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Treatment of Diabetes Dr.

Osama

diabetes
type one and type two
practical
2013

36

Diabetes
treatment
diabetes

treat

126
200

<<

Objective

Diabetes
fasting blood sugar

random post prandial

Hemoglobin A1C
glycated
6.2
diabetic

6.5

diabetes
controlled
fasting
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Treatment of Diabetes Dr. Osama


130

126

130

90

It is recommended
fasting

180

post prandial

glycated hemoglobin
7
6
7

control

target

type two diabetes

diabetes

type one

MODY

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Treatment of Diabetes Dr. Osama


MODY

20

17
diabetes
category
type one

diabetes

strong family history


strong family history

type one diabetes


positive family history

type one

category

diabetes

islets cells antibodies


type one
positive family history
MODY
Maturity onset diabetes of young
Monogenic diabetes
Oral hypoglycemic

MODY
Oral hypoglycemic

Oral hypoglycemic
controlled
MODY

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Treatment of Diabetes Dr. Osama

positive

Islets cells antibodies

type one
oral hypoglycemic

response
respond

MODY
never << type one

respond

40

type two
family history
oral

30
C peptide

Investigations
type one

C peptide
<< type two

type one diabetes


type one

LADA
LADA
latent auto immune diabetes in adults
type one
auto immune
20

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process

Treatment of Diabetes Dr. Osama


type one
late

type one
late

oral hypoglycemic

type one
MODY

type two

oral hypoglycemic

Type one diabetes

Type one Diabetes


type one diabetes

0.8

0.3

60
aggressive

0.5

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Treatment of Diabetes Dr. Osama


hypoglycemia
example
Low dose
0.5
60
30

30 unit

NPH
crystalline << 40 %

mixed insulin
crystalline
1/3
intermediate

insulin
70 / 30 mixtard insulin

twice daily
30

dose
10

20
20
10

30
20

20
13 12
7

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Treatment of Diabetes Dr. Osama

4 3
check
provided
emergency

Provided
500

type one
Insulin infusion

cold case
30
5 4
check
blood sugar
5 units
you cannot predict the response

30
35

5 4
stepwise
controlled

random

random

post prandial

controlled
post prandial

fasting
24

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fasting

Treatment of Diabetes Dr. Osama


glycated hemoglobin

60

40

secretion

basal insulin secretion


24

blood sugar

Long acting insulin


LANTUS
LANTUS

LANTUS
crystalline insulin
dose

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Treatment of Diabetes Dr. Osama


45

40

15

30

type one
type two

45
LANTUS

LANTUS

dose

dose
LANTUS
say

30 %

45
LANTUS

15

LANTUS
peak

LANTUS

No Hypoglycemia at all

LANTUS

15
30

10 10 10

40 %

Page |

30 %

30 %

Treatment of Diabetes Dr. Osama

15

LANTUS
10 10 10
controlled

15
12 12

12

20

LANTUS

LANTUS
LANTUS
LANTUS

basal

sliding scale
sliding
sliding scale
LANTUS

basal

LANTUS
8

200

above

50

crystalline insulin <<

8
200

300
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10

Treatment of Diabetes Dr. Osama


200

100
10

350
200
150
15

stable
10

15

stabilized

10
10
15
10

35
LANTUS

20

trial and errors


type one
dose
0.8 0.3

60
30
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11

Treatment of Diabetes Dr. Osama


1/3

2/3

twice per day << mixed insulin

30
70 / 30 insulin mixtard
10
20

every few days << 5 Units << about


4 3
Optimum
mixtard
Mixtard
crystalline insulin
NPH

action

duration

crystalline insulin
8

NPH
16
dose
dose

NPH

peak

dose

controlled

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12

Treatment of Diabetes Dr. Osama

Hypoglycemia
Mixtard

hypoglycemia

insulin analogue

rapidly acting
peak

insulin analogue
duration

Mixed
Mixed
Novo mix <<

70 / 30 ) Mixtard

mixed

Novo mix
Novo mix
dose

<<

insulin analogue

30 %

Mixtard
sorry
crystalline insulin
mixtard
crystalline insulin << 70 %

Novo mix
crystalline insulin
70 %
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13

Treatment of Diabetes Dr. Osama

twice

insulin analogue

dose

mix
Overlap
Overlap
dose

duration

aggressive
aggressive
physiological
LANTUS
3 << crystalline insulin

crystalline
LANTUS

insulin
3
overlap

LANTUS
analogue

Insulin analogue
Novo rapid
crystalline insulin
short acting insulin analogue << Insulin
Novo rapid
crystalline insulin

Novo rapid

very short acting


4

Mixtard
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14

Mixed insulin analogue

Treatment of Diabetes Dr. Osama


Novo rapid

30 %
70 %
Mixtard

Novo mix

Novo mix
novo mix
analogue

Novo rapid
Hypoglycemia
Novo rapid

mixtard
Novo rapid

LANTUS
Insulin analogue

Long acting

LANTUS
errors

trial
Peak

20

15

60
60
<< LANTUS
3
divided
crystalline
novo rapid

Insulin analogue
LANTUS
12 15

trial and errors

Page |

15

10

Treatment of Diabetes Dr. Osama


10
10

LANTUS

200

50

sliding scale
150

50

170
200

50
5
<< traditional
<<

Hypoglycemia

dose

dose

Novo mix

insulin analogue
30 %
70 %
NPH
duration
16

insulin analogue
rapidly acting
short duration
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16

Treatment of Diabetes Dr. Osama


LANTUS

updated
Novo rapid
Novo rapid

long acting

insulin analogue
LANTUS

long acting analogue

LANTUS
short acting
Novo rapid
premixed
Novo mix

Novo rapid
APIDRA

Novo rapid

LANTUS
Long acting
short acting

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17

Treatment of Diabetes Dr. Osama


LANTUS
Novo rapid
mixed

novo mix

Novo rapid

40
25

40

hypoglycemia

stepwise
emergency
type two

Type Two Diabetes


Oral

release

Oral
Secretagogues
secretagogues

secretagogues

secretagogues
Amaryl
Diamicron

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18

Treatment of Diabetes Dr. Osama


Amaryl
Glimipride

amaryl

amaryl

Amaryl
Sulphonylurea
<< secretagogue

release

exhaustion
release
Amaryl
on and off

On and off

release

Amaryl
On and off

One dose

Amaryl
One dose

very common mistake


<< Amaryl

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19

Treatment of Diabetes Dr. Osama

type two diabetes


type two
5

diabetic
emergency
1
Amaryl

5 4

3 << Amaryl
type two
Obese

insulin resistance
1 << amaryl
2
3

8
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20

Amaryl

dose

Treatment of Diabetes Dr. Osama


6

<< practically
6
3
3

Insulin sensitizer
Insulin sensitizer
Biguanides
500
1000

850

500
500
Amaryl
3

500

500
3

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21

Treatment of Diabetes Dr. Osama


3

1000

1000

1000
3

Amaryl

Amaryl
Exhaustion
responding
no way << definitely type two
sort of insulin resistance
You must add insulin sensitizer
maximum dose of Amaryl
Off
3
insulin sensitizer

exhausted

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22

Insulin action
to preserve

Treatment of Diabetes Dr. Osama


Diamicron

Diamicron

MR

80

Diamicron
MR
Modified release
40

Diamicron
3

Amaryl
amaryl
MR
Modified release

24
60

Modified release
Diamicron
30
30
60
90
120

one dose
one dose
Diamicron MR
30

One dose

two doses
better to be one dose
Page |

23

Treatment of Diabetes Dr. Osama


one dose

Amaryl

Diamicron MR
30
60
120
Insulin sensitizer

renal impairment
hepatic
COPD
Renal impairment

Kidney

renal impairment

excreted
lactic acidosis

diabetic

side effects

insulin sensitizer
Page |

24

Treatment of Diabetes Dr. Osama


Pioglitazones

Pioglitazones

Avandia
Glustin

X Cross

Avandia

Avandia
cardio-toxic

absolutely contraindicated
coronary heart disease
heart failure
heart disease
salt and water retention
pain
12 10

Avandia

Avandia

Glustin
30

15

Glustin

Glustin
heart failure

coronary
30

Page |

25

15

Glustin

Treatment of Diabetes Dr. Osama


24

Diamicron MR

Amaryl
Glustin

oral hypoglycemic
Amaryl
6
Diamicron
120
3
30
Oral hypoglycemic

1000
15

Glustin

insulin

Oral hypoglycemia

10

combination

2
48
12

Page |

26

shift

Treatment of Diabetes Dr. Osama


twice per day << insulin

LANTUS
Oral
LANTUS

LANTUS

Oral
Amaryl
Amaryl

LANTUS
basal secretion

LANTUS
Amaryl
release

Amaryl
Novo norm
Novo Norm
normalized

0.5

Amaryl

Amaryl

<<

Novo norm
average

Novo norm
long acting << Amaryl
diet
Mainly

Amaryl

Novo norm
very short action

Novo norm

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27

Treatment of Diabetes Dr. Osama


insulin

Novo norm
diet
basal insulin
LANTUS

Amaryl

Amaryl
Novo norm

Novo norm

LANTUS
Novo norm

LANTUS

LANTUS
satisfied

Exhausted

insulin
type one

dose
type one dose
0.8 0.3 << dose

Up to 2 units per kg

insulin resistance

type one
type two
resistance

Page |

28

type one
type two
dose

Treatment of Diabetes Dr. Osama

Mixtard
LANTUS

insulin sensitizer
type two
insulin resistance

incretin
incretin effect
incretins

Oral

intra venous
oral

IV

IV

glucagon related peptide


glucagon related peptide
intestine
oral

Page |

29

Oral

oral

Treatment of Diabetes Dr. Osama


glucagon related peptide

500

oral
glucagon related peptide
intestine
incretin effect

incretin effect

oral

IV
glucagon related peptide
release
glucagon related peptide
release
glucagon level
appetite

Page |

30

Treatment of Diabetes Dr. Osama


incretins based therapy
incretins based therapy
glucagon related peptide enhance

Oral
glucagon related peptide << intestine
glucagon related peptide

<< enhance <<


Ganuvia

6
100

Glucagon related peptide


Gulcagon related peptide

enhance

adjuvent therapy
sorry

effective
Page |

31

Treatment of Diabetes Dr. Osama


Diamicron

Amaryl

incretin based therapy

100

30
200

Novo rapid
Long acting << LANTUS
short acting
insulin insulin analogue
Hypoglycemia
overlap duration

Page |

32

Treatment of Diabetes Dr. Osama

Diabetes
55 12
2013
2

www.facebook.com/dr.tafreegh

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33

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