
MANAGEMENT
1- EDUCATION
AND EXCERSICE
&
2-DIET
3-ORAL ANTIDIABETIC DRUGS
4-INSULIN THERAPY

=PROVIDING CARE
CENTERD CARE
–
PATIENT
THAT IS RESPECTFUL AND RESPONSIVE TO
AND
NEEDS
.
PREFFERANCE
PATIENT
…AND THE PATIENT VALUES HAVE AROLE
VALUES
IN GIUDING ALL THE CLINICAL DECESIONS

PRINCIPLES
1-NO SINGLE DIET FOR ALL PATIENTS
2-ADVICE AND NOT ORDER
3-HOLISTIC APPROACH
4-EDUCATION IS CONTINEOUS PROCESS NOT STEP
5-ALL OR NON RULE IS WRONG
6-FOLLOW THE GUIDELINES AS POOSIBLE
7-NON COMPLIANCE(concordance , adherence)=S.E
OF DRUGS OR POOR EDUCATION

TARGETS
B.P=140/90 MM HG OR LESS
HBA1c=LESS THAN OR EQAUL TO 7%(except in
???)
FBG=70 -130 MG/DL
PPG=LESS THAN 180 MG/DL
LDL=LESS THAN 100 MG/DL
HDL= MORE THAN 50 MG/DL
TRIG= LESS THAN 150 MG/DL

STOP OR DECREASE SMOKING AND ALCOHOL
IMMUNUZATION = HEPATITIS
B,PNEUMOCOCCAL,INFLUENZA
MONITOR,PREVENT AND TREAT COMPLICATION
TEAM APPROACH


DIET
ENCOURAGE ECXCERSRCE(30-45 MIN
/DAY)=TYPES?
DECREASE THE AMOUNT AND INCREASE THE
FREQUENCY
TOTAL DIALY CALORIC INTAKE=25*DESIRED
WT(KG)

BMI =ACCEPTABLE?
SALT=LESS THAN 6GM / DAY(IF HPT LESS THAN
3)
SWEETNERS=ACCEPTABLE?
GLYCEMIC INDEX=…?
GLYCEMIC LOAD=…?

Plate model



ORAL ANTIDIABETIC DRUGS
NO SUPRIORITY
METFORMIN IS DRUG OF CHOICE
COMBINATION DRUGS ARE EFFECTIVE
STATIN DRUGS PREFERABLE TO BE USED IF
MORE THAN 40 YEARS OF AGE
EARRLY INITIATION OF INSULIN THERAPY IS
IMPORTANT TO PREVENT COMPLICATIONS



ORAL ANTIDIABETIC DRUGS





GLP-1 Modes of Action in Humans
GLP-1 is secreted
from the L-cells
in the intestine
This in turn…
• Stimulates glucose-dependent
insulin secretion
• Suppresses glucagon secretion
• Slows gastric emptying
Long term effects
demonstrated in animals…
• Increases beta-cell mass and
maintains beta-cell efficiency
• Reduces food intake
Upon ingestion of food…