Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.

1. DR. TANPREET KAUR DHILLON
ASSISTANT PROFESSOR
DEPT. OF PHARMACY PRACTICE
ISF COLLEGE OF PHARMACY
WEBSITE: - WWW.ISFCP.ORG
ISF College of Pharmacy, Moga
Ghal Kalan,nGT Road, Moga- 142001, Punjab, INDIA
Internal Quality Assurance Cell - (IQAC)
DIABETES MELLITUS

2. Introduction
 Diabetes mellitus (DM) is a group of diseases characterized by high levels of
blood glucose resulting from defects in insulin production, insulin action, or
both.
 The term diabetes mellitus describes a metabolic disorder of multiple aetiology
characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat
and protein metabolism resulting from defects in insulin secretion, insulin
action, or both.
 The effects of diabetes mellitus include long–term damage, dysfunction and
failure of various organs.
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Classification of DM
I. Type-1 DM
• Type 1A: Immune mediated ( Autoimmune destruction of β-cells which usually
leads to insulin deficiency).
• Type 1B: Idiopathic (Patients are negative for autoimmune markers)
II. Type-2 DM predominantly affects older individuals, its now known that it also
occurs in obese adolescent children.
• It usually begins as insulin resistance, a disorder in which the cells do not use
insulin properly. As the need for insulin rises, the pancreas gradually loses its
ability to produce insulin.
• Moreover, many Type-2 DM patients requires insulin therapy to control the
hyperglycemia.

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III. Gestational Diabetes:
• A form of glucose intolerance that is diagnosed in some women during
pregnancy.
• It is also more common among obese women and women with a family history
of diabetes.
• During pregnancy, gestational diabetes requires treatment to normalize
maternal blood glucose levels to avoid complications in the infant.
IV. Other types:
•LADA (Latent autoimmune diabetes in adults)
•MODY (maturity-onset diabetes of youth)
•Secondary Diabetes Mellitus.
Classification of DM

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• Diabetes mellitus may present with characteristic symptoms such as thirst,
polyuria, blurring of vision, and weight loss.
• In its most severe forms, ketoacidosis or a non–ketotic hyperosmolar state may
develop and lead to stupor, coma and, in absence of effective treatment, death.
• Often symptoms are not severe, or may be absent, and consequently
hyperglycaemia sufficient to cause pathological and functional changes may be
present for a long time before the diagnosis is made.
Sign and Symptoms

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• The long–term effects of diabetes mellitus include progressive development of
the specific complications of retinopathy with potential blindness.
• Nephropathy that may lead to renal failure.
• Neuropathy with risk of foot ulcers, amputation, Charcot joints, and features
of autonomic dysfunction, including sexual dysfunction.
• People with diabetes are at increased risk of cardiovascular, peripheral
vascular and cerebrovascular disease.
Long Term Effects

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DIAGNOSIS
Symptomatic diagnosis: Polyuria, polydipsia and weight loss, plasma
glucose concentration ≥11.1 mmol/L, Urine tests (glucosuria, ketonuria), oral
glucose tolerance test.
Non-symptomatic diagnosis: Random glucose determination, glycated
haemoglobin (HbA1C), C-peptide assay, insulin assay.

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Testing Criteria for Diagnosis of DM
Expert committee of ADA states that diabetes can be provisionally diagnosed
with any one of the three criteria listed below:
1.A fasting plasma glucose of >126 mg/dl (after no caloric intake for at least 8
hours) or,
2.A casual plasma glucose >200 mg/dl (taken at any time of day without regard
to time of last meal) with classic diabetes symptoms: increased urination,
increased thirst and unexplained weight loss or,
3.An oral glucose tolerance test (OGTT) (75 gram dose) of >200 mg/dl for the
two hour sample.
Oral glucose tolerance testing is not necessary if patient has a fasting plasma
glucose level of >126 mg/dl.

9. 9Management of DM
The major components of the treatment of diabetes are:
Diet and Exercise
Oral Hypoglycaemic Therapy
Insulin Therapy

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 Diet should aim at:
o Ensuring weight control
o Providing nutritional requirements
o Allowing good glycaemic control with blood glucose levels as close to
normal as possible
o Correcting any associated blood lipid abnormalities
 Exercise:
o Physical activity promotes weight reduction and improves insulin sensitivity, thus
lowering blood glucose levels.
o Together with dietary treatment, a programme of regular physical activity and
exercise should be considered for each person. Such a programme must be tailored
to the individual’s health status and fitness.
o People should, however, be educated about the potential risk of hypoglycaemia
and how to avoid it.
Diet and Exercise

11. 11Oral Anti-Diabetic Agents
i. Sulphonylureas:
First Generation: Tolbutamide, Chlorpropamide
Second Generation: Gilbenclamide, Glipizide, Gliclazide, Glimepride
ii. Biguanides: Phenformin, Metformin
iii. Meglitinide analogues: Repaglinide, Nateglinide
iv. Thiazolidinediones (TZDs): Rosiglitazone, Pioglitazone
v. α-glucosidase inhibitors: Acarbose, Miglitol
vi. Insulin

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Oral Hypoglycaemic Medications
Drug class Drug name Daily dose No. of doses
per day
MOA
Sulfonylureas Tolbutamide
Glibenclamide
Glipizide
Glimepride
0.5-3 g
5-15 mg
5-20mg
1-6mg
2-3
1-2
1-2
1
↑ insulin
secretions by
pancreatic β
cells
Biguanides Metformin
Phenformin
0.5-2 g
25-150mg
2-4
1-3
Inhibit
glucose
production by
liver

13. 13Oral Hypoglyceamic Medicines(cont.)
Meglitinides Repaglinide
nateglinide
1.5-8mg
180-480mg
3-4
3-4
↑ insulin
secretions by
pancreatic β
cells
Thiazolidinediones Pioglitazone 15-45mg 1 ↑ glucose uptake
by skeletal
muscle
α glucosidase
inhibitors
Acarbose
Meglitol
25-300mg
25-300mg
1-3
1-3
Inhibit
carbohydrate
absorption in
small intestine

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Self-Care
 Patients should be educated to practice self-care. This allows the patient to
assume responsibility and manage his / her own diabetes. Self-care should
include:
◦Blood glucose monitoring
◦Body weight monitoring
◦Foot-care
◦Personal hygiene
◦Healthy lifestyle/diet or physical activity
◦Identify targets for control
◦Stopping smoking

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