Obese patient with striae distensiae, and Acanthosis nigricans. Obesity ,hypertension, DM, Dyslipedemia all form Metabolic syndrome ,due to insulin resistance. Need to rule out Type 1 DM( Mody ) considering young age of onset . Estimation of insulin and C Peptide will clear this doubt. Need to assess end organ damage and DKA. Admission IV Actrapid, hourly, with 1/2 normal saline infusion ,( since patient is hypertensive) , IV potassium chloride, statins and Fenofibrate. Anti hypertensive, preferably ARB. Once sugar is controlled , life style modifications ,to reduce weight and control sugar. Diet, exercise . Inj Lantus + actrapid once daily , with SGLT 2 inhibitor, + gliptins / glimipride can be considered once patient's sugar is controlled well . Patient education is important since this is a life long battle.
Hypokalamia with hyperglycemia Uncontrolled hba1c Blurred vision with Polydypsia and polyurea suggest pt heading to DIABETIC KETOACIDOSIS and likely in hyprrglycemic coma Hence needs ICU management Put him on insulin pump And inj kcl drip Uncontrolled hypertension get control gradually Manage triglyceridemia with rosuvastatin
UNCONTROLLED DIABETES WITH.. ASSOCIATED COMPLICATIONS.. & .. HYPERTRIGLYCERIDEMIA.. NEED'S.. ENDOCRINOLOGIST OPINION..
Clear symptoms of Diabetes mellitus and that too high. Hypertension is high. Both require immediate treatment
Uncontrolled diabetes mellitus with hypertension with hyperlipidemia
Young age and very high blood sugar It is indicative of insulin dependent diabetes mellitus or insulin resistance This patients needs insulin for control of blood sugar He has hypokalemia, which may become aggravated after administration of insulin, therefore he may need show infusion of potassium in addition to insulin Majority of symptoms are related to very high blood sugar Blood sugar need to be lowered slowly in order to avoid cerebral oedema because of rapid lowering of blood sugar Adequate hydration need to be maintained Antihypertensive for treatment of hypertension Serum C peptide level, Antibody to be checked Islet cell antibodies, antibodies to glutamic acid decarboxylase (GAD-65), insulin autoantibodies (IAA)
All vitals and basic metabolic order is worst effected. Long way to go. First best diabetes co trolled under consideration of Diabetologist and BMI correction below 30 by advice of nutritiona and dieticianl expert.
Acanthosis nigricans +nt (It is the sign of DM) Distensiae striae +nt (due to obese) Uncontrolled DM Dyslipidemia Refer to endocrine department.
Start iv insulin infusion .iv fluids sc insulin injections......check urine ketones ,c peptide GAD antibody
Cases that would interest you
- Login to View the image
Mr.X. 30 years ,taking Biphasic insulin two times day.He was brought to me in a semi conscious state .History not effectively able to elicit due to patients condition,and relatives illiterates .capillary blood glucose reveled HI ,it means his blood sugar was more than 600 mg per DL.. fast acting aspart ,insulin was started 10 units SC hourly basis .Pt is not willing for iv fluids management, in spite there is indication of dehydration which is warranted in this case. On third hour his CBG showed 540 mg of blood glucose by the blood glucose monitor.. 3 hours later he gained consciousness ,advised to go home. FAIS,Fast acting Insulin Aspart ,was advised for bolus insulin regime of 16 units for all meals .Plus NPH for BiD of 30/units for basal control. A week back reported to me.The photo was shot and published here.His Weight was 38 kg. He has altered bowel habits ,polys, ,fatigability, aggressive behaviour,poor sleep, mild cough,,Patient feel better. I remodified the insulin regime ,of Aspart of bolus regime ,and and multiple dose of basal regime . Advised rich proteins. Learned personnel can contribute ,and discuss widely..Dr. Elumalai Subbarayan2 Likes11 Answers
- Login to View the image
15 Amazing Health Benefits Of Acerola stylecraze.com Oct 16, 2017 12:00 PM ￼ Acerola, scientifically known as Malpighia Glabra/Emarginata, is a bright red juicy berry with lots of seeds, good taste and numerous health as well as medicinal benefits. It is used worldwide as an effective remedy for common cold, hay fever, depression, gum infection, tooth decay, and several other health issues. But thorough researches have revealed that it can be consumed to get rid of a number of chronic and deadly diseases too. Top 15 Health Benefits Of Acerola: Acerola comes packed with nutrients, which helps to keep the body fit and disease-free. Here are the top 15 acerola health benefits: 1. Vitamin C Supplement: Acerola is widely known for its high level of Vitamin C content. It contains the second highest amount of Vitamin C right after the neuro-protective berry ‘camu camu’. Consumption of only a couple of these berries can fulfill our recommended daily intake of Vitamin C. Moreover, about 180 ml of acerola juice contains as much as vitamin C present in 14 liters of orange juice. 2. Prevents Scurvy: Being a rich source of Vitamin C, acerola can put a stop to scurvy, which is caused due to the deficiency of this vitamin. 3. Vitamin A Supplement: The Vitamin A content of a small acerola berry is equal to that of a full-sized carrot! We can easily fulfill our daily needs of this vitamin by eating 1 or 2 acerola a day. So, it can be used as a natural Vitamin A supplement too. 4. Boosts Visionary Health: Because of its high level of Vitamin A content, it helps in making our vision better. It also helps avert retinal hemorrhages (bleeding in the eye) as well as cataract formation. 5. Provides Essential Nutrients: Apart from Vitamins C and A, acerola is also loaded with several other nutrients that are essential for maintaining the normal functionality of our system. These include B-Vitamins (B1 or thiamine, B2 or riboflavin, B3 or niacin, B5 of pantothenic acid, B9 or folic acid, etc.) minerals and electrolytes (iron, magnesium, potassium, calcium, zinc, copper, phosphorus, etc.), malic acid, sugars (sucrose, fructose, dextrose, etc.), dietary fiber, protein, lipids, fatty acids, and so on. 6. Rich In Antioxidants: Acerola is packed with polyphenolic anthocyanidin compounds, such as ferulic acid, quercetin, tannins, chlorogenic acid, cyanidin-3-glycoside, and many more, which offer excellent antioxidant properties. Moreover, the Vitamins A and C in the acerola juice concentrate work as natural antioxidants. All these help in preventing infections and cellular aging by making the blood free from harmful free radicals. 7. Enhances Immunity: The antioxidants, especially the phyto-chemical compounds as well as Vitamin C, present in the berry play a key role in making our immune system stronger. It eventually helps us stay away from inflammation, degenerative diseases, cancers, etc. 8. Increases Collagen Production: Studies have found that the Vitamin C content of acerola can produce sufficient collagen in our body, which is necessary for combating aging and enhancing the performances of sports persons. 9. Improves Metabolism: As said earlier, acerola comprises a good amount of B-complex vitamins, which assist our metabolism and makes the digestion of carbohydrates, proteins and fats much easier. 10. Less Gastrointestinal Issues: The high dietary fiber content of the berry can keep our entire gastrointestinal system healthy by facilitating bowel movements and cleansing the intestines. Therefore, it treats digestive issues, such as constipation, diarrhea, dysentery, etc. 11. Offers Better Cardiac Health: Acerola is capable of keeping our cardiovascular system strong by regulating the blood pressure level and normalizing the heart rhythm. The extract of the berry is also known to put off coronary artery diseases, atherosclerosis, thrombosis, etc. 12. Reduces Blood Sugar Level: It is already said that the acerola berries contain lots of antioxidants including chlorogenic acid. When taken in the form of acerola juice benefits in controlling glucose level in our bloodstream, thus reduces the risks of hyperglycemia, diabetes mellitus and type-2 diabetes. 13. Fights Against Oxidative Stress: Acerola extract is very helpful in fighting against ‘Oxidative Stress’, which prevents premature aging. It is beneficial for keeping a number of fatal diseases at bay. 14. Prevents Lung Cancer: The acerola fruit has shown its efficiency in treating lung cancer by decelerating and stopping the abnormal growth of cancerous cells in the organ. 15. Promotes Weight Loss: Being extremely low in fat and calories, acerola helps lose excess body weight. Moreover, it boosts metabolism and provides required nutrition to our cells, which are needed to control obesity and achieve optimum health. So, include acerola in your regular diet today and give yourself a significant health boost! Was this article helpful? Share your views with us in the comments section below. Recommended Articles: Report a problemDr. Tapan Kumar Sau4 Likes9 Answers
- Login to View the image
A 9 yr old boy weighing 46 kg comes with a c/o dark thickened coarse skin over the nape of neck and bilateral axillae. Parents too are obese . Other than high serum triglycerides and raised SGPT, no other abnormality in other investigations. Other than lifestyle modifications, what else can be given. Do statins have a role in children?Dr. Chhaya Shah0 Like8 Answers
- Login to View the image
You can find here key changes in ADA guidelines. They are published in Diabetes Care once yearly in the month of January. GENERAL CHANGES The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the ADA has long been a leader in producing guidelines that capture the most current state of the field. To that end, the “Standards of Medical Care in Diabetes” now includes a dedicated section on Diabetes Technology, which contains preexisting material that was previously in other sections that has been consolidated, as well as new recommendations. SECTION 1. IMPROVING CARE AND PROMOTING HEALTH IN POPULATIONS Additional information was included on the financial costs of diabetes to individuals and society. Because telemedicine is a growing field that may increase access to care for patients with diabetes, discussion was added on its use to facilitate remote delivery of health-related services and clinical information. SECTION 2. CLASSIFICATION AND DIAGNOSIS OF DIABETES Based on new data, the criteria for the diagnosis of diabetes was changed to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from same sample). The section was reorganized to improve flow and reduce redundancy. Additional conditions were identified that may affect A1C test accuracy including the postpartum period. SECTION 3. PREVENTION OR DELAY OF TYPE 2 DIABETES This section was moved and is now located before the Lifestyle Management section to better reflect the progression of type 2 diabetes. The nutrition section was updated to highlight the importance of weight loss for those at high risk for developing type 2 diabetes who have overweight or obesity. Because smoking may increase the risk of type 2 diabetes, a section on tobacco use and cessation was added. SECTION 4. COMPREHENSIVE MEDICAL EVALUATION AND ASSESSMENT OF COMORBIDITIES On the basis of a new consensus report on diabetes and language, new text was added to guide health care professionals’ use of language to communicate about diabetes with people with diabetes and professional audiences in an informative, empowering, and educational style. A new figure from the ADA-European Association for the Study of Diabetes (EASD) consensus report about the diabetes care decision cycle was added to emphasize the need for ongoing assessment and shared decision making to achieve the goals of health care and avoid clinical inertia. A new recommendation was added to explicitly call out the importance of the diabetes care team and to list the professionals that make up the team. A recommendation was added to include the 10-year atherosclerotic cardiovascular disease (ASCVD) risk as part of overall risk assessment. The fatty liver disease section was revised to include updated text and a new recommendation regarding when to test for liver disease. SECTION 5. LIFESTYLE MANAGEMENT Evidence continues to suggest that there is NOT an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, more discussion was added about the importance of macronutrient distribution based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Additional considerations were added to the eating patterns, macronutrient distribution, and meal planning sections to better identify candidates for meal plans, specifically for low-carbohydrate eating patterns and people who are pregnant or lactating, who have or are at risk for disordered eating, who have renal disease, and who are taking sodium–glucose cotransporter 2 inhibitors. There is NOT a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized. A recommendation was modified to encourage people with diabetes to decrease consumption of both sugar sweetened and nonnutritive-sweetened beverages and use other alternatives, with an emphasis on water intake. The sodium consumption recommendation was modified to eliminate the further restriction that was potentially indicated for those with both diabetes and hypertension. Additional discussion was added to the physical activity section to include the benefit of a variety of leisure-time physical activities and flexibility and balance exercises. The discussion about e-cigarettes was expanded to include more on public perception and how their use to aide smoking cessation was not more effective than “usual care.” SECTION 6. GLYCEMIC TARGETS This section now begins with a discussion of A1C tests to highlight the centrality of A1C testing in glycemic management. To emphasize that the risks and benefits of glycemic targets can change as diabetes progresses and patients age, a recommendation was added to reevaluate glycemic targets over time. The section was modified to align with the living Standards updates made in April 2018 regarding the consensus definition of hypoglycemia. SECTION 7. DIABETES TECHNOLOGY This new section includes new recommendations, the self-monitoring of blood glucose section formerly included in Section 6 “Glycemic Targets,” and a discussion of insulin delivery devices, blood glucose meters, continuous glucose monitors (real-time and intermittently scanned, and automated insulin delivery devices. The recommendation to use self-monitoring of blood glucose in people who are not using insulin was changed to acknowledge that routine glucose monitoring is of limited additional clinical benefit in this population. SECTION 8. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES A recommendation was modified to acknowledge the benefits of tracking weight, activity, etc., in the context of achieving and maintaining a healthy weight. A brief section was added on medical devices for weight loss, which are not currently recommended due to limited data in people with diabetes. The recommendations for metabolic surgery were modified to align with recent guidelines, citing the importance of considering comorbidities beyond diabetes when contemplating the appropriateness of metabolic surgery for a given patient. SECTION 9. PHARMACOLOGIC APPROACHES TO GLYCEMIC TREATMENT The section on the pharmacologic treatment of type 2 diabetes was significantly changed to align, as per the living Standards update in October 2018, with the ADA-EASD consensus report on this topic. This includes consideration of key patient factors: (a) important comorbidities such as ASCVD, CKD, and HF, (b) hypoglycemia risk, (c) effects on body weight, (d) side effects, (e) costs, and (f) patient preferences. To align with the ADA-EASD consensus report, the approach to injectable medication therapy was revised. A recommendation that, for most patients who need the greater efficacy of an injectable medication, a GLP-1 agonist should be the first choice, ahead of insulin. A new section was added on insulin injection technique, emphasizing the importance of technique for appropriate insulin dosing and the avoidance of complications (lipodystrophy, etc.). The section on non-insulin pharmacologic treatments for DM1 was abbreviated, as these are not generally recommended. SECTION 10. CARDIOVASCULAR DISEASE AND RISK MANAGEMENT For the first time, this section is endorsed by the American College of Cardiology. Additional text was added to acknowledge heart failure as an important type of cardiovascular disease in people with diabetes for consideration when determining optimal diabetes care. The blood pressure recommendations were modified to emphasize the importance of individualization of targets based on cardiovascular risk. A discussion of the appropriate use of the ASCVD risk calculator was included, and recommendations were modified to include assessment of 10-year ASCVD risk as part of overall risk assessment and in determining optimal treatment approaches. The recommendation and text regarding the use of aspirin in primary prevention was updated with new data. For alignment with the ADA-EASD consensus report, two recommendations were added for the use of medications that have proven cardiovascular benefit in people with ASCVD, with and without heart failure. SECTION 11. MICROVASCULAR COMPLICATIONS AND FOOT CARE To align with the ADA-EASD consensus report, a recommendation was added for people with type 2 diabetes and chronic kidney disease to consider agents with proven benefit with regard to renal outcomes. The recommendation on the use of telemedicine in retinal screening was modified to acknowledge the utility of this approach, so long as appropriate referrals are made for a comprehensive eye examination. Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. The gastroparesis section includes a discussion of a few additional treatment modalities. The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone. SECTION 12. OLDER ADULTS A new section and recommendation on lifestyle management was added to address the unique nutritional and physical activity needs and considerations for older adults. Within the pharmacologic therapy discussion, de-intensification of insulin regimes was introduced to help simplify insulin regimen to match individual’s self-management abilities. SECTION 13. CHILDREN AND ADOLESCENTS Introductory language was added to the beginning of this section reminding the reader that the epidemiology, pathophysiology, developmental considerations, and response to therapy in pediatric-onset diabetes are different from adult diabetes, and that there are also differences in recommended care for children and adolescents with type 1 as opposed to type 2 diabetes. A recommendation was added to emphasize the need for disordered eating screening in youth with type 1 diabetes beginning at 10–12 years of age. Based on new evidence, a recommendation was added discouraging e-cigarette use in youth. The discussion of type 2 diabetes in children and adolescents was significantly expanded, with new recommendations in a number of areas, including screening and diagnosis, lifestyle management, pharmacologic management, and transition of care to adult providers. New sections and/or recommendations for type 2 diabetes in children and adolescents were added for glycemic targets, metabolic surgery, nephropathy, neuropathy, retinopathy, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovary syndrome, cardiovascular disease, dyslipidemia, cardiac function testing, and psychosocial factors. SECTION 14. MANAGEMENT OF DIABETES IN PREGNANCY Women with preexisting diabetes are now recommended to have their care managed in a multidisciplinary clinic to improve diabetes and pregnancy outcomes. Greater emphasis has been placed on the use of insulin as the preferred medication for treating hyperglycemia in gestational diabetes mellitus as it does not cross the placenta to a measurable extent and how metformin and glyburide should not be used as first-line agents as both cross the placenta to the fetus. SECTION 15. DIABETES CARE IN THE HOSPITAL Because of their ability to improve hospital readmission rates and cost of care, a new recommendation was added calling for providers to consider consulting with a specialized diabetes or glucose management team where possible when caring for hospitalized patients with diabetes. SECTION 16. DIABETES ADVOCACY The “Insulin Access and Affordability Working Group: Conclusions and Recommendations” ADA statement was added to this section. Published in 2018, this statement compiled public information and convened a series of meetings with stakeholders throughout the insulin supply chain to learn how each entity affects the cost of insulin for the consumer, an important topic for the ADA and people living with diabetes.Dr. Peerzada Ovais Ahmad6 Likes7 Answers
- Login to View the image
DIABETES MELLITUS #HolisticMedicine #CCAUpdates Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.. Complications Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes Prevention There is no known preventive measure for type 1 diabetes. Type 2 diabetes – which accounts for 85–90% of all cases – can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and consuming a healthy diet. Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes. Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well. The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment. Management: Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).[medical citation needed] Lifestyle People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure. There is no single dietary pattern that is best for all people with diabetes. For overweight people with type 2 diabetes, any diet that the person will adhere to and achieve weight loss on is effective. Medications Medications used to treat diabetes do so by lowering blood sugar levels. There are a number of different classes of anti-diabetic medications. Some are available by mouth, such as metformin, while others are only available by injection such as GLP-1 agonists. Type 1 diabetes can only be treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs. Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver's production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II DM. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased to effect. Among medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not. Aspirin is also recommended for people with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes. Surgery A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.Sushmita Haodijam1 Like0 Answer