Dr. Louise Johnson-Loots
Specialist physician and insulin pump centre
Montana hospital, Pretoria

Diabetes types



Type 1 – auto immune
Type 2 - insulin resistant
Secondary – surgery, medication (i.e. steroids)

GDM ( gestational diabetes)

Type 1
 Younger than 30 yr
 Thin
 Auto-immune disease
 10-20% of Pt.
Type 2
 Older than 30 yr
 Obese –
♂ waist > 94 cm
♀ waist > 80 cm
 Ass diseases i.e.
HT,Dyslipiedemiae
 80% of Pt

Type 2 Type 1

Insulin resistance (metabolic syndrome)

First step on diabetes ladder

Waist circumference Male >94 cm
Female >80cm

Associated disease –Hypertension
- gout
-abnormal cholesterol

How to manage my metabolic abnormality?
 Know your numbers
 Set targets – keep to them
 Know your bar stool (diet, exercise ,medication)
 NO smoking!!
 Test regularly

Targets to achieve

Waist - 94 cm male, 80cm female

Blood pressure < 130/80mmHg

LDL cholesterol< 1.8

HDL cholesterol > 1.0

HbA1c < 7%

FPG < 5.5 , 2h PPG < 7.8

How to get to target?

Diet

Exercise 30 min brisk walking/day

Correct medication – suit your life style

Regular blood glucose testing – 2x/day on insulin
- wake up/2h PPG if on tablets

Test more if unwell

Diabetic diet sign language

Fist – carbohydrate portion (tennis ball size)

Palm size – protein ( thickness of thumb ball )

Two open hands – vegetables

Thumb tip – fat

3 regular meals- don’t skip

Enough water - weight ( 84 kg = 8 glasses)

Alcohol and diabetes

Female 1 unit/day

Male 2 units/day

Unit - single whiskey/brandy (spirits)
- 200 ml dry white/red wine

Stay away from mixes, beer, sherry ,port liqueur

Important pitfalls

Diabetic sweets - too much fat

Flavored water = Coke in calories!!

Fruit juice

Not what we eat but how much of it!

Medication - Type 2 diabetes

Metformin basis of type 2 management

Incretin – tablets and injections (see second lecture after lunch break)

Sulphonylurea – hypoglycemia

TZD- pioglitazone – swelling of feet

Medication Type 1 Diabetes

Insulin –to suit your lifestyle

Basal/bolus

Basal( long acting) Levemir, Lantus,

Bolus (short acting)– novorapid,apidra,humalog

Fixed mixes –novomix,humalog mix25

Insulin pumps

100
?
80
Time of diagnosis
60
40
Pancreatic function
= 50% of normal
20
0
― 10 ―8 ―6 ―4 ―2
Time (years)
0
HOMA=homeostasis model assessment.
Adapted from Holman RR. Diabetes Res Clin Pract 1998;40(suppl 1):S21 ― 5.
2 4 6

 11/1/1922
 Leonard Thompson
 14yr
 25 days on dog insulin

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Complications

Preventable

Preventable!

Preventable!!

Know the rules of the metabolic abnormality to prevent the disease

Rules for diabetes

Rule 1 – medical check 6 monthly with a specialist physician –Blood pressure, kidney
,heart,feet sensation and blood flow.

Rule 2 – eye check at an eye specialist (not the person giving the glasses)

Rule 3 – no bare foot walking

More rules

Rule 4 – sin once every 14 days (ice cream
,chocolate ,cookies etc)

Rule 5 - if female and your baby weighed
>4.0kg – get screened for diabetes yearly

Rule 6 – Become the captain of your own ship !