DEFINITION OF DIABETES MELLITUS : It is the group of metabolic disorders which characterised by hyperglycemia and abnormalities of carbohydrate, fat and protein metabolism. resulting from defects in insulin secretion, insulin action, or. Both . Causes:- Life style Genetics factor Obesity Diet time variation Etiological Classification of Diabetes: Type :-1 Diabetes (insulin dependent) Type :-2 Diabetes (non insulin dependent) Gestational diabetes DEFINTION OF TYPE 1 DIABETES : Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition by the beta cells in islets of Langerhans in the pancreas in which the pancreas produces little or no insulin, due to  the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.  DEFINITION OF TYPE 2 DIABETES : known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, due to body cells don’t respond normally to insulin; this is called insulin resistance. DEFINITION OF GESTATIONAL DIABETES : Gestational Diabetes: Is the increasing of blood sugar levels for Some women tend to experience high levels of blood glucose as during pregnancy due  to reduced sensitivity of insulin receptors. CAUSES : The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys cells which the insulin-producing (islets of Langerhans) cells in the pancreas. Other possible causes include: Genetics Exposure to viruses and other environmental factors Endocrine disorders such as acromegaly , Cushing's syndrome Endocrine disorders e.g. Pancreatitis . Medications e.g. glucocorticoids , niacin , pentamine alpha- interferons . Micro vascular complications (zeroplateas , neutrophils , eosinophil's ) Macro vascular complications (CHF , stroke , peripheral vascular disease) SYMPTOMS : Type 1 diabetes signs and symptoms can appear relatively suddenly and may include: Increased thirst Frequent urination Bed-wetting in children who previously didn't wet the bed during the night Extreme hunger Unintended weight loss Irritability and other mood changes Fatigue and weakness Blurred vision PHARMACOLOGICAL TREATMENT : Insulin: People with type 1 diabetes must take insulin every day. You usually take the insulin through an injection. Metformin : Metformin is a type of oral diabetes medication. For many years, it was only used in people with type 2 diabetes. However, some people with type 1 diabetes can develop insulin resistance. That means the insulin they get from injections doesn’t work as well as it should. Metformin helps lower sugar in the blood by reducing sugar production in the liver. Your doctor may advise you to take Metformin in addition to insulin. B) NON- PHARMACOLOGICAL TREATMENT : CONTROL THE SYMPTOMS . EXERCISES MONITORING THE SUGAR LEVELS HEALTHY FOODS .

1. CASE STUDY ON :
DIABETES MELLITUS
MOHAMMED AYESH ABDO HASAN MOAFA
B.PHARM, M.PHARM, PG.DCA, MBA, MA, M.SC.

2. DEFINTIONS :
DEFINITION OF DIABETES MELLITUS :
It is the group of metabolic disorders which characterised
by hyperglycemia and abnormalities of carbohydrate, fat
and protein metabolism. resulting from defects in insulin
secretion, insulin action, or. Both .
• Causes:-
Life style
Genetics factor
Obesity
Diet time variation

3. Etiological Classification of Diabetes:
I. Type :-1 Diabetes (insulin dependent)
II. Type :-2 Diabetes (non insulin dependent)
III. Gestational diabetes

4. DEFINTION OF TYPE 1 DIABETES :
Type 1 diabetes, once known as juvenile
diabetes or insulin-dependent diabetes, is a
chronic condition by the beta cells in islets of
Langerhans in the pancreas in which the
pancreas produces little or no insulin, due
to the autoimmune destruction of the beta cells
in the pancreas. Although onset frequently
occurs in childhood, the disease can also
develop in adults.

5. DEFINITION OF TYPE 2 DIABETES :
known as adult-onset diabetes, is a form
of diabetes that is characterized by high blood
sugar, due to body cells don’t respond normally
to insulin; this is called insulin resistance.

6. DEFINITION OF GESTATIONAL DIABETES :
• Gestational Diabetes: Is the
increasing of blood sugar levels for
Some women tend to experience
high levels of blood glucose as during
pregnancy due to reduced sensitivity
of insulin receptors.

7. PATHOPHYSIOLOGY
(GENERAL PATHOPHYSIOLOGY)

8. PATHPHYSIOLOGY OF TYPE 1 DIABETES

9. PATHOPHYSIOLOGY OF TYPE 2 DIABETES

10. CLINICAL PRESENTGATION :
Polyuria (frequent urination) , Polydipsia
(increased thirst) , Polyphagia (increased hunger)
, weight loss , hyperglycemia , nocturia (night
urination ).

11. CAUSES :
• The exact cause of type 1 diabetes is unknown. Usually, the
body's own immune system — which normally fights harmful
bacteria and viruses — mistakenly destroys cells which the
insulin-producing (islets of Langerhans) cells in the pancreas.
Other possible causes include:
 Genetics
 Exposure to viruses and other environmental factors
 Endocrine disorders such as acromegaly , Cushing's syndrome
 Endocrine disorders e.g. Pancreatitis .
 Medications e.g. glucocorticoids , niacin , pentamine alpha-
interferons .
 Micro vascular complications (zeroplateas , neutrophils ,
eosinophil's )
 Macro vascular complications (CHF , stroke , peripheral
vascular disease)

12. SYMPTOMS :
• Type 1 diabetes signs and symptoms can appear
relatively suddenly and may include:
• Increased thirst
• Frequent urination
• Bed-wetting in children who previously didn't wet the
bed during the night
• Extreme hunger
• Unintended weight loss
• Irritability and other mood changes
• Fatigue and weakness
• Blurred vision

14. RISK FACTORS :
• Some known risk factors for type 1 diabetes include:
• Family history. Anyone with a parent or sibling with
type 1 diabetes has a slightly increased risk of
developing the condition.
• Genetics. The presence of certain genes indicates an
increased risk of developing type 1 diabetes.
• Geography. The incidence of type 1 diabetes tends to
increase as you travel away from the equator.
• Age. Although type 1 diabetes can appear at any age, it
appears at two noticeable peaks. The first peak occurs
in children between 4 and 7 years old, and the second
is in children between 10 and 14 years old.

15. Complications :
• Heart and blood vessel disease. Diabetes dramatically increases your risk
of various cardiovascular problems, including coronary artery disease with
chest pain (angina), heart attack, stroke, narrowing of the arteries
(atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny
blood vessels (capillaries) that nourish your nerves, especially in the legs.
This can cause tingling, numbness, burning or pain that usually begins at
the tips of the toes or fingers and gradually spreads upward. Poorly
controlled blood sugar could cause you to eventually lose all sense of
feeling in the affected limbs.
• Damage to the nerves that affect the gastrointestinal tract can cause
problems with nausea, vomiting, diarrhea or constipation. For men,
erectile dysfunction may be an issue.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood
vessel clusters that filter waste from your blood. Diabetes can damage this
delicate filtering system. Severe damage can lead to kidney failure or
irreversible end-stage kidney disease, which requires dialysis or a kidney
transplant.

16. • Eye damage. Diabetes can damage the blood vessels of the
retina (diabetic retinopathy), potentially causing blindness.
Diabetes also increases the risk of other serious vision
conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to
the feet increases the risk of various foot complications. Left
untreated, cuts and blisters can become serious infections
that may ultimately require toe, foot or leg amputation.
• Skin and mouth conditions. Diabetes may leave you more
susceptible to infections of the skin and mouth, including
bacterial and fungal infections. Gum disease and dry mouth
also are more likely.
• Pregnancy complications. High blood sugar levels can be dangerous for
both the mother and the baby. The risk of miscarriage, stillbirth and birth
defects increases when diabetes isn't well-controlled. For the mother,
diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems
(retinopathy), pregnancy-induced high blood pressure and preeclampsia.

17. DIAGNOSIS :
• Type 1 diabetes is usually diagnosed through a series of
tests.. Some can be conducted quickly, while others
require hours of preparation or monitoring.
• Type 1 diabetes often develops quickly. People are
diagnosed if they meet one of the following criteria:
• fasting blood sugar > 126 mg/dL on two separate tests
• random blood sugar > 200 mg/dL, along with
symptoms of diabetes
• hemoglobin A1c > 6.5 on two separate tests

18. TREATMENT :
A) PHARMACOLOGICAL TREATMENT :
• Insulin:
People with type 1 diabetes must take insulin every day. You
usually take the insulin through an injection.
• Metformin :
• Metformin is a type of oral diabetes medication. For many
years, it was only used in people with type 2 diabetes.
However, some people with type 1 diabetes can
develop insulin resistance. That means the insulin they get
from injections doesn’t work as well as it should.
• Metformin helps lower sugar in the blood by reducing sugar
production in the liver. Your doctor may advise you to take
Metformin in addition to insulin.

19. • Other medications :
• A new oral medicine may be on the horizon for people
with type 1 diabetes. Sotagliflozin (Zynquista) is
awaiting FDA approval. If it gets the green light, this
drug will be the first oral medication designed to be
used alongside insulin in people with type 1 diabetes.
• This medicine works to lower glucose levels in the
blood by forcing the body to expel it in urine and by
reducing glucose absorption in the gut. Similar
medicines exist already for people with type 2
diabetes, but none are approved for people with type
1.

20. B) NON- PHARMACOLOGICAL TREATMENT :
1) CONTROL THE SYMPTOMS .
2) EXERCISES
3) MONITORING THE SUGAR LEVELS
4) HEALTHY FOODS
5) LITTLE INTAKE OF CARBOHYDRATES
6) MONITOR BP REGULARELY
7) AVOID FAST FOOD
8) AVOID ALCOHOL AND SMOKING

21. SUBJECTIVE :
PATIENT NAME : K.GOPAL
AGE : 35 YRS
SEX : MALE
CURRENT PROBLEM : Patient is admitted with
weight loss , , weakness , tiredness and fatigue for 1
month .
PAST MEDICAL HISTORY : Nil
FAMILY HISTORY : Nil
SOCIAL HISTORY : Bowel habit normal , bladder
habits are normal

22. OBJECTIVE :
Physical examination : General condition ,
conscious , oriented , febrile , not clubbing , not
cyanosed .

23. VITAL SIGNS :

24. URINE ANALYSIS : Nil
ASSESSMENT :
INTERPRETATION :
SUBJECTVE : General fatigue
OBJECTIVE : on diagnosis echo change found to
be observed
DIAGNOSIS : TYPE 2 DIABETES MELLITUS

25. PLAN :
Brand name Generic
name
dose R freq
ue
ncy
1 2 3 4
Inj.Hovalog Insulin lipro iv OD y y y y
Inj.Ferroin Iron source 2 amp iv OD y y y y
Tab . Galus T.vidagliptin 50 mg oral OD y y y y
Tab.Lumina 60 k T.cholicalciferol+vit D oral OD y y Y
Tab. Hemet Metformin HCL+
sustained release
500mg oral OD y y y y
Inj.lantus Inj.insulin 2tsp iv OD y y y y
Tab.gride T.Glimepride 50/20
mcg
1-1-1-
1
y y y y

26. TREATMENT PROGRESSION :
• Inslin lispro :
• Iron source :
• Vidagliptin :
• T.chlecalceferol :
• T.metformin :
• Insulin glargine :
• T.Glimepride :

27. PLAN ON DISCHARGE :
T. Metformin Hcl 500 mg OD
T. Vidagliptin 500 mg OD
T. Glimepride 2 mg OD
T. Zentel 500 mg OD

28. PLAN :
PHARMACIST INTERPRETATION :
All drugs , prescribed are rational

29. PATIENT COUNSELLING :
Health foods like fruits , vegetables , whole
grains .
Avoid alcohol and smoling .
Monitor BP regularely .
Avoid fast food and dairy products .
Keep your immunization power up each day