Speakers discuss diagnosis, Insulin initiation & dose adjustment, complications like Hypoglycemia, DKA and management of T1DM during pregnancy


 Train the trainer program for Type-1 diabetes
Speakers discuss diagnosis, Insulin
initiation & dose adjustment, complications
like Hypoglycemia, DKA and management of
T1DM during pregnancy

By Dr. Amber Naz

ISLAMABAD: Healthcare professionals should be able to identify impending Diabetic ketoacidosis (DKA), so that the people with Type-1 diabetes can be managed properly. Management of this life-threatening complication of diabetes is not complete, until and unless you identify the cause of DKA so as to prevent future recurrence. This was stated by Dr. Musarrat Riaz, Consultant Diabetologist and Endocrinologist at Baqai Institute of Diabetes and Endocrinology, Baqai Medical University. She was speaking at the “Train the Training programme for Tyupae-1 Diabetes by Pakistan Endocrine Society organized here recently.

It may be mentioned here that this program is part of Changing Diabetes in Children (CDIC) project, which is a Public- private partnership sponsored by Novo Nordisk and Roche in collaboration with Health Promotion Foundation (HPF) and Ministry of National Health Services. Presently this project is being executed in 24 countries around the world, Pakistan being one of them. This program provides comprehensive care for children and young people living with type 1 diabetes.

Continuing Dr. Musarrat Riaz pointed out that young adolescents with T1DM are a very vulnerable group and psychological support should always be provided to those at risk. Similarly, pregnancy in people with T1DM women has high rates of fetal and maternal adverse outcomes if not treated properly. Pre- pregnancy counseling, near normal glycemic control before and during pregnancy with frequent blood glucose monitoring, as well as medical nutrition therapy with adjustment in insulin dose to achieve the desired glycemic targets, helps in improving the pregnancy outcomes in these women.

Prof. Abdul Basit, Director BIDE presented an overview of current status of diabetes in Pakistan. He briefly described various initiatives and projects of BIDE to tackle the rising epidemic of diabetes in Pakistan. He emphasized the need for primary prevention programs for diabetes and involvement of all stakeholders including government for better outcomes. Giving example of cardiac registry of Pakistan, where no cardiac catheterization suite keeps working unless angiography and angioplasty data are entered in the cardiac registry Prof A. Basit opined that we need similar ruling to enter diabetes data in DROP Registry.

Group photograph taken during the Train the Trainers program for Type-1 diabetes shows the participants with Prof. Abdul Basit Director BIDE and some other senior faculty members from BIDE alongwith the participants. It is a part of Changing Diabetes in Children (CDIC) project.

Topics covered during the program included diagnosis of type 1 diabetes, Insulin initiation and dose adjustment, complications of T1DM like Hypoglycemia, diabetic ketoacidosis (DKA) and management of Type 1 diabetes during pregnancy. Workshops on medical nutrition therapy, physical activity and self-monitoring of blood glucose were also conducted during the program.

Prof. Jamal Zafar, former Professor of Medicine at PIMS delivered a talk on Diagnosis and management of Type-1 diabetes. As T1DM is a lifelong condition, he emphasized that before prescribing insulin always enquire about the financial status as well as educational levels of the parents so that appropriate insulin regimen can be prescribed.

Dr Arshad Hussain, Consultant Endocrinologist from North West General Hospital talked about Insulin dose adjustment and different insulin regimes. He described in details how to assess discrepancy in result of glucometer and stressed the need to check techniques and also discussed various reasons for this discrepancy like dirty hands, fingers not pressed properly or depth of insertion of needles not adequate. Various types of insulin pumps, continuous and flash glucose monitoring systems were also discussed during his presentation as now these technologies are available in Pakistan.

Dr Saif Ul Haque, from BIDE described the Management of Hypoglycemia, a very important life-threatening complication of Type-1 diabetes. In his talk he elaborated various causes of hypoglycemia and some subtle signs that clinicians should be aware of while dealing with the patient of hypoglycemia. He discussed the pathophysiology as well as management strategies giving practical examples from clinical practice specially emphasizing on the consequences of hypoglycemia if not treated properly.

Dr. Ashar Fawwad highlighted the importance of disease registries in estimating the disease burden and discussed in detail the diabetes registry of Pakistan (DROP). He emphasized the need of putting data in type one diabetes registry to know the burden of disease in our country.

Practical interactive workshops on Diet Management in Diabetes by Ms Mehwish Shiraz, a renowned dietitian in PIMS and How to Advice Physical Activity in people with diabetes by Ms Amber Naz Physical therapist and rehabilitation expert in BIDE were also part of the scientific programme.

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