Diabetes mellitus (DM) is a group of diseases marked by high blood glucose levels due to insulin-related issues, affecting approximately 463 million adults as of 2019, with forecasts of 700 million by 2045. The main types include Type 1, Type 2, and gestational diabetes, each with distinct characteristics and causes, while complications can lead to severe health issues such as retinopathy and nephropathy. Management involves lifestyle changes, medications, and regular monitoring to maintain glucose levels within a target range.

1. Diabetes Mellitus(DM)
Presented by Saim Soleja
Pharm-d (DOW UNIVERSITY OF HEALTH SCIENCS)
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2. What is a DM?
Diabetes mellitus (DM) is a group of diseases characterized by high
levels of blood glucose resulting from defects in insulin production,
insulin action, or both.
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3. • In 2019, Approximately 463 million adults (20-79 years) were living
with diabetes; by 2045 this will rise to 700 million.
• The proportion of people with type 2 diabetes is increasing in most
countries.
• 79% of adults with diabetes were living in low- and middle-income
countries.
3https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html

4. Types of DM
❖ Type 1 Diabetes Mellitus
❖ Type 2 Diabetes Mellitus
❖ Gestational Diabetes
❖ Other types:
❖ LADA (Latent Autoimmune Diabetes in Adults)
❖ MODY (maturity-onset diabetes of youth)
❖ Secondary Diabetes Mellitus
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5. Type 1 DM:
❖ Insulin-dependent diabetes mellitus (IDDM) or juvenile- onset
diabetes.
❖ Develops when the body’s immune system destroys pancreatic
beta cells, the only cells in the body that make the hormone
insulin that regulates blood glucose.
❖ Usually strikes children and young adults,
❖ May account for 5% to 10%
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6. Type 2 DM:
❖ Non-insulin-dependent diabetes mellitus (NIDDM) or adult onset
diabetes.
❖ May account for about 90% to 95%
❖ It usually begins as insulin resistance, a disorder in which the cells
do not use insulin properly. As the need for insulin rises, the
pancreas gradually loses its ability to produce insulin.
❖ Associated with older age, obesity, family history of diabetes,
history of gestational diabetes, impaired glucose metabolism,
physical inactivity.
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7. Gestational diabetes
• Diagnosed in some women during pregnancy.
• After pregnancy, 5% to 10% of women with gestational diabetes are
found to have type 2 diabetes OR 20% to 50% chance of developing
diabetes in the next 5-10 years
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8. Other types of DM
❖Maturity-onset diabetes of youth (MODY) –(genetic conditions)
❖May account for 1% to 5%
❖Latent Autoimmune Diabetes in Adults (LADA) is a form of
autoimmune (type 1 diabetes)
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9. Secondary DM:
Secondary causes of Diabetes mellitus include:
❖ Acromegaly,
❖ Cushing syndrome,
❖ Thyrotoxicosis,
❖ Chronic pancreatitis,
❖ Cancer
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10. Secondary DM Drug induced hyperglycemia
✓ Atypical Antipsychotics
✓ Beta-blockers
✓ Calcium Channel Blockers
✓ Corticosteroids
✓ Fluoroquinolones
✓ Naicin
✓ Protease Inhibitors
✓ Thiazide Diuretics
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11. HOW TO DIFFERENTATE IN DM TYPES
Type 1 DM
• Polyuria
• Polydipsia
• Polyphagia
• Weight loss
• Weakness
• Dry skin
• Ketoacidosis
Type 2 DM
❖ Patients can be asymptomatic
❖ Polyuria
❖ Polydipsia
❖ Polyphagia
❖ Fatigue
❖ Weight loss
❖ Most patients are discovered while
performing urine glucose screening
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12. DM Complication
• Diabetes retinopathy
• Diabetes nephropathy
• Diabetes neuropathy
• Peripheral vascular disease and foot ulcer
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13. Diagnosis of
Diabetes Mellitus
1
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14. Laboratory Tests
1. Glucosuria
2. Ketonuria
3. Fasting blood glucose
4. Random Blood glucose
5. Glucose tolerance test
6. Glycosylated
hemoglobin (HbA1C)
7. Serum Fructosamine
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15. Diagnostic
Criteria
(American
Diabetes
Association
(ADA) )
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A fasting plasma glucose (FPG)
level >126 mg/Dl
A 2-hour plasma glucose level
> 200 mg/dL (during 75-g oral
glucose tolerance test (OGTT)
A random plasma glucose of
>200 mg/dL

16. Management of DM
A
Diet and Exercise
B
Oral hypoglycaemic therapy
C
Insulin Therapy
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17. Oral hypoglycemic therapy
Biguanides Sulfonylureas
Meglitinide
derivatives
Alpha-glucosidase
inhibitors
Thiazolidinediones
(TZDs)
Glucagonlike
peptide–1 (GLP-1)
agonists
Dipeptidyl
peptidase IV (DPP-
4) inhibitors
Selective sodium-
glucose
transporter-2
(SGLT-2) inhibitors
Insulin
Bile acid
sequestrants
Dopamine agonists
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18. Oral Hypoglycemics Agent & Action
Class Compound(s) Primary physiological action(s)
Biguanides Metformin ↓ Hepatic glucose production
Sulfonylureas 2nd generation (Glyburide, Glipizide,
Glimepiride)
↑ Insulin secretion
Meglitinides (glinides) Repaglinide, Nateglinide ↑ Insulin secretion
TZDs Pioglitazone,Rosiglitazone ↑ Insulin sensitivity
α-Glucosidase inhibitors Acarbose, Miglitol Slows intestinal carbohydrate digestion/absorption
DPP-4 inhibitors Sitagliptin ↑ Insulin secretion (glucose dependent)
↓ Glucagon secretion (glucose dependent)
Bile acid sequestrants Colesevelam ↓ Hepatic glucose production
Dopamine-2 agonists Bromocriptine (quick release) Modulates hypothalamic regulation of metabolism
↑ Insulin sensitivity
SGLT2 inhibitors Empagliflozin Blocks glucose reabsorption by the kidney, increasing glucosuria
GLP-1 receptor agonists • Exenatide
• Liraglutide
↑ Insulin secretion (glucose dependent)
↓ Glucagon secretion (glucose dependent)
Slows gastric emptying
Amylin mimetics Pramlintide ↓ Glucagon secretion
Slows gastric emptying
1. Rapid-acting analogs (Lispro, Aspart, Glulisine)
2. Inhaled insulin
3. Short-acting insulin
4. human Regular insulin
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19. Diabetes Management Algorithm
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20. Insulin Type
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21. Diabetes Management with Insulin Algorithm
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22. Self care
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Blood glucose monitoring
Body weight monitoring
Foot-care
Personal hygiene
Healthy lifestyle/diet or physical activity
Identify targets for control
Stopping smoking

23. Reference
• Pages 227-237,Thyroid Disorder, Chapter 20 Pharmacotherapy
handbook, 7th edition J T Dipiro, Barbara G Wells, Terry L
Schwinghammer
• Pages 447- 462 ,Epilepsy Chapter 37Clinical Pharmacy and
Therapeutics, 4th edition Roger Walker, Cate Whittlesea
• https://www.aace.com/publications/algorithm
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24. Thank you
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