BEST NOTES OF DIABETES MELLITUS BY DR SALMAN SHAHAB,INDIA. all about diabetes mellitus and its complications . diabetic ketoacidosis and HHS. anti-diabetic drugs and newer anti-diabetic drugs.

1. DIABETES MELLITUS
BY :- DR SALMAN SHAHAB (MBBS)

2. TOPICS
• Definition and classifications
• Investigations
• Management
• Anti-diabetic drugs
• complications

3. DEFINITION AND CLASSIFICATIONS
Diabetes mellitus:-
It is a clinical syndrome characterised by chronic & persistant hyperglycemia due to absolute or relative
deficiency of insulin.
Absolute :- reduced insulin secretion
Relative :- reduced insulin action/insulin resistance.
Classifications :-
Type-1(juvenile diabetes or insuline dependent)
Type-2(insulin independent)
Gestational diabetes mellitus
Others :- pancreatitis,pancreatectomy,cystic fibrosis,cushings syndrome,drug induced eg :- steroids,diuretics.

4. INVESTIGATIONS :-
• WHO DIAGNOSTIC CRITERIA :-
• Patient complaints :- polyuria, polydipsia, polyphagia, weight loss, weakness.
• Blood sugar level :- fasting >7.0mmol/L(126mg/dl) & random and 2 hrs afters
breakfast > 11.1mmol/L(200mg/dl)
• HbA1c level :- .6.5%
• Other ivestigations :- urine examinations for glucose/protein(nephropathy) &
ketone bodies, fasting lipid profile, serum urea & creatinine, serum electrolytes.

5. MANAGEMENT :-
• History :- wt loss, family history of DM, HTN, IHD, smoking, alcohol use.
• Clinical features :- polyuria, polydipsia, polyphagia, wt loss, weakness, frequent
infections, slow healing skin lesions, mood changes, irritability,erectile dysfunction.
• Treatment :-
• Dietary and lifestyle modifications can control about 50% of newly diagnosed cases.
• Drugs :- oral anti-diabetic drugs for type-2 DM.
• Insulin :- type-1 only needs insulin therapy, type-2 needs when drug combinations
fails,in pregnancy, complications such as DKA, HHS, acute MI, stroke, surgery.

6. ANTI-DIABETIC DRUGS :-
• 1- parenteral :- insulin preprations & GLP1 analouges.
• 2- oral :- insulin secretagogues, insulin sensitizers, newer drugs.
• COMMON INSULIN PREPRATIONS :-
• Human insulin :-
• short acting :- regular insulin/soluble insulin
• Intermediate acting :- isophane,lente.
• Long acting
• Insulin analouges :-
• Rapid acting :- lispro, aspart
• Long acting :- glargine, detemir.

7. INDICATIONS & SIDE-EFFECTS OF INSULIN
• INDICATIONS :- type-1 & 2 DM, DM with complications, GDM, per-operative
& post-operative, DM with severe infections, hyperkalemia.
• SIDE EFFECTS :- hypoglycemia, weight gain, peripheral edema, insulin
antibodies, allergy.

8. ORAL ANTI-DIABETIC DRUGS :-
• Insulin secretagogues :- it increases insulin secretion.
• a) sulfonylureas :- 1st gen :- tolbutamide, tolazamide, 2nd gen :- glibenclamide,
glipizide, gliclazide, glimepiride.
• b) meglitinides :- repaglinide, nateglinide.
• Insulin sensitizers :- increases muscles, fat and liver sensitivity to insulin and lower the
blood glucose.
• a) biguanides :- metformin & phenformin ( causes lactic acidosis so not used now a
days)
• b) thiazolidindiones :- pioglitazone & rosiglitazone.

9. NEWER DRUGS :-
• A) alpha glucosidase inhibitor :- acarbose, voglibose, miglitol.
• B)- incretin mimetics :-
• DPP-4 enzyme inhibitors :- linagliptine, vidagliptin, sitagliptin, saxagliptin.
• GLP-1 analouges :- exenatide, liraglutide.
• C) SGLT2 inhibitors :- dapagliflozin.

10. EXTRAS :-
• Advantage of metformin :-
• it is an insulin sparing agent.
• It does not increases weight.
• Does not causes hypoglycemia.
• Decreases the risk of macro & micro vascular complications
• Useful in prevention of type-2 DM.
• Disadvantages of metformin :-
• not given in AKI & CKD and CLD.

11. THANK YOU
Lecture prepared by DR SALMAN SHAHAB(MBBS)