Latent Autoimmune Diabetes in Adults (LADA) is a slow progressive form of Type 1 Diabetes.
* autoimmune destruction of pancreatic B-islet cells leading to an absolute insuloin deficiency within 2-6 years.
* Distinguished from Type 2 DM by presence of Islet autoantibodies especially to Glutamic Acid Decraboxylase (GAD)
TYPE 2 DM:
* progressive deterioration in glucose tolerance caused by insullin sensitivity and insulin secretion defects.
* Risk factors are: Obesity, hypertension, dyslipidemia and insulin resistance; a strong family history is also a risk factor.
TYPE 1 DM:
* absolute deficiency in Insulin secretion, and usually arises in children aged 15 years or younger.
* 13% of all diabetes in Australia
* Specific autoimmune destruction of insulin producing B-cell in pancreas leading to a dependency in insulin replacement.
* Serological markers for this autoimmune process include: Islet cell cytoplasmic autoantibodies (ICA), autoantibodies to to GAD and insulin or to the tyrosine phosphate IA2.
Patients with LADA:
* more likely to be symptomatic
* poor glycemic control
* existence of other autoantibodies (GAD)
* present clinically as osmeone with Type 2 DM, do not require insulin immediately after diagnosis and may be overweight.
* UKPDS 1997: one in 10 adults aged 25-65 years with Presumed Type 2 DM actually had GAD antibodies.
Showing posts with label Diabetes management. Show all posts
Showing posts with label Diabetes management. Show all posts
Monday, December 14, 2009
SUMMARIZED FROM AUSTRALIAN DOCTOR DIABETES SUPPLEMENT NOV 2009
8 different classes of medications are now available for treatment of diabetes:
1. GLP-1 and DPP-IV
2. insulin 1921
3. Sulfonylureas:stimulate insulin release 1946
4. Metformin:reduced hepatic glucose production and insulin resistance 1957
5. Acarbose: reduces carbohydrate digestion 1995
6. Thiazolidinediones "glitazones": reduce insulin resistance 1997
7. Repaglinide: short term insulin stimulation 1997
8. Exenatide GLP-1 Analogue 2005
9. Sitagliptin DPP-IV inhibitor enhances GLP-1 action 2006
GLP-1 resembles the structure of glucagon but has an OPPOSITE physiological effect:
1. PROMOTES insulin secretion
2. INHIBITS glucagon release
3. REDUCES circulating glucagon levels
GLP-1 is released from the gut wall in response to food. it is degraded very rapidly by enzyme dipeptidyl peptidase-IV (DPP-IV)
New GLP-1 based therapies are: Exenatide an INJECTABLE GLP-1 analogue or mimetic, DPP-IV INHIBITORS such as sitagliptin which slow degradation of GLP-1 and boosts its effects.
LOW RISK HYPOGLYCEMIA FROM TREATMENT AS EFFECT of GLP-1 DECLINES as blood glucose levels fall.
EXENATIDE
developed from exendin-4 compound of Gila monster salivary gland.
In clinical trials: S/c EXENATIDE BID decreased HBA1C by 0.8-0.9% and associated with INCREASED SATIETY, REDUCED APPETITE, WEIGHT LOSS and low rate of hypoglycemia.
side effects"nausea, sweating, vomiting, dizziness,
weight loss 2.5kg at 12 momths using exenatide compared to 2.9kf weight gain with insulin.
PROF DRUCKER from Banting and Best Diabetes Centre in Toronto recommends: EARLY combination therapy with METFORMIN and Sitagliptin.
METFORMIN ALSO STIMULATES GLP-1 SECRETION!
GLP-1 is also CARDIOPROTECTIVE.
Sitagliptin is indicated in Australia for combination therapy woth metformin, sulfonylureas and thiazolinedinediones.
Consensus recommendations from American Diabetes Association and European Association the Study of Diabetes (Diabetes Care 2009;32:193-203):
* Tier 1 medications with well-established safety records and efficacy are diet, eexrcise, metformin, insulin and sulfonylureas.
* Tier-2 less 'well validated" are pioglitazone and GLP-1 agonist exenatide. Useful if recurrent hypoglycemia or for promotion of weight loss.
* Other therapy includes: acarbose, repaglinide, DPP-IV inhibitors such as sitagliptin.
8 different classes of medications are now available for treatment of diabetes:
1. GLP-1 and DPP-IV
2. insulin 1921
3. Sulfonylureas:stimulate insulin release 1946
4. Metformin:reduced hepatic glucose production and insulin resistance 1957
5. Acarbose: reduces carbohydrate digestion 1995
6. Thiazolidinediones "glitazones": reduce insulin resistance 1997
7. Repaglinide: short term insulin stimulation 1997
8. Exenatide GLP-1 Analogue 2005
9. Sitagliptin DPP-IV inhibitor enhances GLP-1 action 2006
GLP-1 resembles the structure of glucagon but has an OPPOSITE physiological effect:
1. PROMOTES insulin secretion
2. INHIBITS glucagon release
3. REDUCES circulating glucagon levels
GLP-1 is released from the gut wall in response to food. it is degraded very rapidly by enzyme dipeptidyl peptidase-IV (DPP-IV)
New GLP-1 based therapies are: Exenatide an INJECTABLE GLP-1 analogue or mimetic, DPP-IV INHIBITORS such as sitagliptin which slow degradation of GLP-1 and boosts its effects.
LOW RISK HYPOGLYCEMIA FROM TREATMENT AS EFFECT of GLP-1 DECLINES as blood glucose levels fall.
EXENATIDE
developed from exendin-4 compound of Gila monster salivary gland.
In clinical trials: S/c EXENATIDE BID decreased HBA1C by 0.8-0.9% and associated with INCREASED SATIETY, REDUCED APPETITE, WEIGHT LOSS and low rate of hypoglycemia.
side effects"nausea, sweating, vomiting, dizziness,
weight loss 2.5kg at 12 momths using exenatide compared to 2.9kf weight gain with insulin.
PROF DRUCKER from Banting and Best Diabetes Centre in Toronto recommends: EARLY combination therapy with METFORMIN and Sitagliptin.
METFORMIN ALSO STIMULATES GLP-1 SECRETION!
GLP-1 is also CARDIOPROTECTIVE.
Sitagliptin is indicated in Australia for combination therapy woth metformin, sulfonylureas and thiazolinedinediones.
Consensus recommendations from American Diabetes Association and European Association the Study of Diabetes (Diabetes Care 2009;32:193-203):
* Tier 1 medications with well-established safety records and efficacy are diet, eexrcise, metformin, insulin and sulfonylureas.
* Tier-2 less 'well validated" are pioglitazone and GLP-1 agonist exenatide. Useful if recurrent hypoglycemia or for promotion of weight loss.
* Other therapy includes: acarbose, repaglinide, DPP-IV inhibitors such as sitagliptin.
Sunday, May 18, 2008
Public Health Talks 19/5/2008-25/5/2008
Topic: Management of Menopause
Date: Saturday 24/5/2008
time:2-4 p.m
location: Tung Shin Hospital
Admission is free.
contact: 03 2072 1655
Topic: Diabetes Management & Diet
Date: 25/5/2008
time: 3-5p.m
location: SJMC, North Tower conference room
contact: register at 03-5639 1556 between 10a.m to 5p.m
Heart Chocolate Indulgence at the Kuala Lumpur Heart Centre.
location: 1B-G-2, Ground Floor, Plaza Sentral, Jalan Stesen Sentral, KL Sentral
Date: Wednesday 21/5/2008
Time: 12p.m onwards
get your passes at www.heart.com.my
http://www.heart.com.my/images/heart_choc.gif
http://www.heart.com.my/heart_choc.asp
Wellness Medical Qigong
organized by KL-Petaling Jaya Alzheimer Caregivers Support Group
Date: Wednesday 24 May 2008
place: Alzheimer's Day Care centre at 9, Lorong Bukit Raja, Taman Seputeh
time: 2.30 p.m
Info: Alzheimer's Foundation Malaysia
o3-22603158
Topic: Management of Menopause
Date: Saturday 24/5/2008
time:2-4 p.m
location: Tung Shin Hospital
Admission is free.
contact: 03 2072 1655
Topic: Diabetes Management & Diet
Date: 25/5/2008
time: 3-5p.m
location: SJMC, North Tower conference room
contact: register at 03-5639 1556 between 10a.m to 5p.m
Heart Chocolate Indulgence at the Kuala Lumpur Heart Centre.
location: 1B-G-2, Ground Floor, Plaza Sentral, Jalan Stesen Sentral, KL Sentral
Date: Wednesday 21/5/2008
Time: 12p.m onwards
get your passes at www.heart.com.my
http://www.heart.com.my/images/heart_choc.gif
http://www.heart.com.my/heart_choc.asp
Wellness Medical Qigong
organized by KL-Petaling Jaya Alzheimer Caregivers Support Group
Date: Wednesday 24 May 2008
place: Alzheimer's Day Care centre at 9, Lorong Bukit Raja, Taman Seputeh
time: 2.30 p.m
Info: Alzheimer's Foundation Malaysia
o3-22603158
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