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diabetes
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investigations
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Criteria for diagnosis of
diabetes mellitus
FPG 126 mg/dl (7.0 mmol/l).OR
Symptoms of hyperglycemia and acasual plasma glucose 200 mg/dl (11.1
mmol/l).OR
2-h plasma glucose 200 mg/dl (11.1
mmol/l) during an OGTT.
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Laboratory methods
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lucose determination in blood and urineThe simplest measurement of carbohydrate homeostasisis glucose determination.Chemical methodsorthotoluidine,neocuproine,ferricyanide
Enzymatic methods:hexokinase-G6PDH,glucose dehydrogenase, glucoseoxidase-peroxidase (ABTS)glucose oxidase (GOD) withother indicator reactions.Qualitative/Semiquantitive
paper test strips: Clinistix, Glucostix,Glucometer(Glucometer Elite XL, Accu-Chek) and newernoninvasive devices(infrared imager, ultrasound imageretc) for self monitoring
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Oral glucose tolerance test (OGTT)The OGTT is a provocation test toexamine the efficiency of the body to
metabolise glucose.More sensitive forthe diagnosis of diabetes than fastingplasma glucose.
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Glycated proteins :All proteins with reactive sites
can be glycated and the concentration of theglycated proteins that can be measured in blood isa marker for the fluctuation of blood glucoseconcentrations during a certain period. Opinion
about diagnostic efficacy is divided.HbA1c is ofmost interest serving as a retrospective indicator ofthe average glucose concentration over theprevious 8 to 10 weeks.Procedures employed are
column chromatography(micro and macro),HPLC, FPLC, isoelectricfocussing, monoclonalantibodies etc.Reference level:HbA1c 4.4 6.4%
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Urine albumin excretion : The early signs of diabetic
nephropathy cannot be detected by the routinescreening tests for proteinuria, so that more sensitivemethods for detecting abnormal albumin excretionmust be used. The early stage of albuminuria is
clinically defined as an albumin excretion rate of 30-300 mg/24 hours.The following procedure is suggestedfor the routine analysis of albuminuria in diabetes.Begin: Type 1 diabetes after 5 years of the disease
Type 2 diabetes with diagnosis of the diseaseCommonly employed screening tests are spot urinaryalbumin:creatinine ratio or spot urine albuminconcentration.RIA or immunoturbidometric assays or
nephelometric assays are also used.
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URINE KETONE AND BLOOD KETONE: TOOLFOR DIAGNOSIS OF DIABETIC KETOACIDOSIS.Urine total ketones should be measured bychemical( nitroprusside, etc) or enzymatic(reagent tabs) or electrochemical methods.Expiredair acetone testing can also be done.-
hydroxybutyrate assays are more sensitive
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C-PEPTIDE: A NEW TEST IN DIABETICMEDICINE: C -peptide is a simple, cost-effectiveand non-invasive method in the assessment of
beta-cell capacity.It is mentioned useful in follow-up of the diabetic complication.It is noted for thegood diagnostic property for diabetic neuropathy,one of the most common complications of DM.
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INSULIN TEST A DIRECT MEASUREMENTOF HORMONEThe measurement of insulin by RIA can bedone but it is not practically used in routinediabetic clinic. Glucose clamp technique(the hyperinsulinemic-euglycemic clamp in
assessing in vivo insulin sensitivity and thehyperglycemic clamp in assessing insulinsecretion) is also performed to measureinsulin secretion and sensitivity.
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Other tests.
Routine blood count and coagulation
screen .Arterial blood gases-in any
emergency like diabetic ketoacidosis.Serum electrolytes and urea-creatinine.
Lipid profile,Liver function tests,Chest X-
ray ECG,Infection screen(depending on
clinical correlates)
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FOUR PILLARS OF MANAGEMENT ARE..
1.DIET2.DRUGS3.PATIENT EDUCATION
and
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4.EXERCISE
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In type 1 DM patients the total
energy input has to be
relatively higher in order to
regain ideal weight and growth.
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In type 2 DM patients caloriesneed to be restricted in order
to avoid obesity
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Goals of medical nutrition therapy
To maintain near normal glycemia.
To maintain optimal lipid profile. To maintain normal blood pressure.
To restore and maintain ideal bodyweight.
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The following points have to be consideredwhileprescribing a diet for diabetic :
The type of diabetes type1 or type2
The weight of the individual in comparison
with his ideal body weight (BMI)
His occupation and activities and to assess
his caloric requirements.
The presence of any complications.
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TOTAL CALORIC INTAKE
This is the most important step while prescribing adiet.
The body mass index (BMI) will help to determine
total caloric requirement.
BMI = Weight (in kg)/ height in m`2
It is desirable to keep BMI between 22 & 25.
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Ideal body weight can be calculated by the
formula :
IDEAL BODY WEIGHT= Height(cm)-100
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Endocrine / physiological responses during
exercise :
Suppression of insulin release- directly as well asthrough epinephrine.
Sympathetic system activation- which inhibits
insulin release and stimulates lipolysis. Non-insulin dependant glucose uptake in the
periphery.
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Benefits of exercise
It improves insulin sensitivity
Decreases triglyceride, increases HDLcholesterol and decreases LDL cholesterol
It lowers blood glucose concentration It lowers BP in mild to moderate hypertension
It helps in cardiovascular conditioning
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Risks of unsupervised exercise in
uncontrolled diabetic :
Hypoglycemia
Hyperglycemia after very strenous exercise
Precipitation of cardiovascular disease
Worsening of long term diabetic complications
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For the average middle aged indian diabetic thefollowing exercise regimen is adequate
walk 3kmon level ground over a period of 45 mts
Swim for 30 mtsat average speed withoutcardiovascular distress
Cycle on level ground at 8km/hr for30mts
Regular sports and game activities
Yoga exercises
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MANAGEMENT OF HYPOGLYCEMIA
Management consist of emergency measures tocorrect the blood glucose level.
If the patient can swallow, 50g of glucosedissolved
in 200ml watershould be given orally.symptomsstart improving within 5-7 mts and the patientbecomes normal within 20-40 mts.
If glucose is not at hand sweet articles and cereal
foods can be given.
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If the patient is unconscious, parenteral glucoseshould be administered. About 15-20g ofglucose isusually needed. This is best administered by IV
infusion of 200-250mlof 100% dextrose, which issafe and effective.
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THER PEUTICS
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The homeopathy drug treatment used indiabetes can be classified in to six groupsnamely
acids,metals,other minerals,
vegetables,
drugs from animals,and organotherapic remedies.
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The acids used for treatment of diabetes
are acetic acid, lactic acid, phosphoricacid, nitric acid, picric acid, carbolicacid, and flouric acid. Acids are oftenused in patients with debility or
persistent weakness.Acid can preventacidosis one of the greatest danger ofdiabetic mellitus
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Metals Aurum met, Argentum met,Argentum nitricum, Uranium nitricum,Vanadium, Plumbum met, Cup ars areused as a homeopathic treatment for
diabetes.
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Other minerals (such as Ars alb, Sulphur, Silicea,Iodum, Natrum sulph), vegetables (such asCephalandra indica, Chimaphilla, Chionanthus,
China, Curara, Nux vom, Helleborus niger), andproducts from Animal kingdom (such asMoschus, Crotalus horridus, Lachesis, Tarentula,Lac defloratum) are prescribed based on the
individual characteristics and symptoms of thepatients.
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Insulin an organo therapic remedy is prescribedin critical cases of diabetes, in lean and thinconsumptive patients and also in coma.
Pancreatin, adrenalin, urea, lecithin are the otherorgano therapic remedies. Biochemic remediesfor diabetes mellitus are Nat mur, Nat sulph, Kaliphos, Kali mur and Kali sulph.
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The metals are usedfor treatment of patientswith hypertension, diabetic nephropathy,arteriosclerosis, mentally and physically exhausted and
various other symptoms. The minerals, vegetables and
animal products are used to manage symptoms such asweakness and prostration, gangrene, diabetescomplicated with digestive troubles, impotence, oculartroubles and other complications of diabetes. Thehomeopathic remedy prescribed to a patient depends onhis/her symptoms and characteristics. Hence two
patients may have diabetes but their prescriptions maybe completely different.
http://www.onlymyhealth.com/high-blood-pressure-hypertension-1295953342.htmlhttp://www.onlymyhealth.com/diabetic-nephropathy-1295951463.htmlhttp://www.onlymyhealth.com/high-blood-pressure-hypertension-1295953342.htmlhttp://www.onlymyhealth.com/diabetic-nephropathy-1295951463.htmlhttp://www.onlymyhealth.com/diabetic-nephropathy-1295951463.htmlhttp://www.onlymyhealth.com/high-blood-pressure-hypertension-1295953342.html8/13/2019 p m Seminar
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Homeopathic treatment with drugs can improvethe general well being of the person withdiabetes. In patients with poor general health it
can be very difficult to achieve good control ofdiabetes. Improvement of general healthimproves the general sense of well-being,decreases the dose and number of drugs neededto control blood glucose and improves bloodglucose control. Remedies such as Syzygium,Uranium nitricum, Phloridzin (obtained from theroot of the apple and other fruit trees) are given toimprove the general health of the patient.
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PHOSPHORUS
Adapted to tall slender persons of sanguinetemperament.
Nervous, weak, desire to be magnetised. Over sensitiveness of all senses.
A weak, empty, all gone sensation in head, chestand entire abdomen.
Constipation: feces slender, long, dry, tough andhard. Voided with great difficulty.
It is useful in diabetes and pancreatic ds especiallyin those of a tuberculous or gouty diathesis.
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URANIUM NITRATE
It has polyuria, polydypsia, dryness ofmouth and skin.
It causes sugar in the urine.
It lessens sugar and quantity of urine.
Enormous appetite and thirst.
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BRYONIA
Adapted to persons of rheumatic or goutydiathesis.
Excessive dryness of mucous membrane of
entire body, lips and tongue dry, parched,cracked.
Great thirst.
Constipation: inactive, no inclination, stoollarge, hard, dark, dry, as if burnt.
Persistent bitter taste. The patient is languid, morose and dispirited.
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PHOSPHORIC ACID
The urine is increased, perhaps milky in colourand containing much sugar.
There will be loss of appetite.
Unquenchable thirst Patient passes large qty of pale colorless urine.
phosphatic deposit in urine
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INSULIN
It maintains the blood sugar at normal leveland the urine remains free of sugar.
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LACTIC ACID
Urinates copiously and freely.
Urine light yellow and saccharine.
Thirst, nausea, debility, voracious appetite andcostive bowels
Dry skin, dry tongue,gastralgia.
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SYZYGIUM JAMBOLANUM
Capable of diminishing the amount of sugarin urine.
Used as palliative.
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CAUSTICUM
SCILLA
STROPHANTHUS
may be of use in diabetes insipidus.
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NATRUM SULPHcorresponds to the hydrogenoidconstituition, with dry mouth and throat.
LYCOPODIUMpatients are emaciated,weary,increased appetite and great thirst. Pale profuseurine.
ACETIC ACIDit has passing of large quantities ofpale urine, intense thirst,hot,dry and markeddebility.
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PODOPHYLLUMhas a bitter taste, but the tongueis flabby. It may be of use in the ds.
CHIONANTHUSthirst and copious urine.
Constipation with light colored stools devoid ofbile.
NAT SULPHpolyuria, intense itching of skin ofthighs.
ARGENTUM METurine is profuse, turbid andsweet odor. Micturition frequent and copious.
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