Left ventricular failure with parkinsons disease and hypertension with type 2 dm
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Transcript of Left ventricular failure with parkinsons disease and hypertension with type 2 dm
1
Case presentation on left ventricular failure with Parkinson's disease and type 2 DM with hypertensionPresented by : Abhimanyu parashar 5th Pharm.D roll no. 1
Saturday 8 April 20232
IP no. : 223050
UNIT : medicine 1
AGE : 70 yrs
SEX : Female
Saturday 8 April 20233
Reasons for admission :c/o :
Generalized weakness x 2 days Inability to move x 2 days
Saturday 8 April 20234
General examination An elderly female , moderately built and
nourished , conscious and cooperative Pulse : 94 BPM BP :140/90 mmHg SPo2 : 94% CBG : 169 mg/dl No meningeal signs
Saturday 8 April 20235
Pallor + No cyanosis , no clubbing CNS : cranial nerves normal P/A : soft and non tender Power :
Tone :
U/L L/LR 3/5 3/5L 4/5 4/5
U/L L/LR N NL N N
Saturday 8 April 20236
DTR : RIGHT LEFT
B +++ ++T ++ ++S ++ ++K +++ ++A +++ ++Plantar increased Normal
Saturday 8 April 20237
Saturday 8 April 20238
PMHx : K/C/O type 2 DM x 8 years and was on
glimipride and metformin (½-0-0) K/C/O hypertension x 8 yrs and was on
losartan (1-0-0) H/O of seizures disorders .
Saturday 8 April 20239
Allergies FHx SHx
NKA NS NS
Saturday 8 April 202310
Personal history DIET : veg
APPETITE : good
SLEEP : undisturbed
BOWEL and BLADDER : normal and regular
Saturday 8 April 202311
PROVISIONAL DIAGNOSIS
TYPE 2 DM with TRANSIENT ISCHEMIC ATTACK
Saturday 8 April 202312
DAY NOTES :
Saturday 8 April 202313
DAY 1 BP : 140/80 mmHg PULSE : 94 BPM SPo2 : 94% CBG :169 mg/dl C/O : generalized weakness since 2 days Unable to move around since 2 days Difficulty in moving all 4 limbs
Saturday 8 April 202314
O/E : CVS: S1S2 present and no murmurs RS: NVBS + , no added sounds CNS: Patient is conscious oriented and
cranial nerves are normal No atrophy or hypertrophy of musclesADV : treatment as per chart ,
Hb ,TC , DC , RBS , Urea , electrolytes
Saturday 8 April 202315
LAB REPORTS :
Saturday 8 April 202316
Hematology
Hb 9.7 g%
RBC 4.18 million cells/cumm
PLT 1.17 L/cumm
WBC 4300
DLC :N 65%
E 04%
B 31%
L 00%
M 00%
ElectrolytesNa 144 mmol/l (135-147)K 4.8 mmol/l (3.5-5.0)Cl 102 mmol/l (95-105)
HbA1C
10.6 (4.0-6.0)
RBS 73 mg/dl (70-150)Urea 20 mg/dl (0-40)
Urine analysisPus cells 2-4Epithelial cells
1-2IMP : microcytic hypo chromic anemia with thrombocytopenia
Saturday 8 April 202317
TREATMENTDRUGS DOSE ROUTE FREEQUEN
CYInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. Aspirin and clopidogrel
150 mg PO 0-1-0
Saturday 8 April 202318
DAY 2 BP : 140/90 mm Hg PULSE : 92 BPM CBG : 107 mmHg O/E : CVS / RS – NAD PA : soft and non tender ADV : treatment as per chart , LFT ,
CKMB , Troponin-I , ortho-opinion for knee osteoarthritis.
Ortho ADV : X ray for both knee standing
Saturday 8 April 202319
LFTAST 94 (0-40)ALT 41 (0-40)ALP 665 (37-147)Billirubin Total 2.60 mg/dl(0.1-
1.0)Direct 1.30 mg/dl(0-0.2)
BiochemistryRBS 216 mg/dlFBS 93 mg/dlPLT 98000 cells/cumm
Lipid profileHDL 35 mg/dl (30-70)LDL 43 mg/dl (60-130)VLDL 16 mg/dl (5-40)TG 82 mg/dl (10-190)
Cardiac enzymesCKMB 44 U/L (0-20)Troponin I
0.002 ng/ml (Less than 0.035 ng/ml)
Saturday 8 April 202320
IgM dengue : NS 1 Ag : negativeIgM anti dengue : not detected
Widal test : negative QBC-MP : negative
Saturday 8 April 202321
TREATMENTDRUGS DOSE ROUTE FREEQUEN
CYInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. Atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj.trineurosol .H 1 cc IV 1-0-0
Saturday 8 April 202322
DAY 3 BP : 140/90 mm Hg PULSE : 82 BPM O/E : CVS/RS – NAD ADV : 2-D ECHO , Carotid doppler,
Optho opinion
Saturday 8 April 202323
Ophthalmology opinion :IMP : no evidence of diabetic
nephropathy
Normal fundus
Saturday 8 April 202324
TREATMENTDRUGS DOSE ROUT
EFREEQUEN
CYInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0
Saturday 8 April 202325
DAY 4 BP : 140/80 mm Hg PULSE : 82 BPM RS/CVS : NAD
Saturday 8 April 202326
At 6:15 PM Not conscious , not responding to oral
commands from afternoon BP : 140/70 mmHg Pulse : 72 BPM SpO2 : 97% CVS : S1S2 + no murmurs RS : NVBS + CNS : responds to deep painful stimuli
Saturday 8 April 202327
Motor system : B/L plantar extension Reflex :
ADV : CT scan , ECG , shift to emergency ward , ABG , U/C , SE
Right LeftUpper limb Decreased Present Lower limb Absent Decreased
Saturday 8 April 202328
Prothrombin timeControl 13.5 secPatient 30.2 secRatio 2.22Index 44.7INR 2.223 (0.8-1.2)
electrolytesNa 138 mmol/lK 3.6 mmol/lCl 104 mmol/lCa 9.0 mmol/l (8.8-
10.8)P 3.6 mmol/l (2.5-5.0)Mg 1.7 mmol/l (1.7-2.7)
LFTAST 170 ALT 104ALP 560Billirubin – total
1.60
direct
1.14biochemistry
Urea 36 mg/dlS. Cr 1.0 mg/dl (0.8-1.4)
Total protein
7.0 g/dl(6-8)
Albumin 4.0 g/dl (3.4-5.0)A/G 1.3 (1.2-2.5) GFR :49.6 ml/min
Saturday 8 April 202329
ABG report pH 7.48 (7.34-7.44)
PCo2 24.4 (35-45 mmHg)
HCo3 18.1(22–26 mEq/L)
PO2 107.5 (75-100 mmHg)
BE -4.3 (−2 to +2 mmol/L)
TCo2 18.9(100-132mg/dl)
Saturday 8 April 202330
TREATMENTDRUGS DOSE ROUT
EFREEQUEN
CYInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0Tab. piracetam 400 mg PO Q8HR.T. feeds 200 ml Q3H
Saturday 8 April 202331
DAY 5 BP : 140/80 mm Hg PULSE : 108 BPM SpO2 : 98% CBG : 130 mg/dl O/E : Patient responds to simple oral
commands , eye movements + Afebrile , no pedal edema
Saturday 8 April 202332
CVS : S1S2 + , no murmur R/S : B/L NVBS + , no added sounds CNS : patient responds to verbal
commands B/L plantar withdrawal Pupil : reactive Moves all 4 limbs . Mild terminal neck
stiffness. Doll eye movement + Cough reflex +
Saturday 8 April 202333
ECG : heart rate 100 / minute Sinus rhythm + axis . T inversion V2V6 ADV : RT feeding 200 ml Q3H , perform CBG
Q8H , IVF NS@ 30 ml/Hr , weil Felix test Weil felix test : negative CST and neurologist opinion .NEURO OPINION : Pt stuporous , max response to painful stimuli ,
maximum movements of limbs Add SYNDOPA (LEVODOPA + carbidopa)
110 mg ½ ½ ½ CT head : not significant ADV : LP-CSF analysis , may require MRI
scan
Saturday 8 April 202334
Saturday 8 April 202335
TREATMENTDRUGS DOSE ROU
TEFREEQUENCY
Inj. Actrapid 6-6-6 units
SC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0Tab. piracetam 400 mg PO Q8HR.T. feeds 200 ml Q3HT.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202336
DAY 6 BP : 140/80 mm Hg PULSE : 100 BPM O/E : patient responds to oral commands
by opening eye SPO2 : 98% CVS : S1S2 + , no murmurs RS : B/L NVBS + CNS : patient stuporous , response to
painful stimuli , B/L plantar --
Saturday 8 April 202337
B/L : pupil 4 mm reactive , doll eye movement + , cough reflex +
ADV : Repeat PLT count , USG abdomen , CXR- PA view , MRI brain
USG abdomen : normal MRI report : old infarction , doesn't
explain clinical state
Saturday 8 April 202338
CXR - PA view showing NORMAL and CARDIAC HYPERTROPHY
Saturday 8 April 202339
TREATMENTDRUGS DOSE ROUT
EFREEQUEN
CYInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. Atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0Tab. Piracetam 400 mg PO Q8Htab. Doxycyclin 100 mg PO ½- ½ - ½ R.T. feeds 200 ml Q3HT.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202340
DAY 7 BP : 160/80 mm Hg PULSE : 102 BPM SPO2 : 98% O/E : patient responds to oral
commands with comprehensive sounds Spontaneous movements of all 4 limbs CVS : S1S2 + no murmurs
Saturday 8 April 202341
RS : B/L NVBS + no added sounds PA: soft and no organomegaly ECG : ST and T wave changes CNS : patient responds to deep pain
stimulation , spontaneous of all 4 limbs +
B/L plantar withdrawal , Cog-wheal rigidity : +
GCS : 8/15
Saturday 8 April 202342
1 2 3 4 5 6
EyesDoes not
open eyes
Opens eyes in
response to
painful stimuli
Opens eyes in
response to voice
Opens eyes
spontaneously
N/A N/A
VerbalMakes
no sounds
Incomprehensible sounds
Utters inapprop
riate words
Confused,
disoriented
Oriented, converses normally
N/A
MotorMakes
no moveme
nts
Extension to
painful stimuli
Abnormal flexion
to painful stimuli
Flexion / Withdra
wal to painful stimuli
Localizes painful stimuli
Obeys comman
ds
Glasgow Coma Scale
. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).
brain injury is classified as:•Severe, with GCS < 9•Moderate, GCS 9–12•Minor, GCS ≥ 13.
Saturday 8 April 202343
B/L : pupil 4 mm and reactive ADV : repeat platelet count, U/C ,
S/E , LP, CSF analysis . At 3:00 PM call attended for LP LP is done in L3 and L4 interspace
Clear and free flow of CSF , 24 drops each in 3 containers Post procedure : BP – 140/90 mmHg PULSE – 100 BPM SPO2 : 99% RS – B/L NVBS +
Saturday 8 April 202344
RBS 45 mg/dl (40-70)Protein 20 mg/dl (20-45)Chlorine 112 mg/dl (116-122 mg/dl)
CSF analysis report
0.1 ml clear fluid Cell count : 3 cells/cumm
Cell type : a few lymphocytesNon malignant cells in smear
CSF analysis reportGram stain No cells no organismZN stain No AFBIndia ink No cryptococcus
Saturday 8 April 202345
PLT 1.09 Lakhs/cumm
UREA 22 mg/dl
S.Cr 0.8 mg/dl
electrolytes
Na 128 mmols/L
K 3.6 mmols/L
Cl 103 mmols/L
Saturday 8 April 202346
TREATMENTDRUGS DOSE ROUTE FREEQUEN
CYInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0Tab. piracetam 400 mg PO Q8Htab. Doxycyclin 100 mg PO ½- ½ - ½ R.T. feeds 200 ml Q3HT.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202347
DAY 8 BP : 170/100 mm Hg PULSE : 98 BPM O/E : CVS : S1S2+ , no murmurs Input/output : 2000/4000 FCBG : 130 mg/dl Pre dinner : 138 mg/dl RS : B/L NVBS +
Saturday 8 April 202348
CNS : responds to deep pain stimuli B/L plantar – Cog-wheel rigidity : + B/L pupil : 4 mm and reactive ECG : T wave inversion in V2 and V4
(ischemic) ST flat in II and III , avf ,V3 and V6
Saturday 8 April 202349
TREATMENTDRUGS DOSE ROUTE FREEQUEN
CYInj. Actrapid 6-6-6 units SC 1-1-1Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0Tab. piracetam 400 mg PO Q8Htab. Doxycyclin 100 mg PO ½- ½ - ½ R.T. feeds 200 ml Q3HT.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202350
DAY 9 BP : 140/70 mmHg PULSE : 84 BPM SPO2 : 94% ECG : t wave inversion an V1 and V6 CVS : S1S2 + , no murmurs RS : B/L NVBS + , no added sounds CNS : conscious oriented , responds to
commands
Saturday 8 April 202351
POWER : 4/5 Cog-wheel rigidity : + GCS : 9/15 B/L pupil : 4 mm and reactive B/L plantar : flexion ADV : 2D-ECHO
Saturday 8 April 202352
ECHO report Mildly dilated cardiac chambers Mild apical-septal hypokinesia Decreased LV systolic dysfunction EF : 36% LV diastolic dysfunction Sclerotic aortic valves with no significant
stenosis ( age related)
Saturday 8 April 202353
Saturday 8 April 202354
TREATMENTDRUGS DOSE ROUT
EFREEQUENCY
Inj. Actrapid 6-6-6 units
SC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Inj. Trineurosol.H 1 cc IV 1-0-0Tab. piracetam 400 mg PO Q8Htab. Doxycyclin 100 mg PO ½- ½ - ½ T.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202355
DAY 10 BP: 120/80 , 140/70 mmHg PULSE : 90 BPM FCBG : 91 mg/dl Pre lunch : 169 mg/dl Pre dinner : 140 mg/dl O/E : patient is feeling better , conscious
, responds well to commands can be shifted to ward
Saturday 8 April 202356
RS : B/L NVBS + CNS : conscious oriented Power : 4/5 , all 4 limbs B/L plantar – B/L pupil Normal and non reactive ECG : HR – 100/ mt ST INVERSION with T wave
inversion an V2 an V6 ADV : shift to ward and CST
Saturday 8 April 202357
TREATMENTDRUGS DOSE ROUT
EFREEQUENC
YInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. Atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel 150 mg PO 0-1-0Inj. Trineurosol.H 1 cc IV 1-0-0Tab. Piracetam 400 mg PO Q8HTab . Doxycyclin 100 mg PO ½- ½ - ½ Ranolazine 500 mg PO 1-0-1T.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202358
DAY 11 BP : 130/70 mmHg PULSE : 88 BPM O/E CVS / RS – NAD CNS : conscious oriented , POWER : 4/5 FCBG : 102 mg/dl Pre dinner : 189 mg/dl Bed sore : + ADV : wound care and CST
Saturday 8 April 202359
TREATMENTDRUGS DOSE ROUTE FREEQUENCY
Inj. Actrapid 6-6-6 units SC 1-1-1Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Tab. piracetam 400 mg PO Q8HTab. Ramipril 2.5 mg PO 1-0-0Cap. Cobadex PO 0-1-0ranolazine 500 mg PO 1-0-1
T.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202360
DAY 12 BP : 120/80 mmHg PULSE : 84 BPM CVS/RS : NAD PA : soft CNS : conscious oriented ADV : neurology opinion , CST , remove
IV line
Saturday 8 April 202361
TREATMENTDRUGS DOSE ROUTE FREEQUENC
YInj. Actrapid 6-6-6
unitsSC 1-1-1
Tab. atorvastatin 40 mg PO 0-0-1Tab. aspirin and clopidogrel
150 mg PO 0-1-0
Tab. piracetam 400 mg PO Q8HTab. Ramipril 2.5 mg PO 1-0-0Cap. Cobadex PO 0-1-0ranolazine 500 mg PO 1-0-1T.syndopa 110 mg PO ½ ½ ½
Saturday 8 April 202362
DAY 13 BP : 120/70 mmHg PULSE : 88 BPM O/E : patient conscious oriented Bed sore + CVS : S1S2 heard RS : NVBS + FCBG : 103 mg/dl Pre dinner : 91 mg/dl ADV : CST
Saturday 8 April 202363
DAY 14 BP : 130/70 mmHg PULSE : 80 BPM Seen by neurologist O/E : responds to commands , rigidity of limbs
+ , no tremors , mask like face + Imp : early parkinsonism ADV : tab rasagiline 0.5 mg 0-1-0 Tab. Pramipexole 0.25 mg 1-0-1 Physiotherapy and CST Patient discharged against medical advice
Saturday 8 April 202364
Drugs D R F 1 2 3 4 5 6 7 8 9 10
11
12
13
14
Inj. Actrapid
6-6-6 units
SC 1-1-1 + + + + + + + + + + +
T. Atorvastatin
40 mg
PO 0-0-1 + + + + + + + + + + + + + +
T. aspirin and clopidogrel
150 mg
PO 0-1-0 + + + + + + + + + + + + + +
Inj. Trineurosol.H
1 cc IV 1-0-0 + + + + + + + + +
T. Piracetam
400 mg
PO Q8H + + + + + + + + + + +
T. syndopa 110 mg
PO ½ ½ ½
+ + + + + + + + + +
R.T. feeds 200 ml
Q3H + + + + + + + + + + + +
Treatment chart
Saturday 8 April 202365
Drugs D R F 1 2 3 4 5 6 7 8 9 10
11
12
13
14
Tab. doxycycllin
100 mg Po ½ -½ - ½
+ + + + +
T. Ramipril 2.5 mg Po 1-0-0 + + + + +
Cap. Ranolazine
500 mg Po 1-0-1 + + + + +
Cap. Cobadex
forte
Po 0-1-0 + + + +
H. mixtard 12-0-16units
SC + +
T. rasagiline
0.5 mg Po 0-1-0 +
Tab. pramiprax
ole
0.25 mg
po 1-0-1 +
Saturday 8 April 202366
PHARMACEUTICAL CARE PLAN (SOAP)
Saturday 8 April 202367
SUBJECTIVE EVIDENCEDiabetes Parkinson's disease
•Generalized weakness •Inability to move around•Reduced power•Stupor present•Mask like face
Saturday 8 April 202368
OBJECTIVE EVIDENCE Hypertension Diabetes Parkinson's
disease• Elevated blood
pressure• Elevated blood
glucose levels• Cog wheal
rigidity
Heart failure
•2-D ECHO report ( EF 36% )•Elevated AST•Elevated CKMB•ECG changes ( ST segment and T wave inversion)
Saturday 8 April 202369
FINAL DIAGNOSIS Based on objective and subjective
evidence the patient was diagnosed as early Parkinson's disease with left ventricular failure and type 2 Diabetes mellitus and hypertension
Saturday 8 April 202370
GOALS OF TREATMENT
Saturday 8 April 202371
For DIABETES to keep patients free of symptoms
associated with hyperglycemia or hypoglycemia (hunger, anxiety, palpitations, sweatiness).
primary goals of DM management are to reduce the risk for microvascular and macrovascular complications
to reduce mortality, and to improve quality of life
Saturday 8 April 202372
Index Goal
HB.A1C <7.0Preprandial capillary plasma glucose
5.0–7.2 mmol/L (90–130 mg/dL)
Peak postprandial capillary plasma glucose
<10.0 mmol/L (<180 mg/dL)
Blood pressure <130/80
Low-density lipoprotein <2.6 mmol/L (<100 mg/dL)High-density lipoprotein >1.1 mmol/L (>40 mg/dL)Triglycerides <1.7 mmol/L (<150 mg/dL)
Treatment Goals for Adults with Diabetes
Saturday 8 April 202373
For HYPERTENSION Treat systolic blood pressure to
recommended goal as primary focus (especially in patients older than 50 years).
Individualize all therapies based on compelling indications and comorbid conditions.
Ultimate treatment goal is the reduction of cardiovascular and renal morbidity and mortality
Saturday 8 April 202374
For CHF Minimize or prevent acute CHF
exacerbations Slow progression of CHF Increase survival
Saturday 8 April 202375
For PARKINSONS DISEASE Improve motor function Maintain ability to complete daily
activities independently Improve non-motor symptoms Maintain quality of life
Saturday 8 April 202376
TREATMENT OPTIONSFor cardiac complications
For diabetes For Parkinson's disease
ACE inhibitors •Ramipril
Anti anginals •Ranolazine
Anti hyper lipidemic•Atorvastatin
Anti platelets•aspirin and clopidogrel
Insulin •Human actrapid
•Human mixtard
Dopamine analogue•Levdopa
MAO inhibitors•rasagiline
Adjuvent treatments•Piracetam
•Vitamin supplements
Saturday 8 April 202377
GOALS ACHIEVED Signs and symptoms were improved BP was controlled and brought WNL Blood glucose was controlled and
brought WNL Patient gained consciousness
Saturday 8 April 202378
PROBLEMS IDENTIFIED Use of aspirin + clopidogrel in
patient with thrombocytopenia Use of doxycyclin even when weil
felix test was –ve PT/INR and cardiac enzymes were
not repeated
Saturday 8 April 202379
MONITORING PARAMETERS Disease related1. Blood pressure2. Blood glucose3. HbA1C4. ECG5. Cardiac enzymes6. Electrolytes 7. Motor symptoms
Saturday 8 April 202380
Drug related For insulin :Monitor hypoglycemic symptomsMonitor for lipid-dystrophy• For ramipril :Monitor serum potassium levelsMonitor blood pressure• For Levodopa :Monitor for motor symptoms and rigidity• For Aspirin and clopidogrel :Monitor blood platelet count • For Atorvastatin :Monitor plasma lipid levels
Saturday 8 April 202381
PATIENT COUNSELLING
Saturday 8 April 202382
About the disease(hypertension)
Saturday 8 April 202383
About the disease(Diabetes)
Signs and symptoms complications
Saturday 8 April 202384
About the disease(heart failure)
Saturday 8 April 202385
About the disease (PD)
Saturday 8 April 202386
About medication
Name and purpose
Dose and frequency
Medication adherence
Possible adverse effects
Missed dose
Saturday 8 April 202387
Saturday 8 April 202388
About life style modification
Healthy life style with daily exercise
(the ADA recommends 150 min/week (distributed over at least 3 days) of aerobic physical activity)
Self-Monitoring of Blood Glucose
Nutritional recommendations
Saturday 8 April 202389
DASH diet
Saturday 8 April 202390
Fat 20–35% of total caloric intakeSaturated fat < 7% of total calories<200 mg/day of dietary cholesterolTwo or more servings of fish/week provide -3 polyunsaturated fatty acids
Carbohydrate 45–65% of total caloric intake (low-carbohydrate diets are not recommended)Sucrose-containing foods may be consumed with adjustments in insulin dose
Protein 10–35% of total caloric intake (high-protein diets are not recommended)
Other components
Fiber-containing foods may reduce postprandial glucose excursions
Nonnutrient sweeteners
Saturday 8 April 2023
91
THANK YOU