‘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?
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.
- Decreased Incretin Effect
- Increased Lipolysis
- Increased Glucose Reabsorption
- Decreased Glucose Uptake
- Neurotransmitter Dysfunction
- Increased HGP
- Increased Glucagon Secretion
- Decreased Insulin Secretion
- Type 1 DM (formerly known as insulin dependent DM or Juvenile DM).
- Type 2 DM (formerly known as non-insulin dependent DM or adult-onset DM).
- Gestational DM: Diabetes first diagnosed during pregnancy.
- Secondary DM: Genetics defects, drug or chemical induced diabetes or other endocrine diseases.
- 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.
- Universal screening using laboratory tests is not recommended as it would identify very few individuals who are at risk.
- Laboratory testing for diabetes and pre-diabetes is recommended for individuals with any of the risk factors for Type 2 DM.
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.
Plenary Lecture II
The lecture opened up with Gestational Diabetes Management by Iris Thiele C. Isip-Tan, MD, FPCP, FPSEM. Here are some notes:
- 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.
- All women with GDM should receive nutritional counseling by a registered dietitian when possible.
- Monitor urine ketones before breakfast to detect starvation ketonuria.
- Non-caloric sweeteners may be used in moderation.
- Daily SMBG appears to be superior to intermittent office monitoring of plasma glucose.
- For women treated with insulin, limited evidence indicates that postprandial monitoring is superior to preprandial monitoring.
- Urine glucose monitoring is not useful in GDM
- Mortality is higher on non-diabetics with hyperglycemia than patients that are diabetics – scary!
- Use of sliding-scale insulin ALONE is discouraged.
- Components of subcutaneous insulin: Prandial (40%-50%), Correction or Supplemental (Variable) and Basal (50%).
- The question is not whether to target postprandial, preprandial or fasting glycemia but when, how and to what goals.
- HbA1C Roles: Assessment of glucose control, marker for complications of diabetes and a diagnostic criteria.
- Screening and treatment recommendations.
- Coronary heart disease screening.
- Screening and treatment recommendations for nephropathy, retinopathy and neuropathy.
- Basic principles in foot care management.
- Total destruction of the pancreatic beta cells.
- All regimens should revolve around the basal and bolus concept.
- One shot a day will not work.
- At least two shots a day are needed to have a decent chance at good glycemic control.
- Diabetes education should involve the whole family.
- The need for good glycemic control should be balanced with the risk of hypoglycemia.
- Hydration – most important initial treatment of hyperglycemic emergencies.
- Plain NSS – Best IV fluid for re-expanding fluids in DKA (Diabetic Ketoacidosis) and HHS (Hypersmolar Hyperglycemic State).
- HHS still remains 15% higher in mortality rate than DKA.
- Infection remains to be the most common precipitating factor in the development of DKA or HHS.
- 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.
- Anion Gap – the best test in monitoring decreasing ketone bodies during therapy.