Diabetes Mellitus
Diabetes Mellitus <ul><li>A multisystem disease related to: </li></ul><ul><li>Abnormal insulin production </li></ul><ul><l...
Diabetes Mellitus <ul><li>Maori & Pacific Islanders are twice as likely to be diagnosed as European/Pakeha </li></ul><ul><...
Normal Insulin Metabolism <ul><li>Insulin produced by  β  cells in the islets of Langerhans of pancreas </li></ul><ul><li>...
Normal Insulin Metabolism <ul><li>Insulin facilitates normal glucose range of 3-8mmol/L </li></ul><ul><li>Insulin promotes...
Counter-Regulatory Hormones <ul><li>Glucagon, adrenaline, growth hormone & cortisol work to oppose the effects of insulin ...
Insulin Secretion
↑  Insulin after Meals <ul><li>Stimulates storage of glucose as glycogen in liver & muscles </li></ul><ul><li>Inhibits glu...
Type 1 Diabetes Mellitus <ul><li>Formerly known as “juvenile onset” or “insulin dependent” diabetes </li></ul><ul><li>Most...
Type 1 DM <ul><li>Results from: </li></ul><ul><li>Progressive destruction of pancreatic  β  cells due to an autoimmune pro...
Causes of Type 1 DM <ul><li>Genetic predisposition & exposure to a virus </li></ul><ul><li>Related to human leucocyte anti...
Onset of Type 1 DM <ul><li>Manifestations develop when pancreas can no longer produce insulin </li></ul><ul><li>Rapid onse...
Onset of Type 1 DM <ul><li>Polydipsia (excessive thirst) </li></ul><ul><li>Polyuria (excessive urinary output) </li></ul><...
Type 2 DM <ul><li>Accounts for 90% of patients with DM </li></ul><ul><li>Incidence  ↑ with age – 50% are over 55 yrs </li>...
Type 2 DM <ul><li>Pancreas continues to produce  some endogenous (self-made)  insulin </li></ul><ul><li>Insulin produced i...
3 Major Metabolic Abnormalities in DM Type 2 <ul><li>Insulin Resistance </li></ul><ul><li>Body tissues do not respond to a...
3 Major Metabolic Abnormalities in DM Type 2 <ul><li>2. Impaired glucose tolerance (IGT) (prediabetes </li></ul><ul><li>- ...
3 Major Metabolic Abnormalities in DM Type 2 <ul><li>3. Inappropriate glucose production by liver </li></ul><ul><li>Instea...
Gestational Diabetes <ul><li>Develops during pregnancy </li></ul><ul><li>Detected at 24-28 weeks of gestation </li></ul><u...
Secondary Diabetes <ul><li>Results from another medical condition or due to the treatment of a medical condition that caus...
Clinical Manifestations Type 1 DM <ul><li>Onset rapid & manifestations are usually acute </li></ul><ul><li>Polyuria </li><...
Clinical Manifestations Type 1 DM <ul><li>Polydipsia </li></ul><ul><li>Results from the intracellular dehydration that occ...
Clinical Manifestations Type 1 <ul><li>Weight loss </li></ul><ul><li>Body cannot utilize glucose & turns to other energy s...
Clinical Manifestaions Type 2 DM <ul><li>Non-specific symptoms </li></ul><ul><li>Fatigue </li></ul><ul><li>Recurrent infec...
Acute Complications of DM Diabetic Ketoacidosis <ul><li>Caused by profound deficiency of insulin </li></ul><ul><li>Most li...
Diabetic Ketoacidosis <ul><li>When circulating supply of insulin is insufficient, glucose cannot be used properly for ener...
Clinical Manifestaions of Ketoacidosis <ul><li>Dehydration – poor skin turgor, dry mucous membranes, tachycardia and ortho...
Hypoglycaemia <ul><li>Low blood sugar levels </li></ul><ul><li>Occurs when there is too much insulin in proportion to avai...
Hypoglycaemia Clinical Manifestations <ul><li>Confusion, irritability </li></ul><ul><li>Diaphoresis </li></ul><ul><li>Trem...
Causes of Hyper & Hypoglycaemia <ul><li>Hyperglycaemia </li></ul><ul><li>Too much food </li></ul><ul><li>Too little or no ...
Clinical Manifestations <ul><li>Hyperglycaemia </li></ul><ul><li>↑  blood glucose </li></ul><ul><li>↑  in urination </li><...
Chronic Complications Angiopathy <ul><li>Blood vessel disease </li></ul><ul><li>Accounts for majority of deaths among pati...
Macroangiopathy   Cerebrovascular Disease   <ul><li>-TIAs & strokes </li></ul><ul><li>Incidence twice as frequent in diabe...
Macroangiopathy Heart Disease <ul><li>CAD, atheroscleotic changes  -> ↓ O 2  & nutrient supply to myocardium </li></ul><ul...
Macroangiopathy Peripheral Vascular Disease <ul><li>Intermittent claudication, absent pedal pulses & ischaemic gangrene - ...
Microvascular Complications <ul><li>Result for thickening of the vessel membranes in the capillaries & arterioles in respo...
Diabetic Retinopathy <ul><li>Process of microvascular damage to retina as a result of chronic hyperglycaemia </li></ul><ul...
Diabetic Nephropathy <ul><li>Microvascular complication associated with damage to the small blood vessels that supply the ...
Diabetic Neuropathy <ul><li>Nerve damage that occurs because of metabolic derangements associated with DM </li></ul><ul><l...
Neuropathic Ulcers
Useful Website <ul><li>http://www.diabetes.org.nz/about/ </li></ul>
Upcoming SlideShare
Loading in …5
×

Diabetes Mellitus Ppt May 2006 Revised

658 views

Published on

overview of diabetes

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
658
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
17
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Diabetes Mellitus Ppt May 2006 Revised

  1. 1. Diabetes Mellitus
  2. 2. Diabetes Mellitus <ul><li>A multisystem disease related to: </li></ul><ul><li>Abnormal insulin production </li></ul><ul><li>Impaired insulin utilization </li></ul><ul><li>Both abnormal production & impaired utilization </li></ul>
  3. 3. Diabetes Mellitus <ul><li>Maori & Pacific Islanders are twice as likely to be diagnosed as European/Pakeha </li></ul><ul><li>Leading cause of heart disease, stroke, adult blindness, & non-traumatic lower limb amputations </li></ul>
  4. 4. Normal Insulin Metabolism <ul><li>Insulin produced by β cells in the islets of Langerhans of pancreas </li></ul><ul><li>Normally insulin is released in small increments continuously into bloodstream (basal rate) </li></ul><ul><li>Increase in release (bolus) when food ingested </li></ul>
  5. 5. Normal Insulin Metabolism <ul><li>Insulin facilitates normal glucose range of 3-8mmol/L </li></ul><ul><li>Insulin promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell </li></ul>
  6. 6. Counter-Regulatory Hormones <ul><li>Glucagon, adrenaline, growth hormone & cortisol work to oppose the effects of insulin </li></ul><ul><li>Hormones work to increase blood glucose levels by stimulating glucose production and decreased movement of glucose into cells </li></ul>
  7. 7. Insulin Secretion
  8. 8. ↑ Insulin after Meals <ul><li>Stimulates storage of glucose as glycogen in liver & muscles </li></ul><ul><li>Inhibits gluconeogenesis (formation of glycogen from fatty acids & proteins rather than carbohydrates) </li></ul><ul><li>Enhances fat deposition in adipose tissue </li></ul><ul><li>Increases protein synthesis </li></ul>
  9. 9. Type 1 Diabetes Mellitus <ul><li>Formerly known as “juvenile onset” or “insulin dependent” diabetes </li></ul><ul><li>Most often occurs in people under 30yrs of age </li></ul><ul><li>Peak onset between ages 11 and 13 </li></ul><ul><li>Represents 10-20% of all persons with diabetes </li></ul>
  10. 10. Type 1 DM <ul><li>Results from: </li></ul><ul><li>Progressive destruction of pancreatic β cells due to an autoimmune process in susceptible people </li></ul><ul><li>Auto-antibodies cause a reduction of 80-90% of normal β cell function before hyperglycaemia and other manifestations occur </li></ul>
  11. 11. Causes of Type 1 DM <ul><li>Genetic predisposition & exposure to a virus </li></ul><ul><li>Related to human leucocyte antigens (HLAs) </li></ul><ul><li>When individual with certain HLA type is exposed to viral infection, the β cells of pancreas are destroyed </li></ul>
  12. 12. Onset of Type 1 DM <ul><li>Manifestations develop when pancreas can no longer produce insulin </li></ul><ul><li>Rapid onset of symptoms </li></ul><ul><li>Present at ED with ketoacidosis </li></ul>
  13. 13. Onset of Type 1 DM <ul><li>Polydipsia (excessive thirst) </li></ul><ul><li>Polyuria (excessive urinary output) </li></ul><ul><li>Polyphagia (excessive eating) </li></ul><ul><li>Recent & sudden weight loss </li></ul>
  14. 14. Type 2 DM <ul><li>Accounts for 90% of patients with DM </li></ul><ul><li>Incidence ↑ with age – 50% are over 55 yrs </li></ul><ul><li>Can occur in children & adolescents </li></ul><ul><li>80-90% of patients are overweight </li></ul><ul><li>↑ incidence in Maori & Pacific Islanders </li></ul>
  15. 15. Type 2 DM <ul><li>Pancreas continues to produce some endogenous (self-made) insulin </li></ul><ul><li>Insulin produced is either insufficient or poorly utilized by the tissues </li></ul>
  16. 16. 3 Major Metabolic Abnormalities in DM Type 2 <ul><li>Insulin Resistance </li></ul><ul><li>Body tissues do not respond to action of insulin </li></ul><ul><li>Results in hyperglycaemia </li></ul>
  17. 17. 3 Major Metabolic Abnormalities in DM Type 2 <ul><li>2. Impaired glucose tolerance (IGT) (prediabetes </li></ul><ul><li>- Occurs when the alteration in β cell function is mild </li></ul><ul><li>Blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes </li></ul>
  18. 18. 3 Major Metabolic Abnormalities in DM Type 2 <ul><li>3. Inappropriate glucose production by liver </li></ul><ul><li>Instead of liver regulating the release of glucose in response to blood levels, it does so in a haphazard way </li></ul><ul><li>Only a minor factor in Type 2 </li></ul>
  19. 19. Gestational Diabetes <ul><li>Develops during pregnancy </li></ul><ul><li>Detected at 24-28 weeks of gestation </li></ul><ul><li>↑ risk for caesarian delivery, peri-natal death, & neonatal complications </li></ul><ul><li>Most have normal glucose levels at 6 weeks postpartum </li></ul>
  20. 20. Secondary Diabetes <ul><li>Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels </li></ul><ul><li>Cushing syndrome </li></ul><ul><li>Hyperthyroidism </li></ul><ul><li>Parental nutrition </li></ul><ul><li>Usaully resolves when underlying condition is treated </li></ul>
  21. 21. Clinical Manifestations Type 1 DM <ul><li>Onset rapid & manifestations are usually acute </li></ul><ul><li>Polyuria </li></ul><ul><li>- When blood glucose ↑, the amt of glucose filtered by glomeruli of kidneys exceeds amt reabsorbed by renal tubules. This results in glycosuria & large losses of water in urine </li></ul>
  22. 22. Clinical Manifestations Type 1 DM <ul><li>Polydipsia </li></ul><ul><li>Results from the intracellular dehydration that occurs as blood glucose levels rise and water is pulled out of body cells </li></ul><ul><li>Polyphagia </li></ul><ul><li>Result of cellular malnourishment when insulin deficiency prevents using glucose for energy </li></ul>
  23. 23. Clinical Manifestations Type 1 <ul><li>Weight loss </li></ul><ul><li>Body cannot utilize glucose & turns to other energy sources such as fat & protein </li></ul><ul><li>Weakness & fatigue </li></ul><ul><li>Body cells lack needed energy from glucose </li></ul>
  24. 24. Clinical Manifestaions Type 2 DM <ul><li>Non-specific symptoms </li></ul><ul><li>Fatigue </li></ul><ul><li>Recurrent infections </li></ul><ul><li>Prolonged wound healing </li></ul><ul><li>Visual changes </li></ul>
  25. 25. Acute Complications of DM Diabetic Ketoacidosis <ul><li>Caused by profound deficiency of insulin </li></ul><ul><li>Most likely to occur with Type 1 </li></ul><ul><li>Caused by illness, infection, inadequate insulin dosage, undiagnosed Type 1 DM, poor self-management & neglect </li></ul>
  26. 26. Diabetic Ketoacidosis <ul><li>When circulating supply of insulin is insufficient, glucose cannot be used properly for energy </li></ul><ul><li>Body breaks down fat stores as secondary source of fuel </li></ul><ul><li>Ketones are by-products of fat metabolism that can cause serious problems when they are excessive in the blood </li></ul><ul><li>Ketones alter pH balance causing metabolic acidosis </li></ul>
  27. 27. Clinical Manifestaions of Ketoacidosis <ul><li>Dehydration – poor skin turgor, dry mucous membranes, tachycardia and orthostatic hypotension </li></ul><ul><li>Lethargy & weakness </li></ul><ul><li>Flushed, dry skin </li></ul><ul><li>Abdominal pain, nausea & vomiting </li></ul><ul><li>Rapid deep breathing </li></ul><ul><li>Acetone on breath (sweet, fruity odour) </li></ul><ul><li>Elevated blood sugar </li></ul><ul><li>Ketones in blood & urine </li></ul>
  28. 28. Hypoglycaemia <ul><li>Low blood sugar levels </li></ul><ul><li>Occurs when there is too much insulin in proportion to available glucose in the blood </li></ul><ul><li>Causes blood glucose level to drop to less than 3.5mmol/L </li></ul>
  29. 29. Hypoglycaemia Clinical Manifestations <ul><li>Confusion, irritability </li></ul><ul><li>Diaphoresis </li></ul><ul><li>Tremors </li></ul><ul><li>Hunger </li></ul><ul><li>Weakness </li></ul><ul><li>Headaches </li></ul><ul><li>Visual disturbances </li></ul><ul><li>Can progress to loss of consciousness, seizures, coma & death </li></ul>
  30. 30. Causes of Hyper & Hypoglycaemia <ul><li>Hyperglycaemia </li></ul><ul><li>Too much food </li></ul><ul><li>Too little or no diabetes medication </li></ul><ul><li>Inactivity </li></ul><ul><li>Emotional, physical stress </li></ul><ul><li>Poor absorption of insulin </li></ul><ul><li>Hypoglycaemia </li></ul><ul><li>Alcohol intake with food </li></ul><ul><li>Too little food </li></ul><ul><li>Too much diabetic medication </li></ul><ul><li>Diabetes medication or food taken at wrong time </li></ul>
  31. 31. Clinical Manifestations <ul><li>Hyperglycaemia </li></ul><ul><li>↑ blood glucose </li></ul><ul><li>↑ in urination </li></ul><ul><li>↑ appetite </li></ul><ul><li>Weakness, fatigue </li></ul><ul><li>Blurred vision </li></ul><ul><li>Glycosuria </li></ul><ul><li>Nausea & vomiting </li></ul><ul><li>Abdominal cramps </li></ul><ul><li>Progression to DKA </li></ul><ul><li>Hypoglycaemia </li></ul><ul><li>Blood glucose < 2.8mmol/L </li></ul><ul><li>Numbness of fingers, toes, mouth </li></ul><ul><li>Tachycardia </li></ul><ul><li>Emotional changes </li></ul><ul><li>Headache </li></ul><ul><li>Nervousness, tremors </li></ul><ul><li>Unsteady gait, slurred speech </li></ul><ul><li>Hunger </li></ul><ul><li>Changes in vision </li></ul><ul><li>Seizures, coma </li></ul>
  32. 32. Chronic Complications Angiopathy <ul><li>Blood vessel disease </li></ul><ul><li>Accounts for majority of deaths among patients with DM </li></ul><ul><li>Macrovascular or microvascular complications </li></ul>
  33. 33. Macroangiopathy Cerebrovascular Disease <ul><li>-TIAs & strokes </li></ul><ul><li>Incidence twice as frequent in diabetics </li></ul><ul><li>Hypertension major risk factor </li></ul><ul><li>Risk highest for females </li></ul><ul><li>Strokes more serious & higher mortality rates </li></ul>
  34. 34. Macroangiopathy Heart Disease <ul><li>CAD, atheroscleotic changes -> ↓ O 2 & nutrient supply to myocardium </li></ul><ul><li>More severe and more affected vessels </li></ul><ul><li>MIs have higher mortality rate & experience CHF, shock & arrhythmias </li></ul>
  35. 35. Macroangiopathy Peripheral Vascular Disease <ul><li>Intermittent claudication, absent pedal pulses & ischaemic gangrene - ↑ incidence in diabetics </li></ul><ul><li>Diabetes cause of more than 50% of non-traumatic amputations </li></ul><ul><li>Trauma to lower limb with resultant ulceration, infection & poor wound healing </li></ul>
  36. 36. Microvascular Complications <ul><li>Result for thickening of the vessel membranes in the capillaries & arterioles in response to conditions of chronic hyperglycaemia </li></ul><ul><li>Complications are specific to diabetes </li></ul><ul><li>Mainly affect eyes (retinopathy), the kidneys (nephropathy) and the nervous system (neuropathy) </li></ul><ul><li>Clinical manifestations occur 10-20 years after onset of diabetes </li></ul>
  37. 37. Diabetic Retinopathy <ul><li>Process of microvascular damage to retina as a result of chronic hyperglycaemia </li></ul><ul><li>Most common cause of new cases of blindness </li></ul><ul><li>Cataracts are also common </li></ul>
  38. 38. Diabetic Nephropathy <ul><li>Microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidneys </li></ul>
  39. 39. Diabetic Neuropathy <ul><li>Nerve damage that occurs because of metabolic derangements associated with DM </li></ul><ul><li>Approx 60-70% of pts with diabetes have some degree of neuropathy </li></ul><ul><li>Most common type is sensory neuropathy which leads to loss of protective sensation in lower extremities and increases risk of complications that result in limb amputation </li></ul>
  40. 40. Neuropathic Ulcers
  41. 41. Useful Website <ul><li>http://www.diabetes.org.nz/about/ </li></ul>

×