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Diabetes: patient introduction

Watch Kirstie introduce Shirley Park, a mildly overweight patient with Type 2 diabetes. Unfortunately for Shirley, diet and exercise have not helped.
-Welcome to this module on type 2 diabetes. This week we meet Shirley Park who is Steve Park’s mum. You’ll remember him from last week’s module on heart disease and cholesterol-lowering medication. Shirley’s a 68-year-old grandmother with type 2 diabetes. She’s moderately overweight and has struggled to lose weight despite many attempts. Diet and exercise have not managed to keep Shirley’s diabetes under control, and she’s recently commenced a medication called gliclazide. In the following short video, Shirley discusses her attempts to lose weight and her diagnosis with diabetes.
-I should really be more careful with what I eat. And Dr. Lamont says, I should try and go for a morning walk. But something always seems to be going on and the time just slips by. I have tried to lose weight, but it’s really hard changing the habits of a lifetime. Anyway, my grandkids say they like me just the way I am, cuddly.
-Diabetes mellitus was best described as the sweet urine disease in Greek and Roman writings. However, the possibility of treating the condition had to wait until the 1920s when Banting and Best discovered the role of the pancreas in the disease and were able to isolate insulin. By the 1930s, it was also realised that there were two separate types of diabetes, now called type 1 and type 2. Diabetes is a major global health problem. And every day in Australia an estimated 280 people develop it. As with outpatient Shirley Park in this module, type 2 diabetes accounts for approximately 90% of people who suffer with this condition.
Patients with type 2 diabetes also benefit the most from lifestyle modification to prevent, delay, and reduce the impact of the disease, hence the encouragement to Shirley to lose weight. One of the key aims of treatment is to minimise complications that can result from poorly controlled or long-term diabetes. These complications can impact on many different body organs and organ systems, making diabetes a significant risk factor in the management of a broad range of other conditions. Modifying disease risk factors has become a central part in managing the disease and preventing its progression. However, one risk factor that’s not modifiable is family history. But awareness of it assists with earlier disease identification. If one parent has type 2 diabetes, the risk doubles.
But if two parents have it, the risk increases sixfold. Management of modifiable risk factors focuses on maintaining blood pressure readings to less than 130 over 80, maintaining a total cholesterol reading of less than four millimoles per litre, maintaining weight within the healthy weight range, and increasing physical activity to about 150 minutes of exercise per week, as well as stopping smoking. It is also essential to keep blood glucose readings within the normal range. Doctors will also often used to test called a haemoglobin A1c, which helps to show the stability of the diabetes over the previous months. Managing diabetes is complex and requires a team-based approach, often involving many different health professionals.
Unfortunately, in many cases, preventive approaches are not sufficient in themselves and the addition of medication is needed. When medication is required, it is used to prevent symptoms and prevent or delay long-term disease complications. Some medications can however predispose patients to episodes of low blood glucose, which may then require the doctor to change to a different medication.
-There are a range of medicines used for treating type 2 diabetes. The common ones are sulfonylureas, metformin, and insulin. Shirley’s medication, gliclazide, belongs to a class of drugs called sulfonylureas. You’ll learn more about how gliclazide and the science behind this medicine in the following sections. We’ll check back in with Shirley at the end of this week’s material to see how she’s getting on with her treatment.

Watch Kirstie introduce Shirley Park, a mildly overweight patient with Type 2 diabetes.

Unfortunately for Shirley, diet and exercise have not helped her lose weight or control her diabetes. She has now started a treatment of gliclazide.

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The Science of Medicines

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