DR.V.SEKAR COIMBATORE DIABETES FOUNDATION

HYPERGLYCEMIA IS THE HALLMARKOF DIABETES HYPERGLYCEMIA IS THE HALLMARK OF DIABETES HYPERGLYCEMIA IS THE HALLMARK OF DIABETES

HYPERGLYCEMIA IS THE HALLMARKOF DIABETES HYPERGLYCEMIA IS THE HALLMARK OF DIABETES DIABETES TREATMENT IS BASED ON THE NUMBER IN MILLIGRAMS BEFORE WE DECIDE WHETHER BLOOD SUGAR IS NORMAL, HIGH OR LOW

HYPERGLYCEMIA IS THE HALLMARKOF DIABETES HYPERGLYCEMIA IS THE HALLMARK OF DIABETES HOW THE BOOLD SUGAR IS DERIVED FROM WHERE,WHAT METHOD IS CRITICAL METHOD IS CRITICAL

HYPERGLYCEMIA IS THE HALLMARKOF DIABETES HYPERGLYCEMIA IS THE HALLMARK OF DIABETES THE MOST CRITICAL ISSUE IS CLINICAL CORELATION BLOOD SUGAR SHOULD NOT BE TREATED THE PERSON WITH BLOOD SUGAR SHOULD BE TREATED

SOURCE OF BLOOD CAPILLARY OR VENOUS PLASMA WHAT METHOD? WHICH MACHINE? MANUAL,SEMI AUTOMATED, FULLY AUTOMATED

STEPS FOR INTERPRETATING BLOOD SUGAR VALUE PRE ANALYSIS ANALYSIS POST ANALYSIS

PRE ANALYSIS BLOOD COLLECTION LABELLING ANTI COAGULANT CENTRIFUGE

BLOOD COLLECTION

ANTI COAGULANT

LABELLING

CENTRIFUGATION VIDEO

PLASMA

PIPETING 1 ML OF REAGENT 10 MICRO LITER OF PLASMA

TYPES OF MACHINE TOTALLY MANUAL SEMI AUTOMATED FULLY AUTOMATED

ANALYSIS

TYPES OF TESTING GLUCOSE OXIDATES DEHYDROGENASE METHOD (GOD) HEXOKINASE METHOD

TYPE OF REAGENTS 1. END POINT METHOD 2. KINETIC METHOD

TESTING VIDEO

TIME OF TESTING BLOOD COLLECTION TIME TESTING TIME REPORT RELEASING TIME IS MORE IMPORTANT

EVERY ONE HOUR THERE IS A FALL OF 10 – 15 MILLIGRAMS

SAMPLE STORAGE ONLY FOR 24 HRS AT 2 – 8 DEGREE

POST ANALYSIS

REPORT RELEASING VERIFICATION RECHECKING CLINICAL CORRELATION

CALIBERATION QUALITY CONTROL

WHY FASTING IS HIGH ? Basal Insulin Deficiency: Pre Dinner / Post Dinner Blood Sugar Abnormality: CHO Load: High Low Medium Glycaemic Index: High Low Fibre Content of Food: High Low Medium Time of Food:Untimely Food Timely Food Somyogi: Dawn Phenomenon: Medication: Check Insulin VialClear Turbid Expiry Checked Storage AreaRefrigerator Room Temp Check Syringe U 40 U100 Check OHALess dose Correct dose  High dose Time of InsulinCorrect Time Untime Insulin Meal Mismatch:

WHY POST PRANDIAL IS HIGH ? Basal Insulin Deficiency: Pre Dinner / Post Dinner Blood Sugar Abnormality: CHO Load: High Low Medium Glycaemic Index: High Low Fibre Content of Food: High Low Medium Time of Food:Untimely Food Timely Food Somyogi: Dawn Phenomenon: Medication: Check Insulin VialClearTurbid Expiry Checked Storage AreaRefrigerator Room Temp Check Syringe U 40 U100 Check OHALess dose Correct dose  High dose Time of InsulinCorrect Time Untime Insulin Meal Mismatch:

PERSISTANTLY  A1C 1.Diet factor: High CHO Load Glycaemic index  High, Low Fibre content of the food  High, Low, Medium Time of Food Timely food, Untimely food 2. Exercise : Frequency Intensity Time Type Aerobics gym yoga exercise

6. Co morbid conditions: HT MAU LIPIDS BDR 7. Complication: IHD PDR NEPHROPATHY NEUROPATHY DFS PVD 8.Doctor factor: Clinical Inertia Selection of drug DosageCONT’

HBA1C MAJESTIC IN THE MANAGEMENT OF DIABETES HBA1C MAJESTIC IN THE MANAGEMENT OF DIABETES MANAGEMENT OF DIABETES

DIABETES MEANS CHRONIC HYPERGLYCEMIA WHAT WE TREAT IS ONLY ACUTE HYPERGLYCEMIA? DIABETES MEANS CHRONIC HYPERGLYCEMIA WHAT WE TREAT IS ONLY ACUTE HYPERGLYCEMIA

BLOOD SUGAR TELLS YOU THE DAY TO DAY VARIATION HBA1C IDENTIFIES THE OVER ALL FLUCCATION OF BLOOD SUGAR BLOOD SUGAR TELLS YOU THE DAY TO DAY VARIATION HBA1C IDENTIFIES THE OVER ALL FLUCCUATION OF BLOOD SUGAR

CLINICAL CASE STUDY MR.SANKARANARAYANAN 60YRS C/O SWELLING IN LEGS HIS HBA1C IS 11.0% CREA 2.4 WITH BDR ON THE DAY OF TESTING

CLINICAL CASE STUDY MRS.PADMINI 60 YRS ON THE DAY OF TESTING HAD BREAKFAST IN HOTEL HER FASTING WAS 140 POST PRANDIAL 260 & HBA1C 6.0%

HBA1C HELPS TO DECIDE ABOUT DIABETES IS UNDER CONTROL OR NOT PREDICTS FUTURE COMPLICATIONS HELPS TO DECIDE THE DIABETES MANAGEMENT

BLOOD SUGAR IS DYNAMIC KEEPS CHANGING WITH EACH MEAL BLOOD SUGAR GOES UP 3 TIMES A DAY 90 TIMES IN A MONTH WE CHECK BLOOD SUGAR ONCE IN A MONTH / FEW MONTHS & DIABETES IS TREATED ON PARTICULAR VALUE UNSCIENTIFIC NOT LOGIC

ROLE OF HBA1C CONTROL < 7 % NOT UNDER CONTROL > 7 % PREDICTS FUTURE COMPLICATION

DCCT, UKPDS STUDY DECIDE ABOUT THE DIABETES MANAGEMENT < 7 %UNDER CONTROL > 7 %NOT UNDER CONTROL 7 – 8 %NEEDS ACTION > 8 %CHANGING THE MEDICATION OR ADDING THE DOSE >10 %MAY REQUIRE INSULIN

LEVEL OF DECREASE IN HBA1C LIFE STYLE MODIFICATION 0.5 – 1 METFORMIN1 – 1.5 SULFONYLUREA1 – 1.5 GLITAZONES0.5 – 1.0 SITAGLIPTIN0.5 – 1.0 INSULINANY NUMBER

CLINICAL DECESION MAKING

1.SYMPTOMS 2.COMPLICATIONS 3.DURATION OF DIABETES 4.AGE 5.HBA1C 6.TYPE 1 OR TYPE 2 7.INSULIN DEFECIENCY OR INSULIN RESISTANCE 8.WHICH BLOOD SUGAR IS HIGH FASTING OR POST PRANDIAL 9.DIFFERENCE BETWEEN FASTING AND PP 10.DIABETES + OBESITY 11.DIABETES + HYPERTENSION 12.DIABETES + DYSLIPIDEMIA 13.PSYCO – SOCIO STATUS,ECONOMIC STATUS 14.CO-OPERATION OF THE PERSON AND HIS FAMILY

SYMPTOMS CLINICAL SYMPTOMS ARE THE MOST IMPORTANT PARAMETER IN DECIDING THE TREATMENT PATHWAY Eg: POLYURIA,POLYPHYGIA,POLYDYPSIA,WT LOSS INDICATES A DECOMPENSATED SYMPTOMATIC DIABETES STATUS – NEEDS INSULIN THERAPY SEVERE NEUROPATHY – THE CHOICE IS INSULIN

COMPLICATIONS BASED ON THE MICRO OR MACRO VASCULAR COMPLICATION THE TREATMENT DECESION MAY DIFFER

DURATION OF DIABETES AT DIAGNOSIS 50 % OF BETA CELL IS LOST LONGER THE DURATION MORE LIKELY REQUIRE INSULIN THERAPY

AGE YOUNG AGE ONSET MIDDLE AGE ONSET / CLASSICAL ONSET OLD AGE ONSET YOUNG AGE ONSET MAY REQUIRE A TIGHT CONTROL

HBA1C INDICATES A CHRONIC HYPERGLYCEMIA HBA1C > 10% MAY REQUIRE INSULIN THERAPY

INSULIN RESISTANCE OR INSULIN DEFECIENCY WHICH IS PREDOMINANT ?

FASTING OR POST PRANDIAL WHICH BLOOD SUGAR IS HIGH? WHAT IS THE DIFFERENCE BETWEEN FASTING AND POST PRANDIAL? Eg: BASAL INSULIN TO CONTROL THE FASTING BOLUS TO CONTROL THE POST PRANDIAL

CO – MORBID CONDITIONS HYPER TENSION OBESITY DYSLIPIDEMIA

PSYCO-SOCIAL, ECONOMICAL STATUS