Presented by: Dr. Emad HamedPracticing Physician, Naga- Hammady

Standardization

in

Diabetes

Standardization in Diabetes

In Prevention.In Screening for early detection.In Diagnosis.In Management

In Routine Investigations In Management Protocols Life Style Modification

Diet Physical Activity

Medications Oral Hypoglycemic Drugs Insulin

Standardization in Diagnosis

Plasma level / Blood level (Laboratory / Glucometers)

The difference is that plasma numbers read about 10 - 12% higher than the older

whole blood numbers. So if your fasting and pre-meal blood glucose target is 90

- 130 mg/dl plasma glucose, it would be 80 - 120 mg/dl if your meter reads

whole blood.(Joslin Diabetes Center)

Blood Pressure Measurement.

Waist Circumference Measurement.

Standardization in DiagnosisBlood Pressure Measurement

A waist measurement of greater than 94cm for men or 80cm for women is an indicator of internal fat deposits, which can coat the heart, kidneys, liver and pancreas, and increase the risk of chronic disease.

Waist circumference should only be used for adults to check the risk of developing a chronic disease. Measurements that indicate increased risks for children and teenagers have not been developed.

Why is waist measurement important?

Standardization in DiagnosisWaist Circumference Measurement

Measuring Waist Circumference

The tape measure should be placed directly on your skin, or on

no more than one layer of light clothing.

The correct place to measure your waist is horizontally halfway

between your lowest rib and the top of your hipbone. This is

roughly in line with your belly button.

Breathe out normally and take the measure.

Make sure the tape is snug, without squeezing the skin.

Standardization in DiagnosisWaist Circumference Measurement

Mode of Action & Dose of Oral Anti-Diabetic Drugs

( Accordinf to the British National Formulary BNF March 2010)

Active Principle Mode of Action Dose Details

MetforminDecreasing gluconeogenesis & increasing peripheral

utilization of glucose. Only if there is residual pancreatic function

Adult and Child over 10 years 500 mg with breakfast > one week > 500 mg with breakfast & dinner > one week > 500 mg with 3 meals

Glibenclamide

Augmentig Insulin secreation. During long term adminestration they have extrapanceatic action

Initially 5 rng daily with or immediately after break fast, dose adjusted according to response ; max. 15 mg daily

Gliclazide(MR)Initially 30 mg daily with breakfast, adjusted according to response every 4 weeks ;

max. 120 mg daily

GlipizideInitially 2.5—5 mg daily shortly before breakfast or lunch, adjusted according to

response; max. 20 mg daily.Up to 15 mg (Sigle dose), higher doses divided.

GlimerprideInitially 1 mg daily, adjusted according to response at 1-2 week intervals; max. 4 mg

daily taken shortly before or with first main meal

RepaglinideStimulate insulin release. Both drugs have a rapid onset of

action and short duration of activity

> 18 years, initially 500 micrograms within 30 minutes before main meals ; up to 4 mg may be given as a single dose, max. 16 mg daily

Natiglinide> 18 years, initially 60 mg 3 times daily within 30 minutes before main meals, up to

max. 180 mg 3 times daily

AcarboseInhibits intestinal glucosidase , delays the digestion &

absorption of starch & sucrose

> 18 years, initially 50 mg daily increased to 50 mg 3 times daily, max. 200 mg 3 times daily Tablets should be chewed with first mouthful of food or swallowed whole

with a little liquid immediately before food

PioglitazoneReduce peripheral insulin resistance, leading to a reduction

of blood-glucose concentration> 18 years, initially 15-30 mg once daily increased to 45 mg once daily according to

response

Vildagliptin Inhibits dipeptidylpeptidase-4 so increases insulin secreation and lowers glucagon secretion

>18 years, in combination with metformin or pioglitazone, 50 mg twice/D in combination with a sulfonylurea, 50 mg daily in the morning

Sitagliptin > 18 years, 100 mg once daily

Standardization in ManagementOral Hypoglycemic Drugs

Transporting Insulin.

Cooling Insulin.

Injecting Insulin.

100 U/ml / 40 U/ml.

Sites of Injection.

Technique (Flash Movies) If insulin leaks from the pen or from your skin after you remove the needle from

the injection site, you may not be leaving the needle under the skin long enough.

It is a good practice to count slowly to 10 before withdrawing the needle.

Standardization in ManagementInsulin

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