1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. goals
2.1.1.1. quality of life
2.1.1.2. lifestyle modification
2.1.1.3. reducing symptoms and prevent complications
2.1.1.4. education regarding therapy
2.1.2. non-pharmacological
2.1.2.1. diet
2.1.2.1.1. low GI diet, high fibre and low saturated fat
2.1.2.1.2. can rarely be enough
2.1.2.1.3. referral to dietitian
2.1.2.1.4. educate how to monitor meal portions
2.1.2.1.5. monitor salt intake for hypertention
2.1.2.1.6. calorie intake
2.1.2.2. exercise
2.1.2.2.1. 150 minutes per week of physical activity
2.1.2.2.2. active muscles increase uptake of glucose from blood thus decreasing insulin resistance
2.1.2.2.3. cardiac assessment in select patients
2.1.2.3. surgery
2.1.2.3.1. bariatric surgery
2.1.2.3.2. specific inclution and excluttion criteria
2.1.2.3.3. liposuction
2.1.2.4. psychological assesmernt
2.1.2.5. education for patient and family
2.1.3. pharmacological
2.1.3.1. HbA1c less than 7
2.1.3.2. medication groups
2.1.3.2.1. decrease insulin ressistance
2.1.3.2.2. decrease glucose absorbtion from GI
2.1.3.2.3. decrease gluconeogenisis in liver
2.1.3.3. sulfonurias
2.1.3.3.1. reduces insulin resistance and increase insulin release from beta cells and decrease glucose production from liver
2.1.3.3.2. weight gain and hypoglycemia
2.1.3.4. metformin
2.1.3.4.1. first line
2.1.3.4.2. low cost and does not cause hypoglycemia and is weight neutral
2.1.3.4.3. decrease glucose uptake from gut
2.1.3.4.4. GI symptoms most prominent
2.1.3.4.5. good effect on LDL
2.1.3.4.6. rare side effect is lactic acidosis
2.1.3.5. TZD
2.1.3.5.1. increase risk of heart failure, anemia and edema
2.1.3.5.2. increase insulin sensitivity
2.1.3.5.3. causes weight gain and hepatotoxicity
2.1.3.5.4. expensive
2.1.3.6. DPP4 inhitors
2.1.3.6.1. new med and not available everywhere
2.1.3.6.2. can reduce weight by working on satiety
2.1.3.7. insulin
2.1.3.7.1. several modalities
2.1.3.7.2. HbA1c over 10 indication for first line therapy
2.1.3.8. blood pressure control
2.1.3.8.1. ACE inhibitors
2.1.3.8.2. should be 140/90 or less
2.1.3.9. lipids
2.1.3.9.1. LDL less than 2.6
2.1.3.9.2. triglycerides less than 1.7
2.1.3.9.3. HDL more thn 1
2.1.3.9.4. statins
2.1.3.10. weight loss
2.1.3.10.1. orlistat
2.1.3.11. OSA
2.1.3.11.1. CPAP?
2.1.3.11.2. sleeping on side
2.2. Prevention
2.2.1. primary
2.2.1.1. environmental factors
2.2.1.1.1. lifestyle
2.2.1.2. public education
2.2.2. secondary
2.2.2.1. public campaigns
2.2.2.1.1. screening test
2.2.2.2. treatment compliance
2.2.3. tertiary
2.2.3.1. screening for micro and macro vascular complications