diabetes mellitus

2. Why To Study Diabetes
 The development of diabetes is projected to reach pandemic
proportions over the next10-20 years.
 International Diabetes Federation (IDF) data indicate that by the
year 2025, the number of people affected will reach 333 million –
90% of these people will have Type 2 diabetes.
 In most Western societies, the overall prevalence has reached 4-6%,
and is as high as 10-12% among 60-70-year-old people.
 The annual health costs caused by diabetes and its complications
account for around 6-12% of all health-care expenditure.

3. DIABETES = diabainein ‘to go through’ or ‘excessive
discharge of urine’
MELLITUS = mell ‘honey-sweet’
What is Diabetes Mellitus?

4. Deffiniton:
0The American Diabetes Association defines DM
as a group of metabolic diseases characterized by
hyperglycemia resulting from defects in insulin
secretion, insulin action, or both

5. History:
• 30-90AD: Diabetes named by Greek Physician Aretaeus: means ‘a
flowing through’ to describe its constant thirst, excessive urination
and weight loss
• Japanese name: 'Shoukachi', the thirst disease
• 1600s: Professor Thomas Willis of Oxford University describes urine
in diabetes mellitus as ‘wonderfully sweet’, distinguishing it from
diabetes insipidus
• 1889: Oskar Minkowski and Joseph von Mering of University of
Strasbourg remove a dog’s pancreas - it produces diabetes
• 1921: Banting & Best isolate insulin, successfully treats a patient,
transforming diabetes to a treatable, chronic condition

6. Signs And Symptoms
0 Frequent urination
0 Excessive thirst
0 Increased hunger
0 Weight loss
0 Tiredness
0 Lack of interest and concentration
0 A tingling sensation or numbness in the hands or feet
0 Blurred vision
0 Frequent infections
0 Slow-healing wounds
0 Vomiting and stomach pain (often mistaken as the flu

7. i) Insulin dependent diabetes
mellitus (IDDM)
ii) Non-insulin dependent diabetes
mellitus (NIDDM)
iii) Other
iv) Gestational diabetes
Types

8. 0Type 1 diabetes is a chronic (lifelong) disease that
occurs when the pancreas does not produce enough
insulin to properly control blood sugar levels.
What Causes Type 1 Diabetes
0The body's own immune system attacks and
destroys beta cells in the pancreas that are
responsible for creating the hormone insulin.
What is Type 1 Diabetes?

10. 0 Type 2 diabetes formerly called non-insulin-dependent
diabetes is a disorder that is characterized by high
blood glucose in the context of insulin resistance and
relative insulin deficiency.
What Causes Type 2 Diabetes
0 Type 2 diabetes occurs when the pancreas doesn't
make enough insulin or the cells of the body become
resistant to insulin.
What is Type 2 Diabetes

12. Gestational Diabetes Mellitus
0 Gestational diabetes mellitus (GDM) is a condition in
which women first exhibit levels of elevated plasma
glucose during pregnancy. Women previously diagnosed
with diabetes prior to pregnancy are excluded from this
classification. After pregnancy, the diagnostic
classification of GDM may be changed based on
postpartum testing.
0 About 60% of women with GDM will develop T2DM in
the ensuing 5 to 10 years and all remain at an increased
risk for the development of T2DM later in life.

13. Other specific types
0 Monogenic DM: (formerly maturity-onset diabetes of
the young) should be considered in children with an
atypical presentation or response to therapy.
0 Latent Autoimmune Diabetes of the Adult (LADA):
which is a slow destruction of the pancreatic β-cells
similar to T2DM, but autoantibodies are present as in
T1DM.

14. Diagnosis
0 Fasting Plasma Glucose Test
0 Oral Glucose Tolerance Test (OGTT)
0 HbA1C Test

15. 0 Normal glucose levels
Fasting plasma glucose 82-110 mg/dl
Plasma gulucose after meals upto 140 mg/dl
0 In diabetic patients
Fasting plasma glucose levels above 126mg/dl
Plasma glucose after meals above 200mg/dl

16. Fasting Plasma Glucose

17. Oral Glucose Tolerance Test
(OGTT)

18. Glycosylated Hemoglobin (HbA1c)
0HbA1c is a test that measures the
amount of glycated hemoglobin in your
blood. Glycated hemoglobin is a
substance in red blood cells that is
formed when blood sugar (glucose)
attaches to hemoglobin.

19. (HbA1c)

20. ?
Who
is
at
risk?

22. Treatment
• Diet and ExerciseA
• Oral antidiabetic therapyB
• Insulin TherapyC

23.  Diet is a basic part of management in every case.
Treatment cannot be effective unless adequate
attention is given to ensuring appropriate nutrition.
 Dietary treatment should aim at:
◦ ensuring weight control
◦ providing nutritional requirements
◦ allowing good glycaemic control with blood glucose
levels as close to normal as possible
◦ correcting any associated blood lipid abnormalities
A. Diet

24. Definition:
“Agents which are given orally to reduce the blood
glucose levels in diabetic patients ”.
0 The oral antidiabetic drugs are given only in the
treatment of type 2 (NIDDM) diabetes mellitus which
cannot be controlled by diet alone.
0 Use of an oral antidiabetic drug with insulin may
decrease the insulin dosage in some individuals.
B. Oral Antidiabetics

25. C. Insulin Therapy
0 All patients with type 1 diabetes need insulin
treatment permanently, unless they receive an islet or
whole organ pancreas transplant; many patients with
type 2 diabetes will require insulin as their beta cell
function declines over time.

26. Statistic In Pakistan
0 Pakistan is one of the 20 countries of the IDF MENA
region.
0 387 million people have diabetes in the world
and more than 37 million people in the MENA Region;
by 2035 this will rise to 68 million.
0 There were 6.9 million cases of diabetes in Pakistan in
2014.

27. DIABETES IN PAKISTAN - 2014
Total adult population (1000s)
(20-79 years)
102,125
Number of
deaths in
adults due to
diabetes
87,548
Prevalence of diabetes in adults
(20-79 years) (%)
6.8
Cost
per person
with diabetes
(USD)
52.7
Total cases of adults (20-79
years) with diabetes (1000s)
6,943.8
Number of
cases of
diabetes in
adults that
are
undiagnosed
(1000s)
3,471.9

28. Off course Too Much Is Bad
For You

30. THANK YOU