1. Diabetes Overview Managing Diabetes in Primary Care

2. James Street Family Practice, Louth GP Registrar Tutorial Diabetes Mellitus Diabetes mellitus is a condition in which there is a chronically raised blood glucose concentration It is caused by an absolute or relative lack of insulin i.e. insulin is not being produced from the pancreas or there is insufficient insulin or insulin action for the bodys needs

3. James Street Family Practice, Louth GP Registrar Tutorial Prevalence 1.3 million in UK 2.5% population diagnosed Missing Million: DUK reckon up to 2% more diabetics undiagnosed Prevalence rises with age 1 in 20 over 65 1 in 5 over 85

4. James Street Family Practice, Louth GP Registrar Tutorial Sociology European perspective Britain among worst rates of Diabetic complications in Europe (renal failure, amputation, blindness) Ethnicity T2DM up to 6* more common in people of South Asian descent T2DM up to 3* more common in people of African or Afro- Caribbean descent Social Class morbidity is up to 3.5* more in poorest than richest in our society

5. James Street Family Practice, Louth GP Registrar Tutorial Gender Variation Prevalence higher in men than women Risk of dying higher in women than men

6. James Street Family Practice, Louth GP Registrar Tutorial Definitions World Health Organisation Diabetes fasting plasma glucose >7.0 2-h post-glucose load >11.1 Impaired Glucose Tolerance fasting <7.0 and 2-h post-glucose load >7.8 Impaired Fasting Glucose fasting 6.1 – 7.0

7. James Street Family Practice, Louth GP Registrar Tutorial Classification Type 1 insulin-dependent Type 2 non-insulin-dependent

8. James Street Family Practice, Louth GP Registrar Tutorial Type 1 Diabetes Presents in childhood or early adult life accounts for 15% cases in England pancreatic ß–islet cells destroyed autoimmune

9. James Street Family Practice, Louth GP Registrar Tutorial Type 2 Diabetes Often presents after age 40 85% of cases in England insulin resistance gradual onset tiredness, frequent urination, increased thirst, weight loss may be detected routinely medical examination

10. James Street Family Practice, Louth GP Registrar Tutorial Complications Microvascular Cardiovascular Other

11. James Street Family Practice, Louth GP Registrar Tutorial Microvascular eye retinopathy maculopathy nephropathy neuropathy feet/ulceration postural hypotension abnormal sweating diarrhoea erectile dysfunction

12. James Street Family Practice, Louth GP Registrar Tutorial Cardiovascular CHD angina myocardial infarction heart failure Stroke/TIA PVD claudication foot ulcers

13. James Street Family Practice, Louth GP Registrar Tutorial Other cataract infections UTI candidal skin soft tissue problems frozen shoulder, trigger finger skin problems necrobiosis lipoidica diabeticorum mental health problems

14. James Street Family Practice, Louth GP Registrar Tutorial Management Options Diet Oral Hypoglycaemics Insulin T1DM T2DM

15. James Street Family Practice, Louth GP Registrar Tutorial Management of T1DM Insulin Pre-mixed biphasic Basal Bolus Insulin Pump

16. James Street Family Practice, Louth GP Registrar Tutorial Management of T2DM Diet low fat high (complex) carbohydrate Lifestyle modification smoking cessation reduce alcohol reduce obesity exercise

17. James Street Family Practice, Louth GP Registrar Tutorial Management of T2DM (2) Glycaemic control sulphonylureas biguanides (metformin) secretagogues (Repaglinide) thiazolidinediones Hypertension control ACEI Lipid control statins

18. James Street Family Practice, Louth GP Registrar Tutorial Organised Diabetic Care Practice Clinic Nurse Specialist GP Specialist Call/Recall Specialist Care Liaison Nurse Screening Services Retinopathy Podiatry