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Diabetes mellitus
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Diabetes mellitus

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  • 1. Diabetes Mellitus By: Roshan Nepal CDBt, Tribhuvan University Kirtipur, Kathmandu, Nepal Universal blue circle : symbol for diabetes
  • 2. Introduction  medical term for what we generally call Sugar, Diabetes, चिनी रोग  medically defined as ‘metabolic disorder affecting multi-organ systems, characterized by hyperglycemia’ - which in simple term means, a person has too much Glucose (sugar) in his/her blood, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.  General symptoms: 3 P’s viz. Polyuria, Polydipsia and Polyphagia.
  • 3. Classification Diabetes mellitus is classified into FOUR broad categories: 1. Type 1 diabetes 2. Type 2 diabetes 3. Type 3 ‘Specific wide range’ of diabetes 4. Type 4 ‘Gestational diabetes’ Source: as proposed by WHO, 1998
  • 4. Type 1 diabetes:  Characterized by loss of insulin-producing - cells of Islets of Langerhans in pancreas, leading to insulin deficiency.  Accounts for approximately 10% of diabetes mellitus cases.  -cells loss is a T-cell mediated autoimmune attack.
  • 5. Type 1 diabetes: SYMPTOMS:  Polyuria  Polydipsia  Polyphagia  Nausea / Vomitting  Weight loss  Fatigue
  • 6. Type 1 diabetes: TREATMENT:  Type 1 diabetes is treated with insulin, exercise and a diabetic diet.  Insulin lowers blood sugar by allowing it to leave the blood-stream and enter cells.  Everyone with type 1 diabetes must take insulin every day.  Pancreas transplant may be an option but has low success rate until now!
  • 7. Type 2 diabetes:  Characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.  Most common, accounts for  90% of diabetes mellitus cases.  Etiology – Unknown, however often associated with obesity, inactivity, hypertension, elevated cholesterol (combined hyperlipidemia).
  • 8. SYMPYOMS: • Apart from 3 P’s they also have 1. Blurred vision 2. Slow healing of wound Type 2 diabetes:
  • 9. Type 2 diabetes: TREATMENT:  First treated with weight reduction, a diabetic diet, and an exercise.  When these measures fail to control the elevated blood sugars, oral medications are used.  If oral medications are still insufficient, treatment with insulin is considered.
  • 10. Comparison betn Type 1 and Type 2 Diabetes mellitus Feature Type 1 Type 2 Onset Sudden Gradual Age at onset Mostly children Mostly adults Body habitus Thin or normal Often obese Ketoacidosis Common Rare Autoantibody Usually present Absent Endogenous insulin Low or absent Normal, decreased or increased Concordance in identical twins 50% 90% Prevalence ~10% ~90%
  • 11. Type 3 diabetes:  This covers a wide range of specific types of diabetes including various genetic defects in insulin action, and diseases of the exocrine pancreas.  Many individual cases are reported which differ from each other.  Some examples: • Prediabetes • Latent autoimmune diabetes of adults (LADA) • Some cases are caused by body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. • Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function.
  • 12. Type 4 ‘Gestational’  GDM resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness.  Occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. (www.wikipedia.org)  Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy.  About 20%–50% of affected women develop type 2 diabetes later in life. (www.wikipedia.org)
  • 13. Type 4 ‘Gestational’  Though transient, untreated GDM can damage the health of the fetus or mother.  Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations.  Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome.  Hyperbilirubinemia may result from red blood cell destruction.  In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment
  • 14. Common consequencesof diabetes...  Over time, diabetes can damage heart, blood vessels, eyes, kidneys, and nerves.  Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).  Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.  Diabetic retinopathy is an important cause of blindness. 1% of global blindness can be attributed to diabetes.  Diabetes is among the leading causes of kidney failure.  The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.
  • 15. Prevention: Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:  achieve and maintain healthy body weight;  be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;  eat a healthy diet of between three and five servings of fruit and vegetables a day and reduce sugar and saturated fats intake;  avoid tobacco use – smoking increases the risk of cardiovascular diseases.
  • 16. Diagnosis and Treatment:  Early diagnosis can be accomplished through relatively inexpensive blood testing.  Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.  moderate blood glucose control. People with type 1 diabetes require insulin; people with type 2 diabetes can be treated with oral medication, but may also require insulin;  blood pressure control;  foot care.
  • 17. Diagnosis and Treatment: Other cost saving interventions include:  screening and treatment for retinopathy (which causes blindness);  blood lipid control (to regulate cholesterol levels);  screening for early signs of diabetes-related kidney disease.  These measures should be supported by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use.
  • 18. References: 1. http://en.wikipedia.org/wiki/Diabetes_mellitus 2. http://www.diabetescare.net/ 3. http://www.medicinenet.com/diabetes_mellitus/ 4. http://diabetes.webmd.com 5. http://www.mayoclinic.com/print/type-1-diabetes 6. http://diabetes.niddk.nih.gov 7. http://www.who.int/topics/diabetes_mellitus/en/ 8. http://www.patient.co.uk/doctor/diabetes-mellitus 9. http://www.news-medical.net/health/Diabetes-Mellitus-Type-2- Pathophysiology.aspx 10. http://www.health.am/db 11. http://diabetes.webmd.com 12. http://en.wikipedia.org/wiki/Insulin
  • 19. Thank you