what is diabetes? type 1 & 2 gestational diabetes secondary diabetes ADA guidlines signs and symptoms prevention management treatment complications

1. DIABETES
MELLITUS

2. What is Diabetes Mellitus?
•Diabetes mellitus is a group of metabolic
disorder in which there is high blood glucose
levels over a prolonged period.
•Diabetes is due to either the pancreas not
producing enough insulin, or the cells of the
body not responding properly to the insulin
produced.

4. CLASSIFICATION OF DIABETES MELLITUS
1. TYPE 1:
Pancreatic islet β
cell deficiency
2. TYPE 2 :
Defective insulin
action or secretion
3. Gestational
diabetes mellitus
4. Secondary
diabetes mellitus

5. TYPE 1 DIABETES MELLITUS
• Insulin dependent diabetes mellitus [iddm], or
juvenile diabetes.
• Results from the pancreas failure to produce
enough insulin due to loss of beta cells, the pancreas
undergoes an autoimmune attack by the body itself
and is rendered incapable of making insulin.

6. TYPE 2 DIABETES MELLITUS
• referred as “non insulin dependent diabetes mellitus”
(NIDDM) or “adult-onset diabetes”.
• In type 2 diabetes, patients can still produce insulin,
but it is Insufficient-either absolutely or relative to
the body's needs.
• A major feature of type 2 diabetes is a lack of
sensitivity to insulin by the cells of the body
(particularly fat and muscle cells)-Insulin resistance.

7. • The release of insulin by the pancreas may also be
defective, and occur late in response to increased
glucose levels.
• Finally, the liver in these patients continues to produce
glucose despite elevated glucose levels.
• The most common cause is the combination of
excessive body weight and insufficient exercise.

8. GESTATIONAL DIABETES MELLITUS
• Is a condition in which women without previously
diagnosed diabetes exhibit high blood
glucose levels during pregnancy(especially during
third trimester of pregnancy after 28 weeks of
gestation).
• Gestational diabetes is caused when the body of a
pregnant woman does not secrete excess insulin
required during pregnancy leading to increased
blood sugar levels.

9. • Pregnancy is associated with increased tissue
resistance to insulin, resulting in increased level of
blood insulin as well as glucose and triglycerides.
• These changes are due to placental lactogen and
elevated circulating oestrogens and progesterone.

10. SECONDARY DIABETES MELLITUS
• Secondary diabetes mellitus develops when the pancreatic tissue responsible
for the production of insulin is absent because it is destroyed by disease, such
as
– Chronic pancreatitis
– Trauma
– Surgical removal of the pancreas.
• Diabetes can also result from other hormonal disturbances,
– Acromegaly
– Cushing's syndrome.
• Certain medications may worsen diabetes control, or "unmask" latent
diabetes.
– Steroids
– Oestrogen

11. SIGNS AND SYMPTOMS
The classic symptoms of untreated diabetes are :
• unintended weight loss
• polyuria (increased urination)
• polydipsia (increased thirst)
• polyphagia (increased hunger)
• Symptoms may develop rapidly(weeks or months)in
type1DM, while they usually develop much more slowly
and may be subtle or absent in type 2 DM.

12. Several other signs and symptoms can mark the onset of
diabetes although they are not specific to the disease, they
include :
• Blurred vision
• Headache
• Fatigue
• Slow healing of cuts
• Itchy skin
• Pruritis
• Urinary tract infection
Prolonged high blood glucose can cause glucose absorption
in the lens of the eye, which leads to changes in its shape,
resulting in vision changes.

13. DIABETIC KETOACIDOSIS
• Develops in type 1 diabetes where there
is complete lack of insulin and reliance
on fatty acids for energy.
• This uncontrolled lipid breakdown
leads to formation of ketones and
causes acidosis and ketonemia. This is a
medical emergency.

14. NON-KETOTIC HYPEROSMOLAR COMA
• Caused due to extreme rise of blood sugar in type 2
diabetes.
• There is just enough insulin to suppress ketone
synthesis.
• The high blood sugar leads to increased osmolarity
of blood which in turn leads to collapse of the blood
vessels and cardiovascular shock. This is a medical
emergency

15. RISK FACTORS
• Overweight (abdominal)
• Over 45 years old
• Sedentary lifestyle
• Non-white race
• Family history of Diabetes
• Family history of high BP
• History of high BP
• High cholesterol
• History of gestational Diabetes
• Delivered a baby > 9 lbs.

16. PREVENTION
Risk of Type 2 Diabetes can be reduced:
• Losing weight
• Taking regular exercise : walking for 30 minutes per day
• Eating healthier food:
• Less fat (burgers, fries, crisps, sweet foods)
• More fibre (fruit and vegetables, wholegrain
alternatives for rice, bread)
• Cutting down on alcohol consumption
Ultimate aim is to reduce the long term complications

17. Up to 80% of type 2 diabetes is preventable
by adopting a healthy diet , increasing
physical activity and by cessation of
smoking.
At present, Type 1 diabetes cannot be
prevented.

19. DIABETIC RETINOPATHY
• Damage to the eyes, known as diabetic
retinopathy, is caused by damage to the blood
vessels in the retina of the eye and can result in
gradual vision loss and eventual blindness.
• Diabetes also increases the risk of having
glaucoma, cataracts and other eye problems.

20. DIABETIC NEPHROPATHY
• Damage to the kidneys, known as diabetic
nephropathy, can lead to tissue scarring, urine
protein loss, and eventually chronic kidney
disease sometimes requiring dialysis or kidney
transplantation.

21. DIABETIC NEUROPATHY
• Damage to the nerves of the body, known as diabetic
neuropathy, is the most common complication of
diabetes.
• The symptoms can include numbness, tingling pain and
altered pain sensation, which can lead to damage to the
skin.
• Diabetes-related foot problems(diabetic foot ulcers)
may occur and can be difficult to treat, occasionally
requiring amputation.
• Proximal diabetic neuropathy causes painful muscle
atrophy and muscle weakness.

22. TARGETS OF CONTROL FOR PATIENTS
HbA1C <7.0%
Blood pressure <140/80 mmHg
LDL cholesterol <100 mg/dl
Statin therapy for those with
history of MI or age >40+ or
other risk factors
HDL cholesterol >50 mg/dl
Triglycerides <150 mg/dl
MANAGEMENT

23. DIABETES MANAGEMENT
1. Education
2. Diet
3. Exercise
4. Medication; oral glucose lowering medications,
insulin and GLP-1 analogs.
5. Self monitoring of blood glucose (SMBG)
6. Regular follow up

24. In type 1 diabetic
patients, insulin
therapy is
mandatory along
with dietary advice
and standard
diabetes
education.
TREATMENT FOR TYPE 1 DIABETES
MELLITUS

25. TREATMENT FOR TYPE 2 DIABETES
MELLITUS
– Education
– Dietary advice
– Weight reduction
(if obese)
– Exercise
– Oral hypoglycemic
drugs
– Insulin

26. ADA GUIDELINES FOR TYPE 2
DIABETES MELLITUS

29. THANK YOU