3rd Diabetes, Prediabetes and Metabolic Syndrome Weekend Course

PSEM Poster

‘Tis such a long title for a post, yet it was also a long course with series and bouts of lectures at Nesta’s Hilltop Hotel, Roxas City yesterday.  It was my first time in Roxas City, the seafood capital of the Philippines.  I didn’t get the chance explore the city, since we left Kalibo at 6:15am and arrived around 7:30am at Nesta’s Hilltop Hotel.  There were three of us and our attendance was personal.  Meaning we were not sent to represent, in my case I was both eager and curious to join lectures other than Bible conferences.  Registration was a breeze with materials:  writing pad, notes, pen and the like.  The program started fairly on time.  It was my first time though to see the PSEM Hymn which was also a music video!  How about that?

Notes and Materials


CSI

Oh, before even the program began there was some sort of a teaser lecture called the Clinical Sign Investigation (CSI:  The Endocrine Eye).  You’ve got to give them credit for those acronyms.

Plenary Lecture I

The lecture kicked off with The Ominous Octet:  A New Paradigm in Understanding Type 2 Diabetes by Leilani B. Mercado-Asis, MD, PhD, FPCP, FPSEM.  Again, you got to love the titles.  If you don’t know what ominous means, it means evil or threatening.  I would have titled this as TOO:  A New Paradigm in Understanding Type 2 Diabetes but that would doing it too much.  Anyway, I’ve learned new terms like prandial (even WordPress doesn’t know!) and ominous.  It’s a good thing I brought along Apple (my iPhone) with me with some handy apps.  In summary, these are the ominous octet and believe me they are pure evil, medically.

  1. Decreased Incretin Effect
  2. Increased Lipolysis
  3. Increased Glucose Reabsorption
  4. Decreased Glucose Uptake
  5. Neurotransmitter Dysfunction
  6. Increased HGP
  7. Increased Glucagon Secretion
  8. Decreased Insulin Secretion
These are the new studies and advancements made in understanding Type 2 diabetes.  Our family has a history of Type 2 diabetes on both sides.  It’s good to know these updates but I think the hardest part would be compliance and discipline.
The second lecture was on Diabetes:  Screening and Diagnosis (NNHeS Data and The Philippine Clinical Practice Guidelines) by Cecilia A. Jimeno, MD, FPCP, FPSEM.  Diabetes Mellitus is classified into 4 clinical types according to etiology:
  1. Type 1 DM (formerly known as insulin dependent DM or Juvenile DM).
  2. Type 2 DM (formerly known as non-insulin dependent DM or adult-onset DM).
  3. Gestational DM:  Diabetes first diagnosed during pregnancy.
  4. Secondary DM:  Genetics defects, drug or chemical induced diabetes or other endocrine diseases.
She also noted that we should use Type “1” and “2” not “I” or “II” to avoid confusion.
In summary, if you think you have risk factors like overweight, obese, sedentary lifestyle, hypertension and the like then it is much better to have yourself screened for DM and other cardiovascular diseases.  The Unite for DM Philippine Practice Guidelines for Diabetes recommends the following:
  1. All individuals being seen at any physician’s clinic or by any health care provider should be evaluated annually for risk factors for type 2 diabetes or pre-diabetes.
  2. Universal screening using laboratory tests is not recommended as it would identify very few individuals who are at risk.
  3. Laboratory testing for diabetes and pre-diabetes is recommended for individuals with any of the risk factors for Type 2 DM.
All patients suspected to have diabetes or those who are at risk for developing diabetes mus first be interviewed regarding any of the classical signs of DM including polyuria, polydipsia, polyphagia and weight loss.

An Obese Note

I didn’t need to jot down the other risk factors but I know being overweight is a pre-requisite to obesity! I know my way in the kitchen (thanks for Mum and happy birthday!) and we love to eat as a family but I think it’s start to hit the road again and start running and to have a change of eating habits. I think it’s hypocritical to any medical professional to be doing quite the opposite of what his profession is all about. Sadly, this is the case nowadays including myself.

Booths & Freebies

After the 2nd speaker there’s an open forum which lasted around 5 minutes or less.  We Filipinos love to participate indirectly on forums.  We love to watch on the sidelines as other people try to speak there minds.  I guess it’ a cultural thing and I think  that’s why we as a a nation are entertainment driven, we love to watch people living their lives – soaps!

Anyway, during the break we were directed to the booths upstairs for some treats and freebies.  There were bags, bags, more bags, pens, notepads, sweets and some health drink.

I love freebies!  Especially icons and fonts but these kind of bags, well, it’s not that I’m not grateful or anything but not really my type.  I don’t know why I lined myself up for bags with all the rushing and the pushing and the double queuing and all of that hassle.

Freebies

Plenary Lecture II

The lecture opened up with Gestational Diabetes Management by Iris Thiele C. Isip-Tan, MD, FPCP, FPSEM.  Here are some notes:

  1. Pregnant women should lose their pregnancy weight in one year after delivery or you don’t lose it at all and carry it on to your next pregnancy.
  2. All women with GDM should receive nutritional counseling by  a registered dietitian when possible.
  3. Monitor urine ketones before breakfast to detect starvation ketonuria.
  4. Non-caloric sweeteners may be used in moderation.
  5. Daily SMBG appears to be superior to intermittent office monitoring of plasma glucose.
  6. For women treated with insulin, limited evidence indicates that postprandial monitoring is superior to preprandial monitoring.
  7. Urine glucose monitoring is not useful in GDM
You can also visit her website at Endocrine Witch.  Think  that’s scary?  She’s got also a blog called Bubbles From My Cauldron.
After the lecture it was time for another open forum which didn’t also last very long, probably everyone’s eyes are on the buffet lunch table.  I’m still a bit full after the snack and now they’re giving us buffet lunch.  Freebies now lunch for only 250 PHP, that is so worth-it.  I wish this was credit as CNE points but I after the first half of the course, though there were many nurses among the group, this was more directed to physicians and residents.  Anyway, it’s not we cannot apply the things we’ve learned.  For me with a family of a history of diabetes and some risk factors, it’s more than enough.
After Lunch
These are the topics the two cased-based discussions with some notes.  I may need to update this post with some notes I wrote that I still have to decipher.  You see, I write in codes.
Inpatient and Perioperative Hyperglycemia:  Challenges in Management by Gabriel V. Jasul, Jr. MD, FPCP, FPSEM and Bien J. Matawaran, MD, FPCP, FPSEM
  1. Mortality is higher on non-diabetics with hyperglycemia than patients that are diabetics – scary!
  2. Use of sliding-scale insulin ALONE is discouraged.
  3. Components of subcutaneous insulin:  Prandial (40%-50%), Correction or Supplemental (Variable) and Basal (50%).
Reaching Glycemic Targets at Home:  Fasting versus Prandial by Nemencio A. Nicodemus Jr., MD, FPCP, FPSEM
  1. The question is not whether to target postprandial, preprandial or fasting glycemia but when, how and to what goals.
  2. HbA1C Roles:  Assessment of glucose control, marker for complications of diabetes and a diagnostic criteria.
Since the course itself is more directed to physicians there were a lot of terminologies, studies and charts that I myself were lost in the translation.  It is a challenge now for me to again dig up, research and do a self-study.  I guess it’s time to dust off the old medical books.
After the case discussions it was time for a short break then resumed with:
Beyond Glucose Control:  A Comprehensive Diabetes Care Checklist in the Office by Alan O. Chang, MD, FPCP, FPSEM
The topic was so comprehensive that my eyelids began to drop but I did get the big picture.  Managing diabetes is not just lowering glucose or managing it.  It involves:
  1. Screening and treatment recommendations.
  2. Coronary heart disease screening.
  3. Screening and treatment recommendations for nephropathy, retinopathy and neuropathy.
  4. Basic principles in foot care management.
Outpatient Management of Type 1 Diabetes Mellitus in Children by Herbert Mo, MD, FPCP, FPSEM
  1. Total destruction of the pancreatic beta cells.
  2. All regimens should revolve around the basal and bolus concept.
  3. One shot a day will not work.
  4. At least two shots a day are needed to have a decent chance at good glycemic control.
  5. Diabetes education should involve the whole family.
  6. The need for good glycemic control should be balanced with the risk of hypoglycemia.
Diabetes Emergencies by Sjoberg A. Kho, MD, FPCP, FPSEM
  1. Hydration – most important initial treatment of hyperglycemic emergencies.
  2. Plain NSS – Best IV fluid for re-expanding fluids in DKA (Diabetic Ketoacidosis) and HHS (Hypersmolar Hyperglycemic State).
  3. HHS still remains 15% higher in mortality rate than DKA.
  4. Infection remains to be the most common precipitating factor in the development of DKA or HHS.
  5. For DKA and HHS, the classical clinical picture includes a history of polyuria, plydipsia, polyphagia, weight loss, vomiting, abdominal pain (only in DKA), dehydration, weakness, clouding of sensoria and coma.
  6. Anion Gap – the best test in monitoring decreasing ketone bodies during therapy.
So there’s a recap on yesterday’s event at Roxas City.  We didn’t get the chance to join the dinner symposium because we need to catch the last trip back for Kalibo.  All in all it was worth it and kudos to PSEM!  Is there an organization of nurses on endocrinology?
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