Counseling Of Diabetic Patient 2

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Counseling Of Diabetic Patient:

Counseling Of Diabetic Patient

Diabetes Mellitus:

Diabetes Mellitus Hyperglycemia DM is a group of metabolic disorders characterized by hyperglycemia & results in chronic complication

Needs For Counseling:

Needs For Counseling Diabetes Mellitus Chronic Disease Complications Counseling Improve quality of life

Pharmacist’s Role in diabetes management:

Pharmacist’s Role in diabetes management Educate the patients about: Proper use of medication Screening for drug interaction Explain monitoring device Counsel patients regarding insulin administration regularly “Glycemic Control”

Types of DM::

Types of DM: Type I Type II Characters Absolute insulin deficiency Relative insulin deficiency IDDM NIDDM Young or ≤ 30 ≥ 30 (Associated with obesity) Treated with Insulin Treated with OHA or Insulin Gestational Diabetes Mellitus

Symptoms Of Diabetic Patient:

Symptoms Of Diabetic Patient

Diagnosis::

Diagnosis: 1. Blood Glucose test Normal Diabetic Fasting ≤ 100 Fasting ≥ 125 Postprandial ≤ 140 Postprandial ≥ 200 2. Hb 1 AC

Counseling regarding lifestyle modification (non-pharmacological therapy):

Counseling regarding lifestyle modification (non-pharmacological therapy)

Counseling regarding lifestyle modification (non-pharmacological therapy):

Counseling regarding lifestyle modification (non-pharmacological therapy) Diet Carbohydrate (regulate sugar intake) Fats (restricted saturated fats & substitute them with unsaturated fats) Fibers (bulky & delay digestion and absorption)

Counseling regarding lifestyle modification (non-pharmacological therapy):

Counseling regarding lifestyle modification (non-pharmacological therapy) Exercise Type II (desired level is 3-4 times a week) Type I (Care must be taken to have adequate metabolic control) Exercise is not recommended if patient has poorly controlled blood glucose level

Counseling regarding lifestyle modification (non-pharmacological therapy):

Counseling regarding lifestyle modification (non-pharmacological therapy) Smoking People with diabetes, especial years, who smoke & have blood pressure, are at higher risk for cardiovascular problems Smoking can lead to serious complications like infections , ulcers , gangrene & even amputation

Counseling regarding lifestyle modification (Pharmacological therapy):

Counseling regarding lifestyle modification (Pharmacological therapy) 1. Oral hypoglycemic agents 2. Insulin

Oral hypoglycemic agents:

Oral hypoglycemic agents Insulin secretogogues Insulin sensitizers α - glucosidase inhibitors Dpp-4 inhibitors

1-Insulin Secretogogues:

1-Insulin Secretogogues A- Sulphonylurea : Glibenclamide Glimepiride Non Sulphonylurea : Nateglinide (Starlix) Repaglinide(NovoNorm)

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Mechanism : Increase Insulin Secretion Increase β Cell Sensitivity Drug Interactions : Allopurinol Salicylates Increase Hypoglycemic action Sulfonamides Chloramphenicol

Proper Dose Timing ::

Proper Dose Timing : Best Taken 30-45 min. B4 Meals & Can Be Taken With Meals If GIT Distress Nate & Repa glinides Must Be Taken 15-30 min B4 Meals. Possible ADV. Effects: Hypoglycemia. G.I.T Disturbance. Headache & Skin rash N.B : Insulin SecretagoguesNeeds Functioning β Cells.

Insulin Sensitizers ::

Insulin Sensitizers : A) Biguanides : Metformin Increase Hepatic Sensitivity To Insulin B) Thiazoldindiones : Pio & Rosiglitazone Increase no. Or sensitivity Of Insulin Receptors In Muscles & Adipose Tissue . Both Are Anti Hyperglycemics Not Hypoglycemics

Proper Dose Timing ::

Proper Dose Timing : Taken With Meals To Minimize G.I.T Upset Possible ADV. Effects: Metformin : G.I.T Disturbance. Small Wt. Loss. Contra Indications : Renal & /Or Hepatic Or Cardiac Disease As They Increases The Risk Of Lactic Acidosis. Long Term Use Interfers With Vit. B12 Absorption.

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metformin Drug Interactions : Furosemide & Nifedipine Increase Its Action TZA : Edema & Wt. Gain Headache & Fatigue Contra Indications : Hepatic Disease. Warning For Severe Heart Failure. Drug Interactions : It Decreases Action Of Oral Contraceptives

α Glucosidase Inhibitor ::

α Glucosidase Inhibitor : E.g : Acarbose “Glucobay” It Is Useful In Patients With Significant Post Prandial Hyperglyvemia Mechanism : It Inhibits Intestinal Alpha Glucosidase enzyme to delay CHO Absorption So There Is Small Slow Rise In Blood Glucose Following A Meal. Proper Dose Timing : Taken With The 1 st bite of a meal

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Ineffective If Taken More Than 30-45 min After Eating . Possible Adverse Effects : - GIT Upset - Contra Indicated In Liver cirrhosis & Bowel Disorder. Drug Interactions : Decreases Metformin Bioavailability Not indicated in pregnancy or breastfeeding.

DPP – 4 Inhibitors(sitagliptin) :

DPP – 4 Inhibitors(sitagliptin) Enhanecement & Prolongation Of GLP -1 & GLP -2 (Incertin Hormones) Uses : DM2 (Most Useful In Early Stage due to adequate level of incertin hormone) But Contra Indicated In DM 1 N.B : Incertin Hormone >>>> Digestion & Absorption Of Nutrients Including Glucose .

Proper Dose Timing ::

Proper Dose Timing : 100 mg/day >>>> Normal. 50 mg/ day >>>>> Moderate Renal Disease. 25 mg / day >>>>> Severe Renal Disease . Possible Adverse Effects : Upper respiratory Tract Infections. Nasopharyngitis. Headache.

Insulin Therapy:

Insulin Therapy Types : Rapid ex:lispro,glulisine. Short ex:regular insulin Intermediate ex:detemir. Long ex:glargine

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Mechanism Of Action: Increase Glucose Uptake. Increase Glycogenesis. Decrease Glycogenolysis. Decrease Lipolysis & Ketogenesis Uses : D.M 1 (ALL Patients) D.M 2 (Poorly Controlled )

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Dosage : DM1 (0.5 U /Kg /day) 3 times /day *pre breakfast * pre supper * Bed time 4times/day * Pre meals(3 Injections ). * Bed Time.

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DM2 (0.15-0.4 U /Kg /day): Once Daily ( Long Or Premixed Insulin) Or Twice Daily ( pre Breakfast 2/3 & Pre Supper 1/3 >>>Pre Mixed) Alteration Ins. Requirements : Increase : Decrease : Weight Gain Weight Loss Inactivity Excersise Infection Renal Failure

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Hypoglycemia Symptoms: Tachycardia Confusion Vertigo Diaphoresis Causes : Excess Insulin Or Hypoglycemics. Delayed Or Insufficient Food Intake. More Excersie Than Usual. Result Of Drug Interaction.

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Treatment : Concious Patients : Glucose : Either Gel , Tab. Or Fruit Juice. Unconcious Patients : - I.V Glucose - Glucagon Injection

Long term complications:

Long term complications 1 . Macrovascular Atherosclerosis Peripheral vascular disease Hypertension 2. Eye diseases (diabetic retinopathy). 3. Diabetic nephropathy 4. Diabetic neuropathy 5. foot,skin&mucous membrane complications.

Cases to be discussed case 1:

Cases to be discussed case 1 1.A 64 years old woman with a history of type 2 diabetes is diagnosed with heart failure Which of the oral hypoglycemics would be a poor choice in controlling her diabetes…………..?

Case 2:

Case 2 Mr .m is admitted w small ulcer on the first joint of his second toe which is exuding pus and smells offensive. He is pyrexial &raised white cell count,his diabetes is usually treated w mixtard insulin (26 am , 16 pm) What are possible causes of foot ulcers ? What about treatment of foot ulcer? Recommendations with respect to footcare?

Case 3:

Case 3 Mrs s 62 years old admitted to hospital with an acute mycardial infarction,she had type 2 diabetes for 10 yrs Her treatment was metformin 500 mg three times daily& nitrolingual spray as needed(stable angina). How should diabetes managed now? What other treatment would you expected mrs s to be receiving prior to her admission? Lipid abnormalities commonly seen….ttt? B-blocker use in this case?

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