROM DERIVED FROM WHERE,WHATWHERE,WHAT
METHOD IS CRITICALMETHOD IS CRITICAL
HYPERGLYCEMIA IS THEHYPERGLYCEMIA IS THE
HALLMARK HALLMARK OF DIABETESOF DIABETES
THE MOST CRITICAL ISSUE THE MOST CRITICAL ISSUE IS CLINICAL CORELATIONIS CLINICAL CORELATION
BLOOD SUGAR SHOULD BLOOD SUGAR SHOULD NOT BE TREATEDNOT BE TREATED
THE PERSON WITH BLOOD THE PERSON WITH BLOOD SUGAR SHOULD BE SUGAR SHOULD BE
TREATEDTREATED
SOURCE OF BLOODSOURCE OF BLOOD
CAPILLARY OR VENOUS PLASMAWHAT METHOD?
WHICH MACHINE?
MANUAL,SEMI AUTOMATED,FULLY AUTOMATED
STEPS FOR STEPS FOR INTERPRETATING BLOOD INTERPRETATING BLOOD
SUGAR VALUESUGAR VALUE
•PRE ANALYSIS
•ANALYSIS
•POST ANALYSIS
PRE ANALYSISPRE ANALYSIS
•BLOOD COLLECTION•LABELLING•ANTI COAGULANT•CENTRIFUGE
BLOOD BLOOD COLLECTIONCOLLECTION
ANTI COAGULANTANTI COAGULANT
LABELLINGLABELLING
CENTRIFUGATIONCENTRIFUGATION VIDEO
PLASMA
PIPETINGPIPETING
1 ML OF REAGENT1 ML OF REAGENT10 MICRO LITER OF PLASMA10 MICRO LITER OF PLASMA
TYPES OF MACHINETYPES OF MACHINE
•TOTALLY MANUAL•SEMI AUTOMATED•FULLY AUTOMATED
ANALYSISANALYSIS
TYPES OF TESTINGTYPES OF TESTING
GLUCOSE OXIDATES DEHYDROGENASE METHOD (GOD)
HEXOKINASE METHOD
TYPE OF REAGENTSTYPE OF REAGENTS
1. END POINT METHOD
2. KINETIC METHOD
TESTINGTESTING VIDEO
TIME OF TESTINGTIME OF TESTING
BLOOD COLLECTION TIME
TESTING TIME
REPORT RELEASING TIME
IS MORE IMPORTANT
EVERY ONE HOUR THERE IS A EVERY ONE HOUR THERE IS A FALL FALL
OF 10 – 15 MILLIGRAMSOF 10 – 15 MILLIGRAMS
SAMPLE SAMPLE STORAGESTORAGE
ONLY FOR 24 ONLY FOR 24 HRSHRSATAT
2 – 8 DEGREE2 – 8 DEGREE
POST ANALYSISPOST ANALYSIS
REPORT RELEASINGREPORT RELEASING
VERIFICATION
RECHECKING
CLINICAL CORRELATION
CALIBERATIONCALIBERATIONQUALITY CONTROLQUALITY CONTROL
WHY FASTING IS HIGH ?WHY FASTING IS HIGH ?Basal Insulin Deficiency:Pre Dinner / Post Dinner Blood Sugar Abnormality:
CHO Load: High Low MediumGlycaemic Index: High Low Fibre Content of Food: High Low MediumTime of Food: Untimely Food Timely Food
Somyogi:Dawn Phenomenon:
Medication:Check Insulin Vial Clear Turbid Expiry CheckedStorage Area Refrigerator Room TempCheck Syringe U 40 U100Check OHA Less dose Correct dose High doseTime of Insulin Correct Time UntimeInsulin Meal Mismatch:
WHY POST PRANDIAL IS WHY POST PRANDIAL IS HIGH ?HIGH ?
Basal Insulin Deficiency:Pre Dinner / Post Dinner Blood Sugar Abnormality:CHO Load: High Low MediumGlycaemic Index: High Low Fibre Content of Food: High Low MediumTime of Food: Untimely Food Timely Food Somyogi:Dawn Phenomenon:Medication:
Check Insulin Vial Clear Turbid Expiry Checked Storage Area Refrigerator Room Temp
Check Syringe U 40 U100Check OHA Less dose Correct dose
High doseTime of Insulin Correct Time UntimeInsulin Meal Mismatch:
PERSISTANTLY PERSISTANTLY A1C A1C 1.Diet factor:
High CHO Load
Glycaemic index High, Low
Fibre content of the food High, Low, Medium
Time of Food Timely food, Untimely food
2. Exercise :Frequency IntensityTimeType Aerobics gym yoga exercise
6. Co morbid conditions:HT MAU LIPIDS BDR
7. Complication: IHD PDR NEPHROPATHY NEUROPATHY DFS
PVD
8.Doctor factor:Clinical InertiaSelection of drugDosage
CONT’CONT’
HBA1C MAJESTIC IN THE MANAGEMENT OF DIABETESHBA1C MAJESTIC IN THEHBA1C MAJESTIC IN THE
MANAGEMENT OF DIABETESMANAGEMENT OF DIABETES
DIABETES MEANS CHRONIC HYPERGLYCEMIA
WHAT WE TREAT IS ONLY ACUTE HYPERGLYCEMIA?
DIABETES MEANS DIABETES MEANS CHRONIC HYPERGLYCEMIACHRONIC HYPERGLYCEMIA
WHAT WE TREAT IS ONLY WHAT WE TREAT IS ONLY ACUTE HYPERGLYCEMIAACUTE HYPERGLYCEMIA
BLOOD SUGAR TELLS YOU THE DAY TO DAY VARIATION
HBA1C IDENTIFIES THE OVER ALL FLUCCATION OF
BLOOD SUGAR
BLOOD SUGAR TELLS YOU BLOOD SUGAR TELLS YOU THE DAY TO DAY VARIATIONTHE DAY TO DAY VARIATION
HBA1C IDENTIFIES THE OVER HBA1C IDENTIFIES THE OVER ALL FLUCCUATION OF BLOOD ALL FLUCCUATION OF BLOOD SUGARSUGAR
CLINICAL CASE STUDY
MR.SANKARANARAYANAN 60YRS C/O SWELLING IN LEGS
HIS HBA1C IS 11.0% CREA 2.4 WITH BDR ON THE DAY OF TESTING
CLINICAL CASE STUDY
MRS.PADMINI 60 YRS ON THE DAY
OF TESTING HAD BREAKFAST IN
HOTEL HER FASTING WAS 140
POST PRANDIAL 260 & HBA1C 6.0%
HBA1C HELPS TO DECIDE ABOUT DIABETES IS UNDER CONTROL OR NOT
PREDICTS FUTURE COMPLICATIONS
HELPS TO DECIDE THE DIABETES MANAGEMENT
BLOOD SUGAR IS DYNAMIC KEEPS CHANGING
WITH EACH MEAL BLOOD SUGAR GOES UP
3 TIMES A DAY 90 TIMES IN A MONTH
WE CHECK BLOOD SUGAR ONCE IN A MONTH / FEW MONTHS &
DIABETES IS TREATED ON PARTICULAR VALUE UNSCIENTIFIC NOT LOGIC
ROLE OF HBA1C
•CONTROL < 7 %
•NOT UNDER CONTROL > 7 %
•PREDICTS FUTURE COMPLICATION
DCCT , UKPDS STUDY DECIDE ABOUT THE DIABETES MANAGEMENT
< 7 % UNDER CONTROL
> 7 % NOT UNDER CONTROL
7 – 8 % NEEDS ACTION
> 8 % CHANGING THE MEDICATION OR ADDING THE DOSE
>10 % MAY REQUIRE INSULIN
LEVEL OF DECREASE IN HBA1C
LIFE STYLE MODIFICATION
0.5 – 1
METFORMIN 1 – 1.5SULFONYLUREA 1 – 1.5GLITAZONES 0.5 – 1.0SITAGLIPTIN 0.5 – 1.0INSULIN ANY NUMBER
CLINICAL DECESION MAKING
1.SYMPTOMS
2.COMPLICATIONS
3.DURATION OF DIABETES
4.AGE
5.HBA1C
6.TYPE 1 OR TYPE 2
7.INSULIN DEFECIENCY OR INSULIN RESISTANCE
8.WHICH BLOOD SUGAR IS HIGH FASTING OR POST PRANDIAL
9.DIFFERENCE BETWEEN FASTING AND PP
10.DIABETES + OBESITY
11.DIABETES + HYPERTENSION
12.DIABETES + DYSLIPIDEMIA
13.PSYCO – SOCIO STATUS ,ECONOMIC STATUS
14.CO-OPERATION OF THE PERSON AND HIS FAMILY
SYMPTOMSCLINICAL SYMPTOMS ARE THE MOST
IMPORTANT PARAMETER IN DECIDING THETREATMENT PATHWAY
Eg: POLYURIA,POLYPHYGIA,POLYDYPSIA,WT LOSSINDICATES A DECOMPENSATED SYMPTOMATIC
DIABETES STATUS – NEEDS INSULIN THERAPY
SEVERE NEUROPATHY – THE CHOICE IS INSULIN
COMPLICATIONSBASED ON THE MICRO OR MACRO VASCULAR
COMPLICATION THE TREATMENT DECESION MAY DIFFER
DURATION OF DIABETESAT DIAGNOSIS 50 % OF BETA CELL IS LOST LONGER THE DURATION MORE LIKELY REQUIRE
INSULIN THERAPYProgressive Beta Cell FailureProgressive Beta Cell Failure
85 %
70 %
50 % Beta Cell Lossat Detection
100 %Betamass IGT PPBS DIABETES 35 %
PHASE III
I I I
-12 -6 0 6 10 14Y EARS
AGE• YOUNG AGE ONSET• MIDDLE AGE ONSET / CLASSICAL ONSET• OLD AGE ONSET
YOUNG AGE ONSET MAY REQUIRE A TIGHT CONTROL
HBA1CINDICATES A CHRONIC HYPERGLYCEMIA
HBA1C > 10% MAY REQUIRE INSULIN THERAPY
INSULIN RESISTANCE OR INSULIN DEFECIENCYWHICH IS PREDOMINANT ?
FASTING OR POST PRANDIAL WHICH BLOOD SUGAR IS HIGH?
WHAT IS THE DIFFERENCE BETWEEN FASTING AND POST PRANDIAL?
Eg: BASAL INSULIN TO CONTROL THE FASTINGBOLUS TO CONTROL THE POST PRANDIAL
CO – MORBID CONDITIONS
• HYPER TENSION• OBESITY• DYSLIPIDEMIA
PSYCO-SOCIAL, ECONOMICAL STATUS