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Programme details:

Date: 01st March 2019

Venue:
Ibrahim Medical College, Shahbag campus(BIRDEM)
(College building,6th floor,Hall no:701)
Schedule:

Time deatails

9:00 A.M Reporting and study material collection

9:15-9:45 A.M Programme inauguration

9:45-12:00 PM Lecture by keynote speaker(1st Layer learning)

12:00-4:00P.M Second layer learning

4:15-5:30 PM Clinical based session(3rd layer learning)

1:00-2:00 P.M Lunch & Prayer break(Lunch will be provided)

4:00-4:15 PM Snacks
 To whom it may concern
Diabetes mellitus is a vast topic.So,it is nearly imposible to gather all the
knowledge in a single day long session.But we have tried to make the way
shortcut.For effective learning,please memorize the following tables.These
are recall based content.Its impossible to understand the lecture, if u fail to
recall the given contents.

Thank you
Inferences of glucose levels in different diagnostic procedures are given below (based
on WHO/IDF and ADA criteria):

Oral Glucose Tolerance Test (OGTT)

Inference 0 min glucose level 120 min glucose level
(venous plasma) (venous plasma)
Diabetes Mellitus (DM) >7.0 mmol/L &/or >11.1 mmol/L
Impaired Glucose Tolerance (IGT) <7.0 mmol/L & 7.8 to <11.1 mmol/L
Impaired Fasting Glucose (IFG) 6.1*to <7.0 mmol/L & <7.8 mmol/L
Normal <6.1* mmol/L & <7.8 mmol/L
*5.6 mmol/L
OGTT denotes one as Diabetic or IGT or IFG or Normal

Fasting Plasma Glucose

Inference Glucose level (venous plasma)
Diabetes Mellitus (DM) >7.0 mmol/L
Impaired Fasting Glucose (IFG) 6.1*to <7.0 mmol/L
Normal <6.1* mmol/L
*5.6 mmol/L

FBG can denote one as Diabetic or IFG but not as normal. A person of either NFG or
IFG, if subjected to OGTT, may become Diabetic or IGT.

Random Plasma Glucose (RPG)

Inference Random glucose level (venous plasma)
Diabetes Mellitus >11.1 mmol/L(+Symptom of hyperglycemia)
Diabetes Mellitus uncertain 5.5 to <11.1 mmol/L
Diabetes Mellitus unlikely <5.5 mmol/L

RPG can suspect one as Diabetic or Non-diabetic. It is useful when a person is

suspected on clinical ground.

HbA1c
Inference HbA1c(%)
Diabetes Mellitus > 6.5
Pre-diabetes 6.0*.6.4
Normal <6.0*
*5.7% (ADA)
 Drugs in diabetes mellitus
Pharmacological agents are of 2 types
1. Oral anti-diabetic drugs (OADs) A. Insulin secretagogues
B. Insulin sensitizers
C. Alpha-glucosidase inhibitors
D. Incretin mimetics
E. SGLT-2 inhibitors
F. Others
2. Injectable agents A. Insulin
B. Other agents
Inhaled insulin is also available

Classification of OADs
Class Name Duration of action (hr) Mode of excretion
A. Secretagogues
1st generation (Not in use at present)
Tolbutamide 6-12 Mostly urine
Chlorpropamide 24-72 Urinef
Sulphonylurese
2nd generation
Glibenclamide 24 Urine & faeces
Glipizide 8-12 Mostly urine
Gliclazide 8-12 Urine & faeces
Glimepiride 24 Urine & Faeces
Meglitinide analogue
Repaglinide 4-5 Mostly urine
Non-sulphonylureas
d-phenylalanine derivative
Nateglinide 4-5 Mostly urine
B. Insulin sensitizers
Biguanides Metformin 8-12 Mostly urine
Thiazolidinediones Pioglitazone 24 Urine & faeces
 Rosiglitazone 24 Urine & faeces
C. Alpha-glucosidase inhibitors
Acarbose 4 Faeces & uring
Miglitol 4 Urine
Voglibose NA Mostly urine
D. DPP-4 inhibitors
Sitagliptin 24 Mostly urine
Vildagliptin 24 Mostly urine
Linagliptin 24 Mostly urine
Saxagliptin 24 Urine & faeces
Alogliptin 24 Mostly urine
E. SGLT-2 inhibitors
Dapagliflozin 24 Urine & faeces
Canagliflozin 24 Mostly urine
Empagliflozin 24 Urine & faeces
F. Other agents
Dopamin-2 agonists Bromocriptine 24 Urine & faeces
Bile acid sequestrants Colesevelam 24 Faeces
Injectable agents:
Insulin is the main injectable agent in treatment of diabetes.Now a days other agents
are also available.Injectable agent include:

Classification of Injectable Anti-diabetic Agents

Class Name Onset of Action Peak Action Duration Time with
meals
A. Insulin
1.Conventional
Short Acting Regular 30-60 min 2-3 hours 6-8 hours 30-60 min a/c
(higher the BG
more the
interval)

Intermediate Acting NPH, Lente 2-4 hours 6-8 hours 12-18 hours 30-60 min a/c;
Or bed time
Long Acting Ultralente 4-6 hours 8-14 hours 24-36 hours No specific time

2. Analogues
Rapid Acting Aspart, 5-15 min 1-1.5 hours 3-4 hours With meals
Analogues Lispro, (within 15min
Glulisine ac/pc)

Long Acting Glargin, 2-4 hours No Peak 24 hours No Specific

analogues Detemir time
Ultra long Acting Degludec 0.5-1.5 hours No peak 40+ hours No Specific
analogues (Half Life time
24+hours)

3. Premixed (biphasic)
Conventional/human Short acting and intermediate acting in proportion of 30/70%,50/50%, 25/75%
Premixed
Premixed analogues Rapid acting analogue and intermediate acting (protaminated rapid acting) analogue
in
Proportion of 30/70 %,50/50%, 25/75%
B. Other agents
GLP-1 agonists Exenatide Type 2 DM; Weight friendly ; 10 ug(in 2 doses ) ac within 1 hour of
meal; increase dose after 4 weeks (max 20ug/day)
Liraglutide Type 2 DM; Weight friendly; 0.6mg daily, increase to 1.2mg after 1
 week ; max dose 1.8mg
Amylin analogues Pramlintide Weight friendly ;use with insulin ;immediate ac
Type 1 DM : 15ugx3; increase dose after 7 days (max 60x3)
Type 2 DM : 60ugx3; increase dose after 7 days (max 120x3)

Lipid Lowering drugs

Lipid regulating drugs

Groups Drugs remarks
Statin (inhibits HMG-CoA  Atorvastatin  Lowers LDL
reductase activity)  Fluvastatin  Lowers triglyceride
 Rosuvastatin  Raises HDL
 Pitavastatin
 Simvastatin
Fibrate (stimulates  Fenofibrate  Lowers triglyceride
lipoprotein lipase activity;  Gemfibrozil  Raises HDL
increase VLDL breakdown)
Nicotinic acid (inhibits Nicotinic acid  Lowers LDL
production of VLDL)  Lowers triglyceride
 Raises HDL
Cholestyramine (prevents re- Cholertyramine  Lowers LDL
absorption of bile acid)
Ezetimibe (prevents Lowers LDL
intestinial absorption of Ezetimibe
cholesterol)
Fish oil (inhibits production of Contains omega-3 fatty  Lowers triglyceride
VLDL) acids-  Raises HDL
eicisanpentaenoic acid
and docosahexaenoic
acid
PCSK9-inhibitor  Evolocumab Inhibits enzyme
 Alirocumab PCSK9
DM in Ramadan:
Risk groups:
Risk categories Features

-Severe hypoglycemia within the last 3 months prior to Ramadan

-Patient with history of recurrent hypoglycemia
-Patient with hypoglycemia unawareness
Very high risk -Patient with sustained poor glycemic control
group -Ketosis within the last 3 months prior to Ramadan
-Type-1 DM
-Acute illness
-Hyperosmolar hyperglycemic coma within the last 3 months
-Patients who performs intense physical labour
-Pregnancy
-Patient on dialysis

-Patient with moderate hyperglycemia (average blood glucose between

150 and 300 mg/dl, HbA1c 7.5-9.0%)
-Patients with renal insufficiency
High risk group -Patients with advanced macrovascular complications
-People living alone who are treated with insulin or sulphonylureas
-Patients with comorbid conditions that presents additional risk factors.
-Old age with ill health
-Drug s that may affect mentation

Well controlled patients treated with short acting secretagogues such

Moderate risk as repaglinide or nateglinide
group

Well-controlled patients treated with diet alone, metformin or a

Low risk group thiazolidinedione who are otherwise healthy