DM is a chronic immunological and endocrine disorder that affects the individuals health and lifestyle

1. Diabetes Mellitus

2. Definition
• It is a syndrome of hyperglycaemia with
glycosuria due to lack of insulin or inefficient
action

3. Classifications
1. Type 1 or IDDM
2. Type 2or NIDDM
3. Gestational
4. Juvenile

4. Type I DM
It is a type of IDDM caused due to moderate
genetically mediated and less of inheritance, patient
with this type of DM have HLA-DR3 and HLA-
DR4 genes which are predispose the conditions.

5. Caues
• Genetics
• Environment factors
• Infection (rubella)
• Autoimmunity
• Immune destruction
• Use of immune suppressive agents
• (auto antibodies destroys the beta cells)

6. Type II DM
1. Genetics
100% for monozygotic twins and genetic
influence is powerful
2. Abnormal insulin secretion
3. Insulin resistance
4. Progressive beta cell failure
5. Factors such as HTN/Obesity/ physical
inactivity and age and pregnancy

7. Pathophysiology

11. Type I
3P’s
Polyuria
Polyphagia and polydipsia
Ketaacidosis
Diabetic ketotic coma
Mental apathy
Confusion
Death if untreated
Type II
Overweight
Less symptoms
Can be detected with
complications
Retinopathy/neuropathy/n
ephropathyIHD/HTN/UTI/
Pruritis
Clinical Manifestations

12. Glucose Test
a. FBS (>110 and <126) prediabetic state
b. PPBS
c. GTT (140-200 is prediabetic state)
d. Detection of glycosuria
e. Urine for protein
f. OGT test (3 days CHO diet an fasting before the
test and FBS blood taken and 75gms of glucose
in 300 ml of water advised to drink and every
half an hour urine tested for sugar for 2 hours)
Diagnosis

13. Interpretation of the test

14. f. Urine for ketone bodies
g. Hb A1C (Glycosylated Hemoglobin)
h. Other blood test like blood count
i. Lipidogram
j. ECG (IHD
k. X ray of chest

15. Management
Goals of management are
1. To achieve normal metabolic state
2. To maintain ideal body weight
3. To keep the patient symptoms free
4. To allow the patient to lead a normal life
5. To prevent the complications

16. Pharmacological Treatment
1. Oral Hypoglycemic Agents
a. Sulfonylureas
(chloropropamide/tolbutamide/glibenclamide)
b. Meglitidine analogues
c. Bigunides (metformin) insulin sensitizers
d. Thiazolidinedianoes
e. Alpha glucosidase inhibitors

17. Diet and life style modifications
The measures are
1. Diet and drug treatment should be matched to
maintain normal metabolic state
2. To keep ideal body weight total energy intake
shuld be specified
3. CHO/Proteins and fats must be in adewquate
amount

18. Dietary Management
Diet should be advised based on age/weight and
level of glucose/height and activity.
For non obese men: 36Kcl/kg
For non obese women: 34Kcl/kg
Carbohydrates: CHO should be in the form of
starch and complex sugars.

19. Requirement: 100-300gms spread over 3 times
(60gms/time)
High fiber diet :
(barley/oats/legumes/beans/peas)
Proteins: amino acids stimulates protein
synthesis.60-100gms

20. Fats: 50-150gms per day in divided meals
Fats should contain 10% saturated fatty acids,
10-15% mono saturated fatty acids/ 10 % ploy
saturated fatty acids

21. Alcohol: prohibited
Salts: 6 gms daily if patient is HTN the reduced
to 3 gms
Sweetening agents: allowed in low caloric diet

22. Types of Diet
1. Low energy and weight reducing diets
2. Weight maintenance diet

23. Life style Modifications

24. Insulin Treatment
Indications of Insulin therapy
1. All young diabetics
2. DM with DKA
3. Emergency with Type 2 DM
4. Gestational DM
5. Complications of DM
6. Uncontrolled DM

25. Types of Insulin
1. Short acting / unmodified
2. Long acting/ Modified
Dosage : always start with 10 units twice a day
or with each meal, and slowly increase the unit
by 2 units till optimum sugar level is reached

27. Side effects
1. Insulin induced hypoglycemia
2. Allergy
3. Weight gain
4. Insulin resistance
5. Lypodystropy

28. Complications of DM
1. Micro vascular Complications
(Nephropathy/neuropathy/retinopathy)
2. Macro vascular complications
(atherosclerotic/CAD/Renal vascular
disease)
3. Combined Micro and Macro cpomplications
(diabetic foot)

31. Other complications are
1. Infections
2. Sexual dysfunctions
3. Dermatological symptoms
4. Eyes: glaucoma and cataracts
5. GI: malabsorption syndrome

32. Care of Diabetic Foot

37. Common preventive measures for
Diabetic Foot are
• Wash foots cleanly
• Dry the foot
• Wear socks
• Apply moisturizers
• Periodic checkup with consultants
• Wear shoes and diabetic slippers of correct size
• Avoid bare foot walking
• Do not soak the foot more than 5 minutes

38. Thank You