p m Seminar

8/13/2019 p m Seminar

1/48


2/48

diabetes


3/48

investigations


4/48

Criteria for diagnosis of

diabetes mellitus

FPG 126 mg/dl (7.0 mmol/l).OR

Symptoms of hyperglycemia and acasual plasma glucose 200 mg/dl (11.1

mmol/l).OR

2-h plasma glucose 200 mg/dl (11.1

mmol/l) during an OGTT.


5/48


6/48

Laboratory methods


7/48

lucose determination in blood and urineThe simplest measurement of carbohydrate homeostasisis glucose determination.Chemical methodsorthotoluidine,neocuproine,ferricyanide

Enzymatic methods:hexokinase-G6PDH,glucose dehydrogenase, glucoseoxidase-peroxidase (ABTS)glucose oxidase (GOD) withother indicator reactions.Qualitative/Semiquantitive

paper test strips: Clinistix, Glucostix,Glucometer(Glucometer Elite XL, Accu-Chek) and newernoninvasive devices(infrared imager, ultrasound imageretc) for self monitoring


8/48glucometer


9/48

Oral glucose tolerance test (OGTT)The OGTT is a provocation test toexamine the efficiency of the body to

metabolise glucose.More sensitive forthe diagnosis of diabetes than fastingplasma glucose.


10/48

Glycated proteins :All proteins with reactive sites

can be glycated and the concentration of theglycated proteins that can be measured in blood isa marker for the fluctuation of blood glucoseconcentrations during a certain period. Opinion

about diagnostic efficacy is divided.HbA1c is ofmost interest serving as a retrospective indicator ofthe average glucose concentration over theprevious 8 to 10 weeks.Procedures employed are

column chromatography(micro and macro),HPLC, FPLC, isoelectricfocussing, monoclonalantibodies etc.Reference level:HbA1c 4.4 6.4%


11/48

Urine albumin excretion : The early signs of diabetic

nephropathy cannot be detected by the routinescreening tests for proteinuria, so that more sensitivemethods for detecting abnormal albumin excretionmust be used. The early stage of albuminuria is

clinically defined as an albumin excretion rate of 30-300 mg/24 hours.The following procedure is suggestedfor the routine analysis of albuminuria in diabetes.Begin: Type 1 diabetes after 5 years of the disease

Type 2 diabetes with diagnosis of the diseaseCommonly employed screening tests are spot urinaryalbumin:creatinine ratio or spot urine albuminconcentration.RIA or immunoturbidometric assays or

nephelometric assays are also used.


12/48

URINE KETONE AND BLOOD KETONE: TOOLFOR DIAGNOSIS OF DIABETIC KETOACIDOSIS.Urine total ketones should be measured bychemical( nitroprusside, etc) or enzymatic(reagent tabs) or electrochemical methods.Expiredair acetone testing can also be done.-

hydroxybutyrate assays are more sensitive


13/48

C-PEPTIDE: A NEW TEST IN DIABETICMEDICINE: C -peptide is a simple, cost-effectiveand non-invasive method in the assessment of

beta-cell capacity.It is mentioned useful in follow-up of the diabetic complication.It is noted for thegood diagnostic property for diabetic neuropathy,one of the most common complications of DM.


14/48

INSULIN TEST A DIRECT MEASUREMENTOF HORMONEThe measurement of insulin by RIA can bedone but it is not practically used in routinediabetic clinic. Glucose clamp technique(the hyperinsulinemic-euglycemic clamp in

assessing in vivo insulin sensitivity and thehyperglycemic clamp in assessing insulinsecretion) is also performed to measureinsulin secretion and sensitivity.


15/48

Other tests.

Routine blood count and coagulation

screen .Arterial blood gases-in any

emergency like diabetic ketoacidosis.Serum electrolytes and urea-creatinine.

Lipid profile,Liver function tests,Chest X-

ray ECG,Infection screen(depending on

clinical correlates)


16/48

FOUR PILLARS OF MANAGEMENT ARE..

1.DIET2.DRUGS3.PATIENT EDUCATION

and


17/48

4.EXERCISE


18/48

In type 1 DM patients the total

energy input has to be

relatively higher in order to

regain ideal weight and growth.


19/48

In type 2 DM patients caloriesneed to be restricted in order

to avoid obesity


20/48

Goals of medical nutrition therapy

To maintain near normal glycemia.

To maintain optimal lipid profile. To maintain normal blood pressure.

To restore and maintain ideal bodyweight.


21/48

The following points have to be consideredwhileprescribing a diet for diabetic :

The type of diabetes type1 or type2

The weight of the individual in comparison

with his ideal body weight (BMI)

His occupation and activities and to assess

his caloric requirements.

The presence of any complications.


22/48

TOTAL CALORIC INTAKE

This is the most important step while prescribing adiet.

The body mass index (BMI) will help to determine

total caloric requirement.

BMI = Weight (in kg)/ height in m`2

It is desirable to keep BMI between 22 & 25.


23/48

Ideal body weight can be calculated by the

formula :

IDEAL BODY WEIGHT= Height(cm)-100


24/48

Endocrine / physiological responses during

exercise :

Suppression of insulin release- directly as well asthrough epinephrine.

Sympathetic system activation- which inhibits

insulin release and stimulates lipolysis. Non-insulin dependant glucose uptake in the

periphery.


25/48

Benefits of exercise

It improves insulin sensitivity

Decreases triglyceride, increases HDLcholesterol and decreases LDL cholesterol

It lowers blood glucose concentration It lowers BP in mild to moderate hypertension

It helps in cardiovascular conditioning


26/48

Risks of unsupervised exercise in

uncontrolled diabetic :

Hypoglycemia

Hyperglycemia after very strenous exercise

Precipitation of cardiovascular disease

Worsening of long term diabetic complications


27/48

For the average middle aged indian diabetic thefollowing exercise regimen is adequate

walk 3kmon level ground over a period of 45 mts

Swim for 30 mtsat average speed withoutcardiovascular distress

Cycle on level ground at 8km/hr for30mts

Regular sports and game activities

Yoga exercises


28/48

MANAGEMENT OF HYPOGLYCEMIA

Management consist of emergency measures tocorrect the blood glucose level.

If the patient can swallow, 50g of glucosedissolved

in 200ml watershould be given orally.symptomsstart improving within 5-7 mts and the patientbecomes normal within 20-40 mts.

If glucose is not at hand sweet articles and cereal

foods can be given.


29/48

If the patient is unconscious, parenteral glucoseshould be administered. About 15-20g ofglucose isusually needed. This is best administered by IV

infusion of 200-250mlof 100% dextrose, which issafe and effective.


30/48

THER PEUTICS


31/48

The homeopathy drug treatment used indiabetes can be classified in to six groupsnamely

acids,metals,other minerals,

vegetables,

drugs from animals,and organotherapic remedies.


32/48

The acids used for treatment of diabetes

are acetic acid, lactic acid, phosphoricacid, nitric acid, picric acid, carbolicacid, and flouric acid. Acids are oftenused in patients with debility or

persistent weakness.Acid can preventacidosis one of the greatest danger ofdiabetic mellitus


33/48

Metals Aurum met, Argentum met,Argentum nitricum, Uranium nitricum,Vanadium, Plumbum met, Cup ars areused as a homeopathic treatment for

diabetes.


34/48

Other minerals (such as Ars alb, Sulphur, Silicea,Iodum, Natrum sulph), vegetables (such asCephalandra indica, Chimaphilla, Chionanthus,

China, Curara, Nux vom, Helleborus niger), andproducts from Animal kingdom (such asMoschus, Crotalus horridus, Lachesis, Tarentula,Lac defloratum) are prescribed based on the

individual characteristics and symptoms of thepatients.


35/48

Insulin an organo therapic remedy is prescribedin critical cases of diabetes, in lean and thinconsumptive patients and also in coma.

Pancreatin, adrenalin, urea, lecithin are the otherorgano therapic remedies. Biochemic remediesfor diabetes mellitus are Nat mur, Nat sulph, Kaliphos, Kali mur and Kali sulph.


36/48

The metals are usedfor treatment of patientswith hypertension, diabetic nephropathy,arteriosclerosis, mentally and physically exhausted and

various other symptoms. The minerals, vegetables and

animal products are used to manage symptoms such asweakness and prostration, gangrene, diabetescomplicated with digestive troubles, impotence, oculartroubles and other complications of diabetes. Thehomeopathic remedy prescribed to a patient depends onhis/her symptoms and characteristics. Hence two

patients may have diabetes but their prescriptions maybe completely different.
http://www.onlymyhealth.com/high-blood-pressure-hypertension-1295953342.htmlhttp://www.onlymyhealth.com/diabetic-nephropathy-1295951463.htmlhttp://www.onlymyhealth.com/high-blood-pressure-hypertension-1295953342.htmlhttp://www.onlymyhealth.com/diabetic-nephropathy-1295951463.htmlhttp://www.onlymyhealth.com/diabetic-nephropathy-1295951463.htmlhttp://www.onlymyhealth.com/high-blood-pressure-hypertension-1295953342.html


37/48

Homeopathic treatment with drugs can improvethe general well being of the person withdiabetes. In patients with poor general health it

can be very difficult to achieve good control ofdiabetes. Improvement of general healthimproves the general sense of well-being,decreases the dose and number of drugs neededto control blood glucose and improves bloodglucose control. Remedies such as Syzygium,Uranium nitricum, Phloridzin (obtained from theroot of the apple and other fruit trees) are given toimprove the general health of the patient.


38/48

PHOSPHORUS

Adapted to tall slender persons of sanguinetemperament.

Nervous, weak, desire to be magnetised. Over sensitiveness of all senses.

A weak, empty, all gone sensation in head, chestand entire abdomen.

Constipation: feces slender, long, dry, tough andhard. Voided with great difficulty.

It is useful in diabetes and pancreatic ds especiallyin those of a tuberculous or gouty diathesis.


39/48

URANIUM NITRATE

It has polyuria, polydypsia, dryness ofmouth and skin.

It causes sugar in the urine.

It lessens sugar and quantity of urine.

Enormous appetite and thirst.


40/48

BRYONIA

Adapted to persons of rheumatic or goutydiathesis.

Excessive dryness of mucous membrane of

entire body, lips and tongue dry, parched,cracked.

Great thirst.

Constipation: inactive, no inclination, stoollarge, hard, dark, dry, as if burnt.

Persistent bitter taste. The patient is languid, morose and dispirited.


41/48

PHOSPHORIC ACID

The urine is increased, perhaps milky in colourand containing much sugar.

There will be loss of appetite.

Unquenchable thirst Patient passes large qty of pale colorless urine.

phosphatic deposit in urine


42/48

INSULIN

It maintains the blood sugar at normal leveland the urine remains free of sugar.


43/48

LACTIC ACID

Urinates copiously and freely.

Urine light yellow and saccharine.

Thirst, nausea, debility, voracious appetite andcostive bowels

Dry skin, dry tongue,gastralgia.


44/48

SYZYGIUM JAMBOLANUM

Capable of diminishing the amount of sugarin urine.

Used as palliative.


45/48

CAUSTICUM

SCILLA

STROPHANTHUS

may be of use in diabetes insipidus.


46/48

NATRUM SULPHcorresponds to the hydrogenoidconstituition, with dry mouth and throat.

LYCOPODIUMpatients are emaciated,weary,increased appetite and great thirst. Pale profuseurine.

ACETIC ACIDit has passing of large quantities ofpale urine, intense thirst,hot,dry and markeddebility.


47/48

PODOPHYLLUMhas a bitter taste, but the tongueis flabby. It may be of use in the ds.

CHIONANTHUSthirst and copious urine.

Constipation with light colored stools devoid ofbile.

NAT SULPHpolyuria, intense itching of skin ofthighs.

ARGENTUM METurine is profuse, turbid andsweet odor. Micturition frequent and copious.


48/48

Documents

p m Seminar