The document is a class presentation outline by Sanjana, a second year student, on the topic of Diabetes Mellitus. The presentation covers the definition of diabetes, its types (Type 1 and Type 2), symptoms, causes, risk factors, complications, diagnostic tests, prevention and treatment. The objectives are to define diabetes, explain its epidemiology, types, causes, symptoms, risk factors, complications, diagnostic tests, prevention and treatment. The presentation contains detailed sections on these topics with definitions, statistics, and explanations.

1. CLASS PRESENTATION
ON
DIABETES MELLITUS
By : Sanjana
2nd year student

2. Name : Sanjana
Year : Second year
Enroll. No. : 047
Subject : Community Health Nursing
Topic : Diabetes Mellitus
Time : 30 minutes

3. Content
◦Introduction
◦Epidemiology
◦Types
◦Sign and symptoms
◦ Causes
◦Risk factors
◦Complications
◦Laboratory diagnosis
◦Prevention
◦Treatment

4. General Objectives
The general objective of this presentation is to share and impart
knowledge regarding Diabetes Mellitus and to gain skills interacting
with group and improve confidence.

5. Specific Objectives
◦ To introduce about the topic
◦ To define about it’s epidemiology
◦ Explain the definition of diabetes
◦ Explain it’s types and their causes , symptoms, risk factors
and it’s complications.
◦ To explain it’s diagnostic tests.
◦ How to prevent it.
◦ Explain it’s treatment.

6. Introduction
◦ Diabetes is one of the major causes of
premature illness and death world wide.
◦ It is a metabolic disease which is characterised by high
glucose levels.
◦ It’s prevalence is increasing in every country in the world,
and the toll is climbing in terms of human lives as well as the
costs to society.
◦ Its is one of the common “ lifestyle disease “ which is
plaguing people in the developed countries and has often a
casual link to heart disease, hypertension and obesity.

7. Epidemiology
◦ Global Scenario
◦ According to WHO -
The number of people with diabetes has risen
from 108 million in 1980 to 422 million in 2014.
The global prevalence of diabetes among
adults over 18 years has risenfrom 4.7%in
1980 to 8.5% in 2014.

8. ◦ Indian Scenario
According to WHO
During 2004 , there were estimated 37.7
million cases of diabetes in country, of
these 21.4 million were in urban and 16.3 in
rural areas .
Prevalance of range from 2.1% in 1972 to
12.4% in 2001.

10. Source: Royal College of
Physicians Of Edinburgh

12. Definition
◦ Diabetes mellitus is a group of metabolic disease in which there
are high blood sugar levels over a prolonged period of time.

13. Epidemiological Traid
Agent
Host Environment

14. Epidemiological Determinants
◦Agent factor:
Diabetes mellitus occur due to a number of mechanism
such as defect in formation of Insulin, destruction of beta
cells, pancreatic disorders, genetic defects or
autoimmunity. Diabetes mellitus occur due:
1. Neoplasm of pancreas
2. Cystic fibrosis

15. 3. Viral infection
4. Genetic defect in insulin gene
5. Auto immunity
6. Chemical agents
7. Pancretitis
All the above factors lead to decreased or no
production of insulin, thereby causing reduced
utilization of glucose and increased level of
glucose in blood and urine. It means decreased
utilization of glucose lead to hyperglycemia.

16. ◦Host Factor
1. Diabetes can occur at any age but studies have
shown that prevalence of diabetes rises with age. It
occurs equally in both the sexes.
2. It occur among individual having defective
immunological mechanism causing destruction of its
own insulin producing cells.
3. Obese people are at risk for developing diabetes.
4. Offsprings of diabetic pregnancies are at risk of
developing type 2 diabetes at an early age.

17. ◦ Environmental Factors
1. Lack of exercise
2. High intake of saturated fat
3. Malnutrition in early infancy
and childhood causes partial
failure of cells of islet of
langerhans.

18. 4. Chemical agents such as
streptozotocin, cynaide etc.
5. Surgery and removal of
pancreas.
6. Excessive intake of alcohol
7. Life style changes

19. Types of Diabetes Mellitus
◦Diabetes is due to either the pancreas not producing
enough insulin or the cells of the body not responding to
the insulin produced.
◦On this basis there are two main types of diabetes :
◦Type 1 diabetes mellitus
◦Type 2 diabetes mellitus.

20. What does Insulin do?
◦ Transports and metabolizes glucose for energy
◦ Stimulates storage of glucose in the liver and
muscle (in the form of glycogen)
◦ Signals the liver to stop the release of glucose
◦ Enhances storage of dietary fat in adipose
tissue
◦ Accelerates transport of amino acids (derived
from dietary protein) into cells

22. Type 1DM
◦ Type 1 diabetes is a condition in
which our immune system destroy
insulin making cells in pancreas
which are beta cells.
◦ This condition is usually
diagnosed in children and young
people so it is used to be called
juvenile diabetes.

23. ◦ A condition called secondary diabetes is like type 1,but in this
our beta cells are wiped out by something else, like a disease
or an injury to the pancreas, rather than our immune system.

24. Causes of type 1 Diabetes
◦ The exact cause of type 1 diabetes is unknown
◦ Our immune system which normally fights bacteria or viruses
– attacks and destroy insulin producing cells in the pancreas,
leaves with little or no insulin.
◦ Type 1 is thought to be caused by a combination of genetic
susceptibility and environmental factors, but what are those
factors is still unclear.
◦ Weight is not believed to be a factor in type 1 diabetes.

26. Risk factors for type 1 diabetes
◦ Although the exact cause of type
1 diabetes is unknown, factors
that may signal an increased risk
include:
◦ Family history
Risk increases if a parent or
a sibling has type 1 diabetes.
◦ Environmental factors
Circumstances such as
exposure to viral illness.

27. ◦ Presence of autoantibodies
Sometimes family members of people with type 1
diabetes are tested for the presence of autoantibodies. If any
of the family member have those autoantibodies then they
have increased risk of developing type 1 diabetes.
◦ Geography
Certain countries such as Finland and Sweden have
higher rates of type 1 diabetes.

28. Type 2 Diabetes
◦ Type 2 diabetes is a chronic condition
that affects the way our body
metabolizes sugar(glucose) – an
important source of fuel of our body
◦ With type 2 diabetes our body either
resists the effect of insulin( hormone
that regulate blood sugar levels in
blood) or doesn’t produce enough
insulin to maintain normal glucose
levels.

29. ◦In type 2 diabetes, cells become resistant to the
action of insulin and pancreas is unable to make
enough insulin to overcome this resistance.
◦Instead of going into cells, sugar build up in blood
stream.

30. Causes of type 2 diabetes
Factors are:
◦ Genes
◦ Extra weight
◦ Metabolic syndrome ( HTN, high
cholesterol, and triglycerides)
◦ Broken beta cells

31. Risk factors of type 2 diabetes
1.Weight
2.Fat distribution
If the stored fat is mainly in abdomen then you have
greater risk for type 2 diabetes.
Risk for type 2 diabetes increases if a man’s waist
circumference increases over 40 inches and for a women if it
increases above 35 inches.
3.Inactivity

32. 4.Family history
5.Prediabetes :a condition
where blood glucose levels are
higher than normal but not high
enough to be called diabetes,
but if left untreated then can
progress to type 2 diabetes)
6.Polycystic ovarian syndrome

34. • Polyuria ( frequent urination)

35. • Polydipsia

36. • Dry mouth

37. •Polyphagia ( excessive eating)

38. • Fatigue

39. • Blurred vision

40. • Frequent infections like UTIs

41. • Weight loss

42. • Tingling sensation in feet and hands

43. • Slow healing of wound and cuts

44. • Bed wetting

45. • Mood changes

47. Complication of DM
Possible complications are:
1. Cardiovascular Disease ( coronary artery disease with
chest pain – angina, heart attack, stroke and
atherosclerosis).
2. Neuropathy ( nerve damage)
Excess sugar can injure the walls of the tiny blood vessels
that nourishes nerves, especially in legs – causes tingling,
numbness, burning or pain that usually begins at the tips of
the toes or fingers and gradually spread upwards. If left
untreated could lose all senses of feeling in the affected limbs.
Damage to the nerves related to digestion can cause

48. problems with nausea , vomiting, diarrhea or constipation. For
men, it may lead to erectile dysfunction.
3.Nephropathy ( kidney damage).
Diabetes can damage delicate blood vessels. Severe
damage can lead to kidney failure or irreversible end stage
kidney disease.
4.Retinopathy ( eye damage)
Diabetes can damage the blood vessels of the retina, potentially
leading to blindness.

49. 5.Foot damage
Nerve damage in the feet or poor blood flow to the feetincresee
the risk of various foot complications. Poor wound healing can
ultimately lead to the foot or leg amputation.
6. Skin condition
Diabetes may leave you more susceptible to skin problems,
including bacterial and fungal infections.
7. Hearing impairment
Hearing problems are more common in people with diabetes.
8. Alzheimer’s disease
Type 2 diabetes may increase the risk of dementia, such as
Alzheimer’s disease. The poorer blood sugar control, the greater
the risk appear to be.

51. Diagnostic Tests

52. ◦There are different types of blood glucose tests:
Fasting plasma
glucose blood test
Random glucose
test
2- hour
postprandial blood
sugar
HbA1c Oral glucose
tolerance test

53. Random
Blood
Glucose.
Fasting
Blood
Glucose
test
2 hour
Postprandi
al Blood
Sugar Test
Oral
Glucose
Tolerance
Test
Hemoglobi
n
A1c Test
Values:
80-120 mg/dl
before meal
and upto 100-
140 mg/dl at
bedtime.
Values:
Less than or
equal to 100
ml/dl – for
norma person
For diabetic
person more
than 126 mg
/dl.
Values :
Less than 240
mg/dl for age
50 and
younger.
Less than
150mg/dl for
people age
50-60.
Less than
Values:
Normal –
Below
140mg/dl.
Prediabetic –
140-
199mg/dl.
Diabetic –
Values:
Normal –
Below 5.7%
Prediabetes-
5.7 you 6.4 %
Diabetes-
6.5 or higher

55. Prevention and Control of Diabetes
1. Primordial Prevention
Primordial prevention is the prevention of emergence or
development of risk factors in the population which haven’t yet
appeared . The effort are directed towards discouraging the adoption
of harmful lifestyle fro childhood.
Parents should made efforts towards children for adoption of
healthy lifestyle such as exercise, low intake of saturated fats and
prevention of malnutrition etc.

56. 2 .Primary Prevention
It is the action taken prior to the onset of diabetes mellitus. It
include two type of strategies:
◦ Population strategy
◦ High risk strategy

57. a. Population strategy
Population strategy for type 2 diabetes should be based on
elimination of all the environmental factors which are responsible for
causing diabetes.
It includes:
◦ Maintaining normal body weight
◦ Adopting healthy nutritional habits
◦ Doing physical exercise
◦ High intake of dietary fiber
◦ Avoid alcohol, sweet foods
◦ Prevent malnutrition by adequate intake of proteins
◦ Eliminate food toxins or chemical ingestion

58. b. High Risk Strategy
High Risk strategy means finding out the population who is at high
Risk and taking appropriate measures to prevent the occurence of
diabetes mellitus among them.
In high risk strategy, avoid the factors which causes diabetes such as:
- Avoid alcohol
- Avoid diabetogenic drugs
- Avoid high fat diet
These strategy should be directed towards the target population
who is at risk.

59. 3. Secondary Prevention
Secondary prevention includes:
a. Early Diagnosis
b. Referral
A. Early Diagnosis
The cases of diabetes should be detected as early as possible and need
to treat adequately. It’s treatment and management is important to prevent
the complications. The diabetes cases should be diagnosed by blood sugar
testing. If the values of the tests are abnormal, then appropriate treatment
should be started as early as possible.
Along withe the treatment the diabetic patients should be checked from
time to time for:

60. - Blood sugar levels
- Urine for proteins and ketones
- Visual acquity
- Neurological problems : loss of sensation
- Nephrological problems :decreased urine output, oliguria
Patients should be taught about self care which
includes:
◦ Compliance with diet - Preventing
hypoglycemia
◦ Compliance with drugs
◦ Self administration of insulin
◦ Abstinence of alcohol
◦ Periodic check up
◦ Maintaining weight

61. B. Referral
The detected cases should be reffered for appropriate treatment and
management of diabetes mellitus.
3. Tertiary Prevention
Tertiary prevention includes the measure which limits the disability which
has occured as a result of complication of diabetes such as Kidney Failure,
Neuropathy, Blindness, Gangrene of Lower Extremities or Coronary
Thrombosis etc.
So specialised clinics and units should be organised where diagnostic and
management skills of high order are available to provide services.
In case of disability occured, then the objective is to rehabilitate the
individual Vocationally, economically so that he can earn his livelihood.

62. MANAGEMENT

63. 1. Diet
Diet is a basic part of management
in every case.
Dietary treatment should aim at :
• ensuring weight control
• providing nutritional requirement
• Allowing good glycemic control
blood glucose level as close to
normal as possible.

65. 2. Exercise
• provide physical fitness
• increase carbohydrate metabolism
• reduce weight and increase insulin sensitivity
• decrease factors for cardiovascular disease
• decrease blood pressure and increase cardiac work

66. 3. Monitoring

67. Medication
◦ Metformin
This is usually the first medication used to treat type 2 diabetes. It
lower amount of glucose liver makes and help body respond better to
insulin it does make. example – fortamet .
◦ Sulfonylureas
This group of drugs helps body to make more insulin. Ex –
glimepriride
◦ Meglitinides
They help body make more insulin and they work faster than
sulfonylureas. Ex – nateglinide

68. ◦ Thiazolidinediones
They make you more sensitive to insulin. They also raise
risks of heart problems. Ex- pioglitazone.
◦ DPP-4 inhibitors
They lower blood glucose levels ex-tradjenta.

69. Insulin Therapy

72. ◦What is diabetes mellitus?
◦What are common sign and symptoms of diabetes
mellitus?
◦What happened in type 1 diabetes?
◦What are the diagnostic tests for diabetes mellitus?
◦How can we prevent diabetes mellitus?

73. 1. It’s a metabolic disorder in which blood glucose levels became
high.
2. Frequent thirst, excessive hunger, frequent urination, poor
healing of wounds Weight loss, fatigue.
3. In this the beta cells of pancreas are destroyed either by disease
or any trauma.
4. Random blood sugar test, HbA1C, OGTT, fasting blood glucose
test
5. By reduce weight, exercise , dietary modifications, change in
lifestyle etc.

74. Summary
In class presentation I have given the topic of ‘Diabetes
Mellitus’.
In this presentation I have completed the definition of
diabetes, it’s types , it’s causes, it’s risk factors,
complications of diabetes, how it can be diagnosed, how it
can be prevented, it’s treatment including medication .

75. Conclusion
◦At last I would like to conclude that people should have
knowledge about Diabetes Mellitus. I hope that I made the
topic Diabetes Mellitus understandable.
◦I want to thank my teacher for providing me this
opportunity so that I can learn that much about this topic.

76. Bibliography
◦ Book - Prevention And Social Medicine by K.Park
Page no. 392-396
Book – Community Health Nursing -1 by Neelam Kumari
page no. – 587- 591
◦ www.slideshare.com
◦ www.mayoclinic.com
◦ www.webmd.com
◦ www.healthline.com