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Type II Diabetes, images asessment of diabetes, download insulin injection…

- - - - Enteric-coated acetylsalicylic acid (80 mg or 325 mg)
      - Insulin (1-4 injections/day)
        
        Rapid-acting analogue
        
        Onset of action
        10-15 min
        
        Administered 0 to 15 min before meal or up to 15 min after meal
        
        Short-acting
        or regular
        
        Onset 1/2 to 1 hour, peak 2-4 hours, duration 3-5 hours
        
        Intermediate-acting
        
        Subcutaneous administration
        
        Duration from 10 to 16 hr
        
        Peak at 4 to 10 hr
        
        Extended long-acting analogue
        
        Once daily subcutaneous at bedtime
        
        Lasts up to 30 hr, no peak action
        
        Combination therapy (Premixed)
        
        Short- or rapid-acting insulin mixed with intermediate insulin
        
        Insulin injections are best absorbed at the abdomen, followed by the arm, thigh and buttocks.
        
        Alcohol is not to be used except in the hospital.
        
        Insulin pens are more user-friendly
      - Lipid-lowering therapy
      - Oral antihyperglycemic agents and non-insulin injectables agents
      - Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
      - Oral antihyperglycemic agents work decreasing insulin resistance, increasing insulin production and decreasing hepatic glucose production.
    - - HgbA1C can be reduced to a max of 1%-2% at the initial stages of Diabetes.
      - Reduction in caloric intake desirable for overweight or obese patients.
      - Effective for glucose control
      - Low-fat diet. Less than 35% of energy
      - High-fiber foods 25 to 50g/day.
      - Protein intake at 15%
      - Carbohydrate intake 45% to 60% of energy.
      - Eating 3 meals/day at regular times, intervals no more than 6 hr apart.
      - Limiting sugars and sweets such as sugar, regular pop, desserts, candies, jam, and honey.
      - Drinking water when thirsty
      - Consuming foods with low Glycemic Index which is used to describe the rise in blood glucose levels after a meal.
    - - Regular consistent exercise is essential.
      - Start slow with gradual progression under practitioner control
      - Types of activities:
        
        Light (100-200 kcal/hr)
        
        Moderate (200-350 kcal/hr)
        
        Vigorous (400-900 kcal/hr)
      - Strenuous activity can be perceived as a stress causing temporary elevation in blood glucose.
- - - - Asian, South Asian, particularly Chinese followed by Indian, and by Latin American, Indigenous, African Descent have the highest prevalences (Prasad & Groop, 2015).
      - Some specific genes have been identified that reliably are linked to type 2 diabetes across multiple populations, namely the CAPN10 and TCF7L2 that cause blood glucose insulin dysregulation (Prasad & Groop, 2015).
      - Obesity, sedentary lifestyle and diet have been identified to be stronger predictors of type 2 diabetes which have a genetic heritable basis as well (Ali, 2013).
    - - Weight gain/obesity
- - - - Ketosis is the fall in pH in the body and Ketonuria is low pH of urine.
      - Glucose levels rise and cause dehydration and loss of minerals and electrolytes, vomiting occurs and the patient may go into a coma.
      - Acetone breath with a sweet fruity odour is a sign of late stage compensatory pH lowering mechanisms.
      - Electrolyte and water IV therapy should be initiated to bring potassium levels ≥ 3.3 mmol and then insulin therapy is initiated to stabilize the patient.
    - - This causes release of epinephrine that stimulates the autonomic nervous system and causes anxiety, nervousness, palpitations, pallor.
      - Brain doesn’t receive enough glucose which causes vision changes, stupor, confusion and coma.
      - Snacks should be eaten in moderation and must not include fat that decreases the glucose absorption rate.
      - Asymptomatic hypoglycemia is when there are no symptoms of hypoglycemia, but the blood glucose levels are dangerously low.
  - - - 2-3 times the greater risk for cerebrovascular and heart disease in diabetics.
      - Insulin resistance interacts with dyslipidemia and increases risk of atherosclerosis.
      - Atherosclerotic plaque is one of the causes and it is increased in type II diabetes.
    - - Usually happens 10-20 years after onset of DM after the damage has been made.
    - - Nonproliferative retinopathy is when aneurysms form in the retinal capillaries, capillary fluid leaks out from them and causes edema.
      - In proliferative retinopathy, capillaries become occluded, new capillaries that can hemorrhage easily form to compensate for this and the patient starts seeing black or red spots until they go blind, they may pull on the retina and cause tears that may progress to retinal detachment.
      - Frequent eye exams are necessary to diagnose and prevent the condition, and vitrectomy may be performed which is the aspiration of excess fluids from the eye through an incision.
    - - Sensory neuropathy is when the patient feels paresthesias or increased sensation of pain even to pressure from the bed sheets, loses pain sensation or has pains at night.
        
        It can be treated by reducing abnormal levels of blood glucose or with pain medications.
      - Autonomic neuropathy affects nearly all body systems.
        
        Leads to hypoglycemic unawareness, incontinence, diarrhea, urinary retention.
        
        Postural hypotension, resting tachycardia and painless myocardial infarction, sexual dysfunction is the first sign of neuropathy.
        
        Neurogenic bladder develops and causes difficulty voiding, stream of urine and possible infection.
    - - Sensory neuropathy causes the patient to have poor sensation in the lower extremities which increases foot injury and ulceration risk.
      - PVD decreases oxygen supply and makes wound healing worse.
      - Charcot foot develops due to neuropathy and chronic inflammation and causes joint dysfunction and foot drop which causes unequal distribution of weight and ulcers.
    - - Hypertension is a big risk factor for retinopathy and nephropathy so it is aggressively treated.
- - - - Hemoglobin A1C shows average blood glucose over the past 3 months.
  - - - Ophthalmological examination may show diabetic retinopathy.
      - Pigmented lesions on legs, loss of hair on toes, reduced sensation in feet.
      - Hypotension, diminished peripheral pulses, fruity breath.
      - High creatinine, LDL, VLDL cholesterol and triglycerides, low HDL.
    - - Symptoms: nonspecific, fatigue, recurrent infections, recurrent vaginal yeast or monilia infection, prolonged wound healing, visual changes, frequent urination.
      - Past health history, genes, compliance with insulin medications.