உன்னை வெல்வேன் நீரிழிவே - Diabetes by Siva

Diabetes by Siva
written by Sivaram
Jagadeesan

DIABETES BY SIVA
" " ,
, ,

written by Sivaram Jagadeesan (Sivaramj@gmail.com)
Diabetes by Siva
.......................................................................................................................................................................................... 2
...........................................................................................4
1.......................................................................................................................................................... 6
2........................................................................................................................................................... 9
- 1..................................................................................................................12
- 2..................................................................................................................14
.......................................................................................................................................16

...........................................................................................................19

- .....................................................21

- ..........................................23
...................................................................................................................................................................... 27

- - ..........30
- 2
.......................................................................................................................................33
- 1
- ...................................................................................................................40
................................................................................................................43
............................................................................................................................................................. 45
1 :......................................................................................................................................................47
.............................................................................................................................................49
(Diabetic Nephropathy -DN):..............................................................................................................49
, ..................................................................52
............................................................................................................................................................. 55
.................................................................................................................................................................. 58
..........................................................................................................................................................................67
.......................................................................................................................................................69
................................................................................................................................................................................. 71
.................................................................................................................................................................................. 73
.......................................................................................................................................75
Diabetes by Siva
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Diabetes by Siva
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1, 2 .
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1. Insulin Dependent Diabetes Melitus - -1
2. The Insulin-Resistant Diabetic - -2.
. - Latent Autoimmune Diabetes
LADA. 35
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-1 -2 . HBA1C
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Diabetes by Siva
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Diabetes by Siva
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140 , ,
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Diabetes by Siva
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HBA1C HBA1C
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100 1.30 (1 1.5 2
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Diabetes by Siva
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70 95 .
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Diabetes by Siva
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Diabetes by Siva
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Diabetes by Siva

,
.
, Hba1C:
.
(). 80-100 , 100120 . .
.
HBA1C
. , .
.
.
24 HBA1C
. 200
HBA1C . , , HBA1C
. (
).

. .
Serum C-Peptide (-):
- .
- . ,
. ,
,
.
Complete Blood Count:
. ,
, .
Serum Ferritin :
14
Diabetes by Siva
, (-2)
.
Lipid profile :
HDL, LDL, Triglycerides .
CRP (C-reactive protein)
.
:
.
.
& :
.
24
( ) .
, .
Insulin-like Growth Factor 1 (IGF-1):
( 300-400 )

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R-R Interval study:
( ) .
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180 , 200 ,
.
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15
Diabetes by Siva
,
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Diabetes by Siva
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Glucograf III .
.
17
Diabetes by Siva

-

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18
Diabetes by Siva
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, , 36%
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0.8 .
, / 1.8
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(,
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.

.
glomerular filtration rate (GFR).
GFR
.
, ,
.
.
.
. , , ,
, , (100 62 )
. .
.
.
.
19
Diabetes by Siva

-
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20
Diabetes by Siva
. , ,
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80% .

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-3
. : :
20% : 65% : 15% .
.
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.

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(atherosclerosis). (CRP Test reading)
, . ,
.

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.
. .
. , ;
21
Diabetes by Siva
,
. . .

.
: 200 .
HDL: , 40
LDL: , 130 . ,
. ,
. 100
, .
.
CRP . 2
.
Triglyceride: . 150
. .

. (Ketone Bodies)
. .
.
22
Diabetes by Siva

. (ketone bodies)
.
, 40
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Diabetes by Siva

. 48

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24
Diabetes by Siva

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Diabetes by Siva
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Diabetes by Siva
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27
Diabetes by Siva
( , ,
.
,

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(Oral Hypoglycemic Agents - OHAs) .
* (Insulin sensitizers) -
.
* (Insulin mimetics) - .
* .
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() -2 .

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.
.
.

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.

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300 , , ,
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(tyrosine kinase) . ,
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28
Diabetes by Siva
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Biguanides ():

. ,
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. .
.

( ) ,
. (Lactoasidosis)
.
29
Diabetes by Siva
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30
Diabetes by Siva
.
.
1940
. , ,
, . 1952
, . 1954
1956
.
.
,
.
.
. -1 .
. ,
.
.
.
.

tolbutamide
acetohexamide
tolazamide
chlorpropamide

glipizide
glyburide or glibenclamide
glimepiride
gliclazide
glycopyramide
gliquidone
31
Diabetes by Siva

.
Canagliflozin
Dapagliflozin
. ,
. ,
,
. .

Miglitol
Acarbose
Voglibose
(
- 7 )
. 300 .
,
, .
, ,
.
. , ,
. ,

.
.
, 7 ,
. , ,

. 11
, .
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. .
, ,
.
32
Diabetes by Siva
.
.
. (
, ,
).
. , ,
. .

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.
.
- 1 -
-1
.
, ,
, 1
. 1 2

.
1 .
.
. .
1 .
.
1 2 ? 30
2 1 .
33
Diabetes by Siva
300 1
. 1 .

. /
.

. .
.
.
1
.
.
1. Islet Cell Cytoplasmic Autoantibodies (ICA): ,
(Islet) .
70-80 .
2. Glutamic Acid Decarboxylase Autoantibodies (GADA) :
.
3. Insulinoma-Associated-2 Autoantibodies (IA-2A) : #2
.
4. Insulin Autoantibodies (IAA) :
.
. .
.
. .
.
, .
.
. .
( ) . , ,
, . .
40 100 . 100
.
. .
, ( ) .
.
,
, . ,
. 56 80
. .
34
Diabetes by Siva
(Generic names)
. , ,
, ,
.
:

. .
. .
.
(Lispro) : 15-30 30-90
3-5 .
(Aspart) : 10-20 40-50
3-5 .
(Glulisine) : 20-30 4-12
18-24 .
.
.
35
Diabetes by Siva
:
(Regular or Crystalline) : 30-60
2-5 5-8 .
(Velosulin) : 30-60 2-3
2-3 .
. ( )
:
--------- ------------ ---------- --------.. (NPH (N)) : 1-2 2-5
5-8 .
.
:
------------ ------- ------ ------------ -------Insulin glargine (Lantus): 1-1.5 24
. .
.
.
Insulin detemir (Levemir) : 1-2 6-8
24 .
():
------------ ------- ------ ------------ - , ,
. 8 - 12
, 20/30/50
NPH . 1

. 70/30. 70
, 30 .
.
.
, ,
.
. .
. ,
.
.
.
36
Diabetes by Siva
NPH / REGULAR 70/30 - NPH 70 Regular 30 .
Insulin Aspart 70/30 - 70
30 .
Insulin Aspart 75/25 - 75
25 .
.
.

.
40 , 100 200, 300, 500
. ,
200
. 30 24
15 5-8 .
.
. .
.
.

.
.
.
, ,
.
2/3/4 .
. continuous
subcutaneousinsulininfusiontherapy. .
1. .
2.
3.
.
.
Basal24 .
37
Diabetes by Siva
Bolus .

.
.
, ,,
.
,
.
.
. .

.

. .
.
.

.
.
,
, .MedtronicMiniMed
530G . ,
. ,
, 1
.
(Inhaledinsulin)
2006 FDA .
Exubera. 2007 ,
. 2014 Afrezza
.
. .
.

.
38
Diabetes by Siva
1 :
,1()
.LCHF
(LowCarbHighFat)
BloodGlucose.
LCHF.23
..
.23
.
.
.HBA1C
.5.5,5.66.0.6
.()
.Figure1ActivityofInsulin
Preparations.
,.
70/3075/25
NPH..
NPH.
,23.
BloodGlucose23.
.
.6
.(,).
.NPH
..
.
.
.
(.
..
.)
39
Diabetes by Siva
40
Diabetes by Siva

, ,
, . 250300
.
300 ,
, , , ,
,
. ,,,,
. 300
,,
.
.
(Diabetic Nephropathy -DN):
.,
. 1
10 .
().
.
, .
.
,
.
. 40 , ,50

.
. .
.
*,
*,, , ,

*
*
,
. , .
41
Diabetes by Siva
BUN(BloodUreaNitrogen) SerumCreatinine
. .

. .24
, .36

. .
.GFR(GlomerularFilterationRate)
.
ESRD(EndStageRenalDisease) .
ESRD 23
.
.
.
. 1, 2
, 2 . 2
.
.
.
.

.
.
.
42
Diabetes by Siva
,
,
.
,
. ,
.
. ,
. .
. .
. .
120/80. 140/90. .
.
.
43
Diabetes by Siva

.
. ABC
AHBA1C .
BBloodpressure
CCholesterol
. HDL
,
. 100
. 100
.

(coronaryarterydisease) .
.
.
:
*,,,
*
* ( . )
*
*
.
.
. .

.
.
,
. .
(PeripheralArteryDiseasePAD).
,
.
, , ( ,
100 ), ,
, , .
.
.
, ,
.
44
Diabetes by Siva
PAD (AnkleBrachial
Index).
. PAD .
, MRI .
,HBA1C ,
. ,
.
,
.
.
45
Diabetes by Siva

.
. 1
. 2
20
.
.
,
. . 40
.
""
.
.
.
.
.
(). .,
() ,
. ( )
().
(macula). ,
. .
, .

. .
(capillaries) ,
. , ,
. .
.
.
. vitreoushemorrhage .
.

.
.
,, .
(DiabeticMacularEdemaDME) .
46
Diabetes by Siva
DME .
.
Glaucoma:
. ,
.
. ,
.
Cataract:
.
.

.
:
*
* (Tonometry) .
* (PupilDilation)
.
.

.
* (OpticalcoherenceTomography)
,

fluoresinangiogram
. ,
.
, , ,
.
40 2,10
1 .
.
.
47
Diabetes by Siva

. .
.
.

.
.
.
.
, , , , ,
.
, ,,,
.
60 70 , ,
.
.
25 .
. 200,250,300,
48
Diabetes by Siva
, ,

, .
,
.
.
* , ,
()
*
* ( )
* (carpaltunnelsyndrome)
* ,
.
:
.
.
,
. .
. . 300
.
.
.
:
*,,,,
.
*
*, ,
*
*
*
.(
)
* .
.
.
49
Diabetes by Siva
* ( ),,
.
.
.

.
.

. ?

.

.
.
* , ,
, ,
,, .
,,
( ) .
.
.
.

.
.
.,
.
.

. (gastroparesis). ,,
.
. .

. .
?
.
.
.
.
, .
50
Diabetes by Siva

.
* , .
, .
.
.
.
* ,
. .
.
, ,
(Bell'sPalsy)

,,
.

.
.

. ?

.
.
. QuantitativeAutomatic
FunctionTests(QAFT) .
QuantitativeSensoryTesting(QST) .
.
1.Symptoms(S)
2.PhysicalExamination(PE)
3.Electrophysiology
4.QuantitativeSensoryTestsQST
5.CardiovascularTestsCT
,
. ,(10gmonofilament
tests), ,
.

.
51
Diabetes by Siva
.
.

. 8
. .
. .
.
?

.

.
.
, ,, ,
.
.

.
.
.
.
. ,
.

.
(ElectromyographyEMG),
( )
.
.
EMG .
.
.
. ,
,
. .
EMG ,

.

. .
52
Diabetes by Siva
.
.

.
.
. ,
.
., ,
,,
. ,
.
.
.
, .
.
.
,
.; , , .
.
. . .
.
.
. .
Ibuprofen .
.
( )
.
., ,
, , .
.
.
[
]
:
,
.
, ,
.
53
Diabetes by Siva

.
.

.
.

.
.
,
.
[ : .

]
,, .
.
.Alprostadil
.
.
.
(Inflatableprosthesis)
.
.
.
, ,
.
.
35 .
.
?
, ?

.
.
.
54
Diabetes by Siva

GestationalDiabetesMelitus(GDM) Gestational
DiabetesMelitus(GDM) .

.
, ()
.
(Humanplacentallactogen) .

().
.
.

.
55
Diabetes by Siva

. GDM
, 2 .
, 24 28
GDM . 24
. .
.

. .
.
.

.
.
(4
).

.

.
.
.
.
.
.
95 , 140 ,
120 .
.
.
.

. 1
.
.
.
.
.
. (PCOS/PCOD)
GDM
. .
PCOS .
56
Diabetes by Siva
GDM
.
( )
.

(PCOS/
PCOD) .
?
.
. .
.
. 2
.

.
. .

. ,
, ,
, ,
.
65
. .

.
.
, ,
.
.
.
. .
.
.
.

.
.
( ,
57
Diabetes by Siva
). ( )
. 3
.
.
.
.
.
. .
.

. 1 ,2
.
58
Diabetes by Siva
, ,
. 10000
.
10000 .
.
.
, .

. ,
/ ,
.
. ,,
, .
. 12
.
.

. ,
. ,,
(,, ),,,
, , .
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, ,
.
.

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. (
),, ,, .
.
.
.
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,, .
.,,
.
,
.
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. , ,
59
Diabetes by Siva
, ,
.
.
.
.
40
. 60% 30% 10%.
.
. ,
.
. .
.
.
. .
www.selvan.wordpress.com.

.
. .
. .
. ,D2
D3 . D2.
D3.D3 .
. ,
.
, ,
. ,
. ,
,, .
(Oateomalacia)
.
,
. 20
. 100 .
, ,
.
60
Diabetes by Siva
. 11
1 .
15 30 .,
. ,
. IU
. 2000 4000IU
.
, .
.
.

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61
Diabetes by Siva

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62

உன்னை வெல்வேன் நீரிழிவே - Diabetes by Siva

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உன்னை வெல்வேன் நீரிழிவே - Diabetes by Siva

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Diabetes by Siva

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

(Diabetic Nephropathy -DN):

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)

written by Sivaram Jagadeesan (Sivaramj@gmail.com)