Transcript 127 Killers of Century DM-HTN&CAD

The common Crippler & Killer of the Century
Weapon Used ,Complications & Regulation
Presented By
Dr. Richard Nabhan
M.B. Ch. B, D.T.M. & H., M.R.C.P (UK),FRCP(Lond)
Senior Consultant Physician & Cardiologist, & Diabetologist
Q. What Accelerates the Narrowing of
the Lumen ?
Atherosclerosis
A. Diabetes.
(Hardening of the arteries)
B. Hypertension
C. Smoking
D. High Lipids
E. Family History
-Cholesterol
-LDL
-Triglycerides
-HDL
F. Obesity
G. Inactivity
Need to change
the lifestyle
H. Stress
Thickening of the wall at the expense of
the lumen
Q. What happens if the lumen narrows ?
Ischemic Pain.
Q. What happens if this narrowed
lumen ultimately closes ?
Death of the tissue supplied.
Effects of Occlusion of a Vital Artery on a Vital Organ
Brain Infarction
Heart-attack (Myocardial infarction) Stroke (Hemiplegia)
Occlusion of a Peripheral Artery of the Lower Limbs
G
A
N
G
R
E
N
E
MicroVascular Complications
M
I
C
R
O
Diabetic Retinopathy
M
A
C
R
O
Diabetic Nephropathy
Diabetic Neuropathy
Attacks more than 66% of Diabetics
7th Nerve Palsy
Foot Drop
3rd Nerve Palsy
Neuropathic Foot Ulcer
Care of the Foot in Diabetes
Diabetic Retinopathy
Diabetic Cataract
A cataract causes light to scatter at the level of the lens causing blurry image.
Successful removal of the cataract allows the image to be seen clearly.
Q. What happens if the Pancreas goes on strike ???
No Insulin
ON STRIKE
AT ALL
Type
I
Type
Diabetes
Door Totally Closed
Little Insulin ±
Insulin
resistance
AGE
II Diabetes
Door Partially Closed
SYMPTOMS
TREATMENT:
1. Diet
2. Glucose control
Short-term Complications
- Hyperglycemia
- Hypoglycemia
3. Exercise
4. Medications
Ketones: Ketonuria indicates no more insulin in the pancreas
Hb A1c: A marker of average glucose levels during the preceding 6-8 weeks
Microalbunminuria: A n early marker of diabetic nephropathy
Criteria for the Diagnosis of Diabetes Mellitus!!!
≥126 mg/dL
 Fasting blood sugar level
OR
 Symptoms (polyuria, polydipsia, weight loss with
good appetite) plus random blood sugar level
≥ 200 mg/dL
OR
≥ 200 mg/dL
 GTT 2-hour blood sugar level
during a 75-g oral glucose tolerance test.
Our Goals for Glycemic Control
Biochemical Index
Normal Range
Goal
Action Suggested
Fasting/preprandial blood
sugar level (mg/dL)
<110
80-120
<80 or >140
Bedtime blood sugar level
(mg/dL)
<120
100-140
<100 or >160
Hemoglobin A1c (%)
4 - <6
<7
>8
Glycated Hemoglobin(HBA1C)
It’s an excellent Monitor of the
behavior of Blood Glucose over
the last three Months(age of the
RBC).
As the Hemoglobin in the RBCs
moves in the Blood , it picks a
Glucose coating
Quiz
2 Diabetic Patients have the same HBA1C
of 7% .
Patient No.1 did not develop any target
organ damage,
Patient No.2 developed accelerated
Retinopathy .
WHY???????????
The common Crippler & Killer of the Century
Weapon Used ,Complications & Regulation
Presented By
Dr. Richard Nabhan
M.B. Ch. B, D.T.M. & H., M.R.C.P (UK),FRCP(Lond)
Senior Consultant Physician & Cardiologist, & Diabetologist
ANSWER
Patient No. 1 has
Minimal Glucose
fluctuation specially
Postprandial, thus is
exempted from
microvascular
complications
HBA1C=7%
Patient No. 2 has high
fluctuation of the daily
Glucose Monitoring, thus
HBA1C=7%
Postprandial
hyperglycemia triggers
early microvascular
complications
Benefits of daily Glucose
Monitoring
1.Regulator
2. Educator
3. Instructor
4. Psychological stimulator
THANK YOU
FOR
YOUR PATIENCE