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DIABETES MELITUS
TYPE II
MAL AYSIAN CPG 2009
The disease
It is a common disorder
There is chronic hyperglycemia together with other metabolic abnormalities
It is due to insulin resistance and / or defiency as well as increased hepatic glucose output
It is a risk factor of CVD
Currently there is no cure but the disease can be controlled enabling the person to lead a
healthy and productive life.
The aim of management is directed at reducing complications (microvascular &
macrvascular)
Initial assesment
At diagnosis a detailed history ,physical examination must be done to asses
the risk factors and complications of diabetes. The following baseline should
be performed :
1. FPG
2. HbA1C
3. Renal profile
4. Urine analysis
5. ECG
Initial Management
Diet
1. regular meal timing
2. should consist of carbohydrate from cereals (preferably whole grain),
fruits, vegetables, legumes, and low-fat or skimmed milk
3. limit intake of saturated fatty acids, trans fatty acids, and cholesterol
Can have synergistic effects when used with other OAD agents and may be
combined with insulin.
If hypoglycaemia occurs when used in combination with SUs or insulin, advise
patients to take monosaccharides, e.g. glucose.
The commonest side effects are bloating, abdominal discomfort, diarrhea and
flatulence.
Biguanides (Metformin)
1. Metformin does not stimulate insulin secretion, and lowers blood
glucose by decreasing hepatic glucose production.
2. Metformin monotherapy is usually not accompanied by hypoglycaemia
and can lower plasma glucose by up to 20% as first line drug treatment
especially in overweight/obese patients.
3. Can increase insulin sensitivity and reduce insulin requirements.
4. Most common adverse effects are nausea, anorexia and diarrhea.
Thiazolidinediones (TZDs)
1. Thiazolidinediones are peroxisome proliferator-activated receptor-gamma
(PPAR-) agonists and act primarily by increasing insulin sensitivity of
muscle, adipose tissue and liver to endogenous and exogenous insulin
(insulin sensitizers).
2. Improvement in glycaemic control may only be seen after six weeks and
maximal effect up to six months.
3. Side effects include an increase in adiposity, largely subcutaneous (S/C),
with redistribution of body fat, weight gain, fluid retention, and
haemodilution.
Recent long term studies have found that both TZDs have been associated
with an increased risk of fractures, particularly in women.
TZDs are contraindicated in patients with CCF 75 and liver failure.
Use of TZDs with insulin is not recommended.
Medication
Hypertension and DM
Metabolic Syndrome
Management of Chronic
Complication
Retinopathy
Referral to an ophthalmologist is necessary for the following situations
1. Unexplained poor vision
2. Diabetic retinopathy greater than occasional microaneurysms
3. Macular oedema or hard exudates within the macula
Diabetic Nephropathy