Diabetes mellitus


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Aetiology and management of Diabetes.

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Diabetes mellitus

  1. 1. Diabetes Mellitus<br />Dr. Gopalrao Jogdand, M.D. Ph.D.<br />Professor & Head<br />Department of Community Medicine<br />
  2. 2. Information related to Diabetes is found as early as 1552 B.C.<br />Description of the disease is found in Ayurveda.<br />1889 Mehring and Minkowski created diabetic dog by removing its pancreas<br />1921 Banting, Best, Collip & McLeod identify<br /> insulin & treat successfully depancreatised dog<br />Historical Background<br />
  3. 3. Best and Banting<br />
  4. 4. Global: currently there are 150 million cases of D.M. <br />Highest No. of cases exist in China and India. <br />30 million cases are found in SEAR.<br />Rates increasing - set to double over next 15 years (2025). <br />Increasing incidence parallels that of obesity<br />(e.g. Massachusetts: 1958 - 0.9%; 1995 - 3%)<br />Prevalence<br />
  5. 5. Pancreas<br />
  6. 6. Aetiology of Diabetes<br />
  7. 7. Type 1 Diabetes<br />Insulin Dependent Diabetes Mellitus<br />Used to be called juvenile onset diabetes<br />Most commonly begins during childhood<br />Cells that produce insulin in the pancreas have<br /> been destroyed by the immune system<br />Accounts for about 15% of people with diabetes<br />Need daily injections of insulin to survive<br />Clinical Classification<br />
  8. 8. Previously called as maturity onset D.M. <br /> Pancreas does not produce adequate quantity of insulin or the cells do not uptake insulin.<br />Generally occurs in those over the age of 40 years.<br />Exhibits familial tendency.<br />30 to 40% patients need insulin therapy.<br />Type II Diabetes<br />
  9. 9. W.H.O. Classification<br />
  10. 10. Host factors: <br />Age- Type I diabetes is common in children and young adults.<br />Type II diabetes incidence increase with the age, common over the age of 40 years.<br />Sex- In SEAR males suffer more than females.<br />Genetic factors- In identical twins the concordance rate is 90% indicating a strong genetic link.<br />Epidemiology<br />
  11. 11. Evidence of genetic predisposition is proved by the presence of genetic markers i.e. HLA DR3 and DR4.<br />Defective immune response leading to destruction of islet of Langerhan’s cells.<br />Obesity- Central obesity is considered as a risk factor for DM.<br />Continued….<br />
  12. 12. Sedentary life style.<br />High saturated fat intake in diet.<br />Malnutrition- Partial failure of β cells activity.<br />Excessive intake of alcohol.<br />Viral infections involving glandular tissues i.e. Mumps and Rubella.<br />Chemical agents- Alloxan, streptozotocin, and cyanide.<br />Environmental stress.<br />Environmental factors<br />
  13. 13. In the community: DM surveys consist of multiphasic screening i.e. Urine examination followed by blood sugar testing.<br />Applied to high risk individuals, family H/O DM, obese and overweight, age over 40 years.<br />Individual level: Suspected patients showing signs of DM i.e. polyuria, polydipsia and polyphagia should be screened for Diabetes.<br />Screening For Diabetes<br />
  14. 14. Principles of Diabetes Control:<br />Controlling the blood sugar either by oral anti-diabetic drugs or insulin.<br />Dietary modification.<br />Exercise promotion.<br />Management of Diabetes<br />
  15. 15. Diabetic ketoacidosis and Diabetic coma.<br />Diabetic Occulopathy.<br />Diabetic Nephropathy.<br />Hypertension.<br />Stroke or myocardial infarction.<br />Diabetic foot. <br />Complications<br />
  16. 16. Diabetic foot<br />
  17. 17. Primary Prevention<br />a. Population strategy: There is hardly any scope for this strategy in IDDM. However this can be adopted for NIDDM in which one can practice Primordial prevention. <br /> b. High risk strategy: Since NIDDM is linked to life style parameters, persons at risk can be identified and life style modification can be attempted, <br />Prevention & Control<br />
  18. 18. Adequate treatment: aim of the treatment is to maintain the blood glucose level within normal limits.<br />Monitoring the blood glucose level: estimation of Hb% by glycosylated hemoglobin method which gives insight into the blood glucose maintenance for previous three months. <br />Self care.<br />Secondary Prevention<br />
  19. 19. Establishment of specialty clinics (Diabetic clinic).<br />Prevention of co-morbidities.<br />Follow up of the patients.<br />Tertiary Prevention<br />
  20. 20. Thank You<br />