Diabetes MellitusDiabetes MellitusPrepared by:Prepared by:Michaella M. Combine andMichaella M. Combine andAira Dominica LavinaAira Dominica Lavina
Diabetes MellitusDiabetes MellitusA heterogeneous group of disordersA heterogeneous group of disorderscharacterized by an elevation in thecharacterized by an elevation in thelevel of glucose in the blood.level of glucose in the blood.In Diabetes there may be a decrease inIn Diabetes there may be a decrease inthe body’s ability to respond to insulinthe body’s ability to respond to insulinand/or a decrease or absence of insulinand/or a decrease or absence of insulinproduced by the pancreas.produced by the pancreas.
What is an Insulin?What is an Insulin? Secreted by the beta cells, which are one of four typesSecreted by the beta cells, which are one of four typesof cells in the islets of langerhans in the pancreas. It isof cells in the islets of langerhans in the pancreas. It isconsidered to be an anabolic, or storage, hormone. Whenconsidered to be an anabolic, or storage, hormone. Whena meal is eaten, insulin secretion increases and movesa meal is eaten, insulin secretion increases and movesglucose from the circulation into muscle, liver, and fatglucose from the circulation into muscle, liver, and fatcells.cells. During “fasting periods” (between meals and overnight)During “fasting periods” (between meals and overnight)there is a lower production of insulin accompanied by anthere is a lower production of insulin accompanied by anincreased release of another pancreatic hormone theincreased release of another pancreatic hormone theglucagon. The net effect of the balance between insulinglucagon. The net effect of the balance between insulinand glucagon levels is to maintain a constant level ofand glucagon levels is to maintain a constant level ofglucose in the blood through release of glucose from theglucose in the blood through release of glucose from theliver.liver.
Insulin Functions….Insulin Functions…. Stimulates storage of glucose in the liver andStimulates storage of glucose in the liver andmuscle (in the form of glycogen).muscle (in the form of glycogen). Enhances storage of dietary fat in adiposeEnhances storage of dietary fat in adiposetissue.tissue. Accelerates transport of amino acids (derivedAccelerates transport of amino acids (derivedfrom dietary protein) into the cells.from dietary protein) into the cells. Insulin also inhibits the breakdown of storedInsulin also inhibits the breakdown of storedglucose, protein, and fat.glucose, protein, and fat.
What are the causes ofdiabetes• Diabetes is made when the pancreas doesnt’tmake enough or any hormone insulin• You get it when you have to much glucose in yourbody
• high blood levels of glucose• blurry vision• fatigue• thirst• painful urination• frequent urination• sores that do not heal• nausea• vomiting• weight loss• Hunger• **In some cases…there are no symptomsat all!!• **Diabetes type 1 and type 2 symptomsare closely similar, although, type 1 isoften worse in severitySymptoms of diabetes
Who are at risk of diabetes?Who are at risk of diabetes?children of diabeticschildren of diabeticsobese peopleobese peoplepeople with hypertensionpeople with hypertensionpeople with high cholesterol levelspeople with high cholesterol levelspeople with sedentary lifestylespeople with sedentary lifestyles
Types of DiabetesTypes of Diabetes Type 1 : Insulin-dependent diabetes mellitusType 1 : Insulin-dependent diabetes mellitus Type 2 : Non-insulin-dependent diabetesType 2 : Non-insulin-dependent diabetesmellitusmellitus Gestational diabetes mellitusGestational diabetes mellitus
Types of DiabetesTypes of Diabetes Type 1: About 5% to 10% of people with Diabetes. AType 1: About 5% to 10% of people with Diabetes. Aform of diabetes wherein there is inadequate amounts ofform of diabetes wherein there is inadequate amounts ofinsulin are produced by the pancreas, resulting in theinsulin are produced by the pancreas, resulting in theneed for insulin injections to control the blood glucose.need for insulin injections to control the blood glucose.It is also characterized by sudden onset usually beforeIt is also characterized by sudden onset usually beforethe age of 30 years.the age of 30 years. Type 2: About 90% to 95% of people with Diabetes.Type 2: About 90% to 95% of people with Diabetes.Cause by a decrease in the sensitivity of the cells toCause by a decrease in the sensitivity of the cells toinsulin and the decrease in the amount of insulininsulin and the decrease in the amount of insulinproduced. It can be treated with diet, oral hypoglycemicproduced. It can be treated with diet, oral hypoglycemicagents and insulin injections. It occurs most frequentlyagents and insulin injections. It occurs most frequentlyin people who are over 30 years of age and obese.in people who are over 30 years of age and obese.
Classification of Diabetes Mellitus and Related GlucoseClassification of Diabetes Mellitus and Related GlucoseIntoleranceIntoleranceCurrent ClassificationCurrent Classification Previous ClassificationsPrevious Classifications Clinical CharacteristicsClinical CharacteristicsType 1: Insulin – dependentType 1: Insulin – dependentdiabetes mellitus (IDDM)diabetes mellitus (IDDM)Juvenile diabetesJuvenile diabetesKetosis prone diabetesKetosis prone diabetesBrittle diabetesBrittle diabetesEtiology includes genetic,Etiology includes genetic,immunologic, and orimmunologic, and orenvironmental factorsenvironmental factorsNeed insulin to preserve lifeNeed insulin to preserve lifeAcute complication ofAcute complication ofhyperglycemia: diabetichyperglycemia: diabeticketoacidosisketoacidosisType 2: Non-insulin-Type 2: Non-insulin-dependent diabetes (NIDDM)dependent diabetes (NIDDM)Adult onset diabetesAdult onset diabetesMaturity onset diabetesMaturity onset diabetesKetosis resistant diabetesKetosis resistant diabetesStable diabetesStable diabetesEtiology includes obesity,Etiology includes obesity,heredity, and environmentalheredity, and environmentalfactorsfactorsOral hypoglycemic agents mayOral hypoglycemic agents mayimprove blood glucose levelimprove blood glucose levelAcute complication:Acute complication:hyperosmolar nonketotichyperosmolar nonketoticsyndromesyndrome
Classification of Diabetes Mellitus and Related GlucoseClassification of Diabetes Mellitus and Related GlucoseIntoleranceIntoleranceCurrent ClassificationCurrent Classification Previous ClassificationsPrevious Classifications Clinical CharacteristicsClinical CharacteristicsDiabetes mellitus associatedDiabetes mellitus associatedwith other conditions orwith other conditions orsyndromessyndromesSecondary diabetesSecondary diabetes Accompanied by conditionsAccompanied by conditionsknown or suspected to causeknown or suspected to causethe disease: pancreaticthe disease: pancreaticdiseases; hormonaldiseases; hormonalabnormalities; drug such asabnormalities; drug such asglucocorticoids and estrogenglucocorticoids and estrogencontaining preparationscontaining preparationsGestational diabetesGestational diabetes Gestational diabetesGestational diabetes Onset during pregnanacy 2Onset during pregnanacy 2ndndand 3and 3rdrdtrimestertrimesterDue to hormones secreted byDue to hormones secreted byplacenta , which inhibit theplacenta , which inhibit theaction of insulinaction of insulinRisk factor: obesity, age overRisk factor: obesity, age over30, family hx of diabetes,30, family hx of diabetes,previous large babies (overprevious large babies (over9lb)9lb)
Investigation-Fasting Blood Sugar (FBS)-Random Blood Sugar (RBS)-Glucose Tolerance Test (GTT)-Glycosylated Hemoglobin (Hemoglobin A1c)-Serum Fructosamine-Urinalysis to detect glucose in the urine-Urine For Proteinuria-Complete Blood Count (CBC)-Urea, Creatinine & Electrolytes-Fasting Serum Cholesterol & Triglyceride
Fasting Blood Sugar(FBS)Normal Fasting Glucose level is less the 110mg/dlImpaired fasting Glucose is >110 but < 126 mg/dlIf fasting blood sugar is greater than 126mg/dl on more than oneoccasion, diabetes is confirmed
Random Blood Sugar(RBS)If random blood sugar is greater than 200 mg/dl on two separateoccasion, the diabetes is confirmed, however the more reliable test is FBS
Glucose Tolerance Test(GTT)After the overnight fast, 75 gm of the glucose is taken in 250 – 300 ml ofthe waterNormally 2 – hour after the glucose load is < 140 mg/dlImpaired glucose tolerance test is labeled, when 2 – hour after glucose is> 140mg/dl but < 200 mg/dlDiabetes is confirmed if two hours after glucose is > 200mg/dl- GTT is confirmatory test, require only when the FBS glucose level isgreater than normal
Glycosylated Hemoglobin(HB A1C)Level of the glycosylated HB reflect the state of the glycemia over thepreceding 8 – 12 weeksNormal level is 4 – 6%Therapy is require when the HB A1c is above the normalThe sensitivity of the test is about 85%The test is quite is specific in 91% of the cases
Serum – FructosamineSerum fructosamine is formed by nonenzymatic glycosylation of the serumprotein predominantly the albuminSerum fructosamine level reflect the state of the glycemic control forpreceding 2 weeks.Normal values are 1.5 – 2.4 mmol/L
Urinalysis To DetectGlucose In UrineStrips are used for detection of theglucose in the urine
Complications of DiabetesComplications of DiabetesChronic Complications of type 1 and type 2 diabetesChronic Complications of type 1 and type 2 diabetesgenerally occur 10 to 15 years after the onset ofgenerally occur 10 to 15 years after the onset ofdiabetes.diabetes. Macrovascular (large vessel) disease – affecting coronaryMacrovascular (large vessel) disease – affecting coronaryperipheral vascular, and cerebrovascular circulations.peripheral vascular, and cerebrovascular circulations. Microvascular (small vessel) disease – affecting the eyesMicrovascular (small vessel) disease – affecting the eyes(retinopathy) and kidneys (nephropathy).(retinopathy) and kidneys (nephropathy). Neuropathic diseases – affecting sensorimotor andNeuropathic diseases – affecting sensorimotor andautonomic nerves and contributing to such problems aqsautonomic nerves and contributing to such problems aqsimpotence and foot ulcers.impotence and foot ulcers.
Foot and Leg Problems in DiabetesFoot and Leg Problems in Diabetes55% to 75% of lower extremity amputations are performed55% to 75% of lower extremity amputations are performedon people with Diabetes. 50% of these amputations areon people with Diabetes. 50% of these amputations arepreventable, provided patients are taught preventivepreventable, provided patients are taught preventivefoot care measures and practice preventive foot care onfoot care measures and practice preventive foot care ona daily basis.a daily basis.Three diabetic complications contribute to the increasedThree diabetic complications contribute to the increasedrisk of foot infections. They are:risk of foot infections. They are:A. NeuropathyA. Neuropathy – Sensory neuropathy leads to loss of pain– Sensory neuropathy leads to loss of painand pressure sensation, and autonomic neuropathy leadsand pressure sensation, and autonomic neuropathy leadsto increased dryness and fissuring of the skin (secondaryto increased dryness and fissuring of the skin (secondaryto decreased sweating).to decreased sweating).
Therapy For TheDiabetesType I:- Diet Modification- Insulin InjectionType II:- Oral hypoglycemic AgentsSulphonylureas (Thin pts)Biguanides (Obese Pts)Oral hypoglycemic agents are contraindicated in pregnancyVascular complication of the diabetes can be reduced by the low doseaspirin
What can you do to control yourWhat can you do to control yourblood sugar?blood sugar?1. Diet Therapy1. Diet Therapy* Avoid simple sugars like cakes and* Avoid simple sugars like cakes andchocolates. Instead have complexchocolates. Instead have complexcarbohydrated like rice, pasta, cereals andcarbohydrated like rice, pasta, cereals andfresh fruits.fresh fruits.* Do not skip or delay meals. It causes* Do not skip or delay meals. It causesfluctuations in blood sugar levels.fluctuations in blood sugar levels.* Eat more fiber-rich foods like vegetables.* Eat more fiber-rich foods like vegetables.* Cut down on salt.* Cut down on salt.* Avoid alcohol. Dietary guidelines recommend* Avoid alcohol. Dietary guidelines recommendno more than two drinks for men and no moreno more than two drinks for men and no morethan one drink per day for women.than one drink per day for women.
2. Exercise2. ExerciseRegular exercise is an important part of diabetesRegular exercise is an important part of diabetescontrol.control.Daily exercise . . .Daily exercise . . .* Improves cardiovascular fitness* Improves cardiovascular fitness* Helps insulin to work better and lower blood sugar* Helps insulin to work better and lower blood sugar* Lowers blood pressure and cholesterol levels* Lowers blood pressure and cholesterol levels* Reduces body fat and controls body weight* Reduces body fat and controls body weightExercise at least 3 time a week for ate least 30 minutesExercise at least 3 time a week for ate least 30 minuteseach session. Always carry quick sugar sources like candyeach session. Always carry quick sugar sources like candyor softdrink to avoid hypoglycemia (low blood sugar)or softdrink to avoid hypoglycemia (low blood sugar)during and after exercise.during and after exercise.
3. Control your weight3. Control your weightIf you are overweight or obese, start weightIf you are overweight or obese, start weightreduction by diet and exercise. This improvesreduction by diet and exercise. This improvesyour cardiovascular risk profile.your cardiovascular risk profile.* It lowers your blood sugar* It lowers your blood sugar* It improves your lipid profile* It improves your lipid profile* It improves your blood pressure control* It improves your blood pressure control4. Quit smoking.4. Quit smoking.Smoking is harmful to your health.Smoking is harmful to your health.
5. Maintain a normal blood5. Maintain a normal bloodpressure.pressure.Since having hypertension puts aSince having hypertension puts aperson at high risk ofperson at high risk ofcardiovascular disease, especiallycardiovascular disease, especiallyif it is associated with diabetes,if it is associated with diabetes,reliable BP monitoring and controlreliable BP monitoring and controlis recommended.is recommended.
Medications • Tablets People with Type 2 diabetes may not be able to adequatelycontrol their blood glucose levels through diet, exercise andlifestyle changes alone. Therefore, in many cases diabetictablets are required. There are a variety of tabletsavailable, which work in different ways. These include:• • Tablets to increase insulin output from the pancreas eg:Glipizide, Glibenclamide.• Tablets to reduce insulin resistance eg: Metformin• Tablets that stop the absorption of carbohydrates fromthe bowel eg: Acarbose.•
BLOOD GLUCOSE TESTING ("BLOOD SUGARS")To enable blood glucose levels to be tested, adroplet of blood is obtained from a small fingerprick test and is measured on a special testingstrip. The results will help to determine howmuch medication is required, how much exercisecan be undertaken and what foods should beeaten. This simple home test needs to beperformed regularly, in some cases up to severaltimes per day. It is important to follow theguidelines given by the treating doctor as to howoften they should be done.
InsulinIn people with Type 1 diabetes and in some people with Type2 diabetes, insulin injections are required. There are anumber of different types of insulin available that vary inthe duration of time they are effective.Insulin is injected under the skin of the abdomen or thighand can be administered by using a disposable syringe andneedle, or a preloaded insulin “pen”. Insulin can also beadministered by a pre-programmed insulin pump. An insulinpump is a small battery powered device into which insulincan be a loaded. The insulin is pumped into the abdomen viaa thin plastic tube connected to a very thin plastic needlethat is secured under the skin.