This document discusses diabetes mellitus, a metabolic disorder characterized by high blood sugar levels resulting from defects in insulin production or insulin action. There are three main types of diabetes: type 1 caused by lack of insulin production; type 2 caused by insulin resistance; and gestational diabetes during pregnancy. Risk factors include family history, age, obesity, and physical inactivity. Symptoms include frequent urination, increased thirst and hunger. Diagnosis involves blood and urine tests. Treatment depends on diabetes type but may include medications to increase insulin production/sensitivity, insulin injections, diet control, exercise, blood sugar monitoring and management of complications which can include kidney disease, vision loss and heart disease if uncontrolled.

1. BY :- Mr. Baljinder Singh
Assistant Professor
PIMS, Panipat

2. An endocrine disorder in which there is
insufficient amount or lack of insulin
secretion to metabolize carbohydrates.
It is characterized by hyperglycemia,
glycosuria and ketonuria.

3. Diabetes mellitus is a group of
metabolic diseases characterized by
elevated levels of glucose in the blood
(hyperglycemia) resulting from defects in
insulin secretion, insulin action, or both

4. Insulin, a hormone produced by the
pancreas, controls the level of glucose in
the blood by regulating the production and
storage of glucose. In the diabetic state, the
cells may stop responding to insulin or the
pancreas may stop producing insulin entirely.
This leads to hyperglycemia, which may
result in acute metabolic complications such
as diabetic ketoacidosis (DKA) and
hyperglycemic hyperosmolar nonketotic
syndrome (HHNS).

7. THE
INSULIN
WHEN
SOMEONE
SUFFER
HAPPEN
WITH

8.  Risk of diabetes typically increase when
you are:
 Older age (45 years or older)
 Less active (sedentary life)
 Overweight or obese
 Family history of diabetes
 Pre-diabetes
 High blood pressure
 High lipids (triglycerides and low
HDL)
 Diabetes during pregnancy or baby
>9 lbs.

9.  Type 1 - IDDM
• little to no insulin
produced
• 20-30% hereditary
• Ketoacidosis
 Gestational
• overweight; risk for
Type 2
 Type 2 - NIDDM
• some insulin produced
• 90% hereditary
 Other types include Secondary
Diabetes :
• Genetic defect beta cell or
insulin
• Disease of exocrine
pancreas
• Drug or chemical induced
• Infections-pancreatitits
• Others-steroids,

10. Type 1 diabetes is a chronic (lifelong)
disease that occurs when the pancreas
produces too little or no insulin to regulate
blood sugar levels appropriately.
Causes :-
Viral infection
Genetics
Not caused by life style.

11. Type 2 diabetes also called NIDDM is
a chronic, life-long disease that
results when the body's insulin does
not work effectively.

12. Causes and risk factors
Genetics
 low activity level
poor diet
excess body weight (especially around the
waist)
Race/ethnicity;

13. PATHOPHYSIOLOGY

20.  History
 Blood tests
• Fasting blood glucose test: two tests > 126 mg/dL
• Oral glucose tolerance test: blood glucose > 200
mg/dL at 120 minutes
• Glycosylated hemoglobin (Glycohemoglobin test)
assays
• Glucosylated serum proteins and albumin
 FSBS – (finger stick) monitoring blood sugar

23. Urine testing for ketones
Urine testing for renal function
Urine testing for glucose

25. ORAL ANTI-DIABETIC DRUGS:-
Oral sulfonylureas (like glimepiride,
glyburide, and tolazamide) trigger the
pancreas to make more insulin.
Biguanides (Metformin) tell the liver to
decrease its production of glucose, which
increases glucose levels in the blood
stream.

26. Alpha-glucosidase inhibitors (such as
acarbose) decrease the absorption of
carbohydrates from the digestive tract,
thereby lowering the after-meal glucose
levels.
Thiazolidinediones (such as rosiglitazone)
help insulin work better at the cell site. In
essence, they increase the cell's sensitivity
(responsiveness) to insulin.

27. Oral Antidiabetic Agents

28.  Insulin lowers blood sugar by allowing it to leave
the blood stream and enter cells. Patients with
Type 1 diabetes mellitus depend on external
insulin (most commonly injected subcutaneously)
 The commonly used types of insulin are:
 Rapid-acting insulin These begin to work within 5
to 15 minutes and are active for 3 to 4 hours.
 Short-acting, such as regular insulin – starts
working within 30 minutes and is active about 5 to
8 hours.

29. Intermediate-acting,– starts working in 1 to
3 hours and is active 16 to 24 hours.
Long-acting, insulin – starts working in 4 to
6 hours, and is active well beyond 32
hours.

35. Diabetes Diet: A healthy diet is
key to controlling blood sugar
levels and preventing diabetes
complications.
Eat a consistent, well-balanced
diet that is high in fiber, low in
saturated fat, and low in
concentrated sweets.

37.  Purpose - controls
blood glucose and
lowers blood glucose
 Purpose - reduce the
amount of insulin
needed

39.  Urine - Ketones
 FBS
 Wear ID Bracelet

41. Diabetic ketoacidosis
Hyperglycemic-hyperosmolar-
nonketotic syndrome
Hypoglycemia from too much insulin or
too little glucose

43.  Physical
 General signs
 Ill appearance
 Dry skin
 Dry mucous membranes
 Decreased skin turgor
 Vital signs
 Tachycardia
 Hypotension
 Tachypnea
 Hypothermia
 Fever, if infection
 Specific signs
 Ketotic breath (fruity, with acetone smell)
 Confusion
 Coma
 Abdominal tenderness

44. 1. Fluids
- If in shock, initial resuscitation with normal saline. Dehydration
should then be corrected gradually over 48 to 72 hour
using 0.45% Saline
- Monitor :
- Fluid input and output
- Electrolytes, creatinine and acid-base status regularly
- Neurological states
2. Insulin
- insulin infusion is started, titrating the dose according to the
blood glucose. Monitor blood glucose regularly.
- aim for gradual reduction of blood glucose .

45. Cardiovascular disease
Cerebrovascular disease
Retinopathy (vision) problems
Diabetic neuropathy
Diabetic nephropathy
Male erectile dysfunction

46. Uncontrolled diabetes
can lead to…
Kidney failure
Amputations
Loss of Sensations
Heart disease
and strokes
Blindness
Death

48. By :- Baljinder Singh ,
Assistant Professor
PIMS, Panipat
08053142473