dr jignesh vora

1. Diabetes
Dr. Jignesh Vora

2. Symptoms-1
• Thirst due to increased amount of glu.
In urine which lead to dehydration
• Fatigue & lethagy [ carb-glu-glu need
insulin to transport it to cells.if glu cant
transported to cell then cells starve ,so]
• Urine sugar + [ unutilized glu is
excreated in urine]
• Blurred vision [ due to fluctuation of bl
sugar]

3. Symptoms-2
• wt despite of appetite
[due to insulin glu is not utilized. so body’s
need of energy breakdown protein & fat. So
muscle wasting happens which leads to wt.
• Insulin is anabolic hormone that encourages
storage of fat & muscle. So when it is wt
• NV due to bl sugar
• T & N due to ischemia and neuropathy

4. Causes
• Absent or insufficiency of insulin by
beta cells of pancreas
• Inability of cells to use insulin.[insulin
resistance] by cells of muscles and fat
tissues
• Obesity ,Hyglycemic diet
• Lack of exercise , stress
• Hereditary ,genetics

5. Types
• Type-1 :IDDM [juvenile , autoimmune]
• Type-2 :NIDDM
• Gestastional diabetes [temporary during
pregnancy]
• Secondary DM: Ch.panceratitis, trauma,
surg. removal of pancreas, acromegaly[
incresed GH] , cushings syndrome[
increased cortisol by adrenal gland]
• Rx: steroids, rx of Hiv

6. Investigations
• FBS [ 8 hrs minimum]
desirable < 100 mg/dl
if > 126 then repeat again. mg/dl
• When FBS is between 100-126 .It is kn
as IFG {Impaired fasting glucose}
• RBS :> 200 mg/dl then DM
• OGTT-oral glu tolerance test
for gestastionl DM & PCOD [due to
insulin resistance]

7. Investigation
• HBA1c-glycosylaed Hb
normal 4-6 %
well controlled 6-7 %
poor controlled > 8 %
6= 135 7=170 8=205
9=240 10=275 11=310
if pt is anemic then HBA1c is altered

8. Complications
acute
• Hypoglycemia
• Dehydration
• DKA-diabetic ketoacidosis
• Coma and death
chronic
• Microvascular :
eye, brain , kidneys, nerves
• Macrovascular :
heart and blood vessels
[atherosclerosis-angina-
stroke . leg pain-lack of
blood-cludication ]
• Diabetic retinopathy
• Diabetic nephropathy
• Diabetic neuropathy

9. Hypoglycemia
Due to higher dose of insulin or OHAs
vigorous exercise,
starvation
Symp: dizziness, confusion, wkness, tremors,
palpitation
If not treated – coma, seizures,
brain death[ < 40 mg/dl]
Rx glycogen inj [im]

10. DKA-diabetic ketoacidosis
• Insulin decreased – breakdown of protein &
fat –ketosis –blood becomes acidic-DKA
• Shock –coma –death
• Symp: nv ,abd pain
• Can be caused due to trauma and stress which
require more insulin

11. retinopathy
• Bl vessels in back of eyes causes leakage of
protein and bl in retina and also cause small
aneurysms
• Bleeding fm bl vessels-retinal detachment &
impaired vision
• Retinopathy is cured by LASER by destroying
and prevention of small aneurysms and brittle
bl vessels

12. nephropathy
• Due to leak of protein in urine
• Rx is dialysis , kidney transplantation
• ACEs
• ARBs

13. neuropathy
• T & N , burning, aching feet and lower limbs due to
ischemias
• When nerve damage causes complete sesnsation in feet ,pt
may not aware of injury
• Due to poor bl circulation-delayed healing-infection-ulcer-
gangrene
• ED
• NV
• Gastroparesis-delayed emptying of stomach
• Wt loss
• Diarrhoea
• Rx : gabapentin, pregabaline, duloxetine

14. Rx
• Sulfonylyreas-long acting – once a day
increase insulin o/p by panrcreas
older rx: chlorpropamide ,tolbutamide
newer rx : glipizide , glimepiride
ADRs : hypoglycemia

15. Rx
• Meglitinides
increase insulin o/p by pancreas
hypoglycemia < sulfonylyreas
eg. Repaglinide , nateglinide before meal
with Metformin result

16. Rx
• Biguanides : amount of glu produced by liver
Metformin : does not insulin, so
hypoglycemia does not happen.
appetite so prevents wt gain
CI : renal failure

17. Rx
• Thiozolidinediones
sensitivity of cells to insulin
eg. Pioglitazone , rosiglitazone . Once a day
ADRs : stroke, heart attack , myopathy
fluid retention-wt gain-swelling-so spirolactone
should be added
CI : liver disease, heart failure [ EF < 40%]
* Takes 6 wks to bl sugar
and 12 wks for max benefit
* # of distal bones of limbs
benefits : HDL , TG

18. Rx
• ACARBOSE : 25-100 mg thrice a day
@beginning of meal
absorption of carb by intestine
HBA1c
ADRs :abd pain,diarrhoea , gas

19. Rx
• Pramlintide
injectable
PPBS control
in DM-1 with insulin
insulin fluctuation during day
satiety- wt loss

20. Rx
• Exenatide
* slows release of glu fm liver
* slows stomach emptying
* inj [bf meal ]
ADRs : hypoglycemia

21. DPP-IV inhibitors
• 2 nd lline drugs
• 1st line of drug is metformin
• GLP-1 is broken down by DPP-IV . So DPP-IV
inhibitors stop GLP-1 breakdown
• Eg. Sitagliptin , saxagliptin, linogliptin
• saxagliptin 5mg /day or 2.5 mg;day if GFR is <
50ml / min
• adrs * pancreatitis

22. Combination therapy
• Glipizide/ glicazide/ glimepiride +metformin
• Pio/ rosi + metformin
• Sitagliptin + metformin

23. Insulin
• Very short acting: 5-15 min to 30-60
• Regular/short acting 30 min to 2-5 hrs
• NPH/intermediate 1-2 hrs to 8-14 hrs
• Lente/intermediate 1-2.5 hrs to 8-12 hrs
• Ultralente/long acting 4-6 hrs to 10-18 hrs
• Mode of delivery
1 Prefilled pens-300 units
2 insulin pumps-minimize hypoglycemia
3 Inhaled insulin-disappointed results
4 Transdermal patch- disappointed

24. Inhaled insulin - (Afrezza)
• forvboyh type 1 or type 2 DM
• rapid-acting insulin is taken before each meal,
or soon after starting to eat
• Afrezza won't replace the need for injected
long-acting insulin for those who need it
• Because it's inhaled, it's absorbed more
quickly and in a different way.
• "Afrezza is rapidly absorbed from the cells in
the lungs [to the blood stream]

25. Pancreas transplantation