Diabetes mellitus

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  • IFG- Impaired fasting glucose ,, IGT-impaired glucose tolerance.
  • Diabetes mellitus

    1. 1. Dr saurav singh
    2. 2.  Definition  Classification  Symptoms  complications  Investigations  Fasting and post-prandial blood glucose  GTT  Urinary glucose testing  Glycosylated Hb1Ac
    3. 3.  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
    4. 4. Type 1 Diabetes Type 2 Diabetes - blood glucose levels rise due to - Absolute deficiency of insulin due to destruction of β cells of pancreas . - results in insulin dependence - commonly detected before 30 1) Lack of insulin production 2) Insufficient insulin action (resistant cells) - commonly detected after 40 - effects > 90% - eventually leads to β-cell failure (resulting in insulin dependence)
    5. 5. Type 1  Young age  Normal BMI, not obese  No immediate family history  Short duration of symptoms (weeks)  Can present with diabetic coma (diabetic ketoacidosis)  Insulin required Type 2  Middle aged, elderly  Usually overweight/obese  Family history usual  Symptoms may be present for months/years  Do not present with diabetic coma  Insulin not necessarily required  Previous diabetes in pregnancy
    6. 6.  characteristic symptoms are increased thirst, polyuria, blurring of vision, unexplained weight loss, fatigue and recurrent infections such as candida.  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.
    7. 7.  Short term:  Symptoms of diabetes  Dehydration  Diabetic Coma  Infections  Long term:  Kidney disease  Eye disease  Heart  Circulation  Amputation  Nerve damage
    8. 8.  Diagnosis of Diabetes mellitus  Screening of Diabetes mellitus  Assessment of glycemic control  Assesment of associated long term risks  Management of acute metabolic complications
    9. 9.  The diagnosis of diabetes in an asymptomatic subject should never be made on the basis of a single abnormal blood glucose value.  For the asymptomatic person, at least one additional plasma/blood glucose test result with a value in the diabetic range is essential, either fasting, from a random (casual) sample, or from the oral glucose tolerance test (OGTT)
    10. 10.  -Glucose may be estimated in either plasma or whole blood.  -The glucose concentration in whole blood is approximately 15% lower than the glucose  concentration in serum or plasma, because the volume of distribution of glucose is lower, as erythrocytes contain less free water than plasma.  -Samples for glucose can be obtained either by veinpuncture or by a fingerprick technique (collected in capillary tubes).
    11. 11.  -Blood cells continue to metabolize glucose after veinpuncture and serum or plasma must be refrigerated and separated from the cells within 1 hour to prevent substantial losses of glucose by the cellular fraction.  -A preservative that inhibits glycolysis should be used (sodium fluoride, together with potassium oxalate as an anticoagulant, is used for this purpose).
    12. 12.  Fasting Plasma Glucose Test (FPG) Fasting morning blood glucose is the best initial test. It is a cheap and fast test done after 10-16 hrs of fasting. * fasting B.G.L. 100-125 mg/dl signals pre-diabetes * >126 mg/dl signals diabetes
    13. 13.  -The two-hour postprandial glucose measurement is often used in conjunction with the fasting plasma glucose.  -The patient is advised to consume a meal that contains approximately 75 grams of carbohydrates.
    14. 14.  -Two hours after eating, a blood sample is drawn for plasma glucose measurement.  -A glucose value greater than 200 mg/ dl indicates diabetes mellitus.
    15. 15.  -The OGTT is the most sensitive test for the diagnosis of diabetes.  It refers to the ability of the body to metabolize glucose.  -A sample of the patient's blood is drawn after an over night fast.  -The patient then consumes 75g of a glucose solution and blood is drawn every 30 minutes for two hours.
    16. 16.  Impaired glucose tolerance is diagnosed with a plasma glucose between 140 and 200 mg/dL (7.8 and 11.1 mmo1/L) at 2 hours time point in the test ( prediabetes)  A plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L) at the 2-hour time point indicates diabetes mellitus.
    17. 17.  Gestational diabetes is considered present when the values of the OGTT are greater than the following;  fasting, 105 mg/dL (5.8 mmo1/L)  1 h, 190 mg/dl (10.6 mmo1/L)  2 h, 165 mg/dL (9.2 mmo1/L)
    18. 18. Test Normal Prediabetes Diabetes FBG < 100 100-125 (IFG) >125 < 140 140-199 (IGT) ≥ 200 (mg/dl) OGTT – 2hr result (mg/dl)
    19. 19.  If serum glucose level exceeds the renal glucose threshold (180 mg/dl), it appears in urine (GLUCOSURIA) as in diabetes mellitus.  Glucose can be detected in urine using the specific test strips that contain glucoseoxidase, peroxidase, and a chromagen.  -Other carbohydrates using Benedict's and Fehling's reagents.
    20. 20.  HbA1c is the largest subfraction of normal HbA in both diabetic and non-diabetic subjects and is formed by the reaction of the-beta chain of HbA with glucose.  This fraction reflects the concentration of glucose present in the body over a prolonged time period.  The measurement of glycated haemoglobin therefore gives an indication of the overall degree of blood glycaemic control, in contrast to glucose measurements which give information for a single time-point.
    21. 21.  HgA1C is therefore the gold standard test  All treatment decisions for Type 2 Diabetics should be based on Hb A1C levels  There appears to be a direct relationship between cardiovascular risk and HbA1C.  The goal is to achieve an HbA1C as low as possible, preferably less than 7.0%, without causing unacceptable hypoglycaemia.  HbA1C > 8 mmol/L is a sign of inadequate control for most people
    22. 22.  HgA1C < 6% - normal.  HgA1C < 7% - goal.  HgA1C 7.0 - 7.5% - good control.  HgA1C > 7.5% - additional therapy

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