Diabetes mellitus is a chronic disease that occurs when the pancreas does not produce enough insulin or the body cannot effectively use the insulin produced. Over time, uncontrolled diabetes can damage many organs and body systems. The number of diabetes cases has risen dramatically worldwide in recent decades and poses a major global health challenge. Diabetes prevalence is increasing more rapidly in low and middle income countries. Early diagnosis and treatment can prevent or delay diabetes complications.
The worldwide explosion of obesity has resulted in an ever-increasing prevalence of type 2 diabetes. The importance of insulin resistance and β-cell dysfunction to the pathogenesis of type 2 diabetes was debated for a long time; many thought that insulin resistance was the main abnormality in type 2 diabetes, and that inability to secrete insulin was a late manifestation. This notion is now challenged. This presentation deals with the important contributing factors in the development of type 2 diabetes mellitus.
Shashikiran Umakanth made this presentation at the "First Endocrine Update Program” – ENDO EGYPT 2015, from 17-20 December 2015 in the Historic City of Luxor, Egypt. This endocrine update was organised by the Egyptian Association of Endocrinology , Diabetes and Atherosclerosis (EAEDA) in collaboration with the Endocrine Society, USA.
The worldwide explosion of obesity has resulted in an ever-increasing prevalence of type 2 diabetes. The importance of insulin resistance and β-cell dysfunction to the pathogenesis of type 2 diabetes was debated for a long time; many thought that insulin resistance was the main abnormality in type 2 diabetes, and that inability to secrete insulin was a late manifestation. This notion is now challenged. This presentation deals with the important contributing factors in the development of type 2 diabetes mellitus.
Shashikiran Umakanth made this presentation at the "First Endocrine Update Program” – ENDO EGYPT 2015, from 17-20 December 2015 in the Historic City of Luxor, Egypt. This endocrine update was organised by the Egyptian Association of Endocrinology , Diabetes and Atherosclerosis (EAEDA) in collaboration with the Endocrine Society, USA.
Learning objectives:
Understand the definition, causes, symptoms, risk factors of type 1 Diabetes.
Understand the definition, causes, symptoms, risk factors of type 2 Diabetes.
Understand the definition, causes, symptoms of Gestational Diabetes.
Advances and Management of Diabetes MellitusPratiksha Doke
Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. High blood glucose levels are symptomatic of diabetes mellitus as a consequence of inadequate pancreatic insulin secretion or poor insulin-directed mobilization of glucose by target cells. Diabetes mellitus is aggravated by and associated with metabolic complications that can subsequently lead to premature death. This presentation explores diabetes mellitus in terms of its types, causes and management interventions for improved lifestyle for patient.
Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
All what you have to know about Diabetes MellitusYapa
All what you have to know about Diabetes Mellitus is here.Introduction of Diabetes,Regulation of blood glucose,Predisposing factors of DM,Clinical presentation,DM and pregnancy ,Diabetes ketoacidosis ,Complications of DM ,Diagnosis ,Dietary management of DM & Prevention of DM.
Student seminar on Diabetes Mellitus presented by 2007/2008 Batch students of Faculty of Medicine,University of Peradeniya,Sri Lanka.
lecture about diabetes mellitus for undergraduated student, master student
its include definition of diabetes, type 1 diabetes, type2, gestational, diagnosis criteria, complication, world day
Learning objectives:
Understand the definition, causes, symptoms, risk factors of type 1 Diabetes.
Understand the definition, causes, symptoms, risk factors of type 2 Diabetes.
Understand the definition, causes, symptoms of Gestational Diabetes.
Advances and Management of Diabetes MellitusPratiksha Doke
Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. High blood glucose levels are symptomatic of diabetes mellitus as a consequence of inadequate pancreatic insulin secretion or poor insulin-directed mobilization of glucose by target cells. Diabetes mellitus is aggravated by and associated with metabolic complications that can subsequently lead to premature death. This presentation explores diabetes mellitus in terms of its types, causes and management interventions for improved lifestyle for patient.
Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
All what you have to know about Diabetes MellitusYapa
All what you have to know about Diabetes Mellitus is here.Introduction of Diabetes,Regulation of blood glucose,Predisposing factors of DM,Clinical presentation,DM and pregnancy ,Diabetes ketoacidosis ,Complications of DM ,Diagnosis ,Dietary management of DM & Prevention of DM.
Student seminar on Diabetes Mellitus presented by 2007/2008 Batch students of Faculty of Medicine,University of Peradeniya,Sri Lanka.
lecture about diabetes mellitus for undergraduated student, master student
its include definition of diabetes, type 1 diabetes, type2, gestational, diagnosis criteria, complication, world day
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose level caused by either absolute or relative deficiency of insulin. Classifications,sings and symptoms,complications,and prevalence of the disease particularly in Egypt are presented. Management of diabetic patients undergoing oral surgical procedures is discussed.
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.
There are 3 types of diabetes
1. Type 1 diabetes
2. Type 2 diabetes
3. Gestational diabetes
Worldwide status
The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries.
Asia accounts for 60% of the world’s diabetic population.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
People from South Asian communities are up to 6 times more likely to have diabetes than the general population and 2011 data reveals that almost 1/5th of the world’s population resides in South Asia.
2011 estimates indicate that 8.3% of the adult population, or 71.4 million people have diabetes, 61.3 million of whom are in India.
SEA region has the second highest number of deaths attributable to diabetes with 1.16 million deaths in 2011 with represents 14.5% if all deaths for the region and 55% if these death occur in people under the age of 60.
Burden of diabetes in Nepal
According to Nepal Diabetes Association, the prevalence of diabetes in the people 20 years and above in urban areas is 14.6% and in rural areas is 2.5%
In 2017, over 10, 000 individuals died due to T2DM or diabetes-related complications in Nepal, which is the 11th most common cause of disability in terms of disability-adjusted life years.
In 2020, the prevalence of T2DM in Nepal was 8.5% which was higher than that of 8.4% in 2014. Similarly, in 2020 the prevalence of pre-diabetes was 9.2% compared to 2014, which was 10.3%
Symptoms of diabetes
Polyuria
Polydipsia
Polyphagia
Weight loss
Vision change
Fatigue
Diabetes refers to a group of diseases that affect how the body consumes blood sugar (glucose). Glucose is an important source of energy for the cells that make up muscles and tissues. It is also the main source of energy for the brain.
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.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Problem statement of Hypertension. Measurement of blood pressure. Recent diagnostic criteria and management guidelines. Prevention of Hypertension. National Programme for Prevention and Control of Cancer, Diabetes,Cardiovascular Diseases and Stroke
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
3. Introduction
Diabetes is a chronic disease that occurs either when the pancreas does not
produce enough insulin or when the body cannot effectively use the insulin
it produces.
Insulin is a hormone that regulates blood sugar.
Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled
diabetes and over time leads to serious damage to many of the body's
systems, especially the nerves and blood vessels.
4. Health impact
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and
nerves.
Adults with diabetes have a two- to three-fold increased risk of heart
attacks and strokes.
Combined with reduced blood flow, neuropathy (nerve damage) in the feet
increases the chance of foot ulcers, infection and eventual need for limb
amputation.
Diabetic retinopathy is an important cause of blindness, and occurs as a
result of long-term accumulated damage to the small blood vessels in the
retina. Diabetes is the cause of 2.6% of global blindness.
Diabetes is among the leading causes of kidney failure.
5. Types of diabetes
Type of diabetes Brief description
Type 1 diabetes β-cell destruction (mostly immune-mediated) and absolute insulin
deficiency; onset most common in childhood and early adulthood
Type 2 diabetes Most common type, various degrees of β-cell dysfunction and insulin
resistance; commonly associated with overweight and obesity
Hybrid forms of diabetes
Slowly evolving,
immune-
mediated
diabetes of adults
Similar to slowly evolving type 1 in adults but more often has features
of the metabolic syndrome, a single GAD autoantibody and retains
greater β-cell function
Ketosis-prone
type 2 diabetes
Presents with ketosis and insulin deficiency but later does not require
insulin; common episodes of ketosis, not immune-mediated
WHO CLASSIFICATION OF DIABETES MELLITUS 2019
6. Types of diabetes
Other specific types Brief description
Monogenic diabetes
- Monogenic defects of
β-cell function
- Monogenic defects in
insulin action
Caused by specific gene mutations, has several clinical manifestations
requiring different treatment, some occurring in the neonatal period,
others by early adulthood
Caused by specific gene mutations; has features of severe insulin
resistance without obesity; develops when β-cells do not compensate for
insulin resistance
Diseases of the exocrine
pancreas
Various conditions that affect the pancreas can result in hyperglycaemia
(trauma, tumor, inflammation, etc.)
Endocrine disorders
Occurs in diseases with excess secretion of hormones that are insulin
antagonists
Drug- or chemical-
induced
Some medicines and chemicals impair insulin secretion or action, some
can destroy β-cells
Infection-related
diabetes
Some viruses have been associated with direct β-cell destruction
Uncommon specific
forms of immune-
mediated diabetes
Associated with rare immune-mediated diseases
Other genetic syndromes
7. TYPES OF DIABETES
Hyperglycaemia first detected during pregnancy
Diabetes mellitus in
pregnancy
Type 1 or type 2 diabetes first diagnosed during pregnancy
Gestational diabetes
mellitus
Hyperglycaemia below diagnostic thresholds for diabetes in
pregnancy
Diagnostic criteria for diabetes: fasting plasma glucose ≥ 7.0 mmol/L or 2-hour post-load
plasma glucose ≥ 11.1 mmol/L or Hba1c ≥ 48 mmol/mol
Diagnostic criteria for gestational diabetes: fasting plasma glucose 5.1–6.9 mmol/L or 1-
hour post-load plasma glucose ≥ 10.0 mmol/L or 2-hour post-load plasma glucose 8.5–
11.0 mmol/L
8. Problem statement
The number of people with diabetes rose from 108 million in 1980 to 422
million in 2014.
The global prevalence of diabetes* among adults over 18 years of age rose
from 4.7% in 1980 to 8.5% in 2014.
Between 2000 and 2016, there was a 5% increase in premature mortality
from diabetes.
Diabetes prevalence has been rising more rapidly in low- and middle-
income countries than in high-income countries.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke
and lower limb amputation.
In 2016, an estimated 1.6 million deaths were directly caused by diabetes.
Another 2.2 million deaths were attributable to high blood glucose in 2012.
Almost half of all deaths attributable to high blood glucose occur before the
age of 70 years. WHO estimates that diabetes was the seventh leading cause
of death in 2016.
WHO GLOBAL REPORT ON DIABETES
9. Problem statement
• An estimated 463 million adults aged 20 –79 years are currently living with
diabetes. This represents 9.3% of the world’s population in this age group. The
total number is predicted to rise to 578 million (10.2%) by 2030 and to 700 million
(10.9%) by 2045.
• The estimated number of adults aged 20–79 years with impaired glucose tolerance
is 374 million (7.5% of the world population in this age group). This is predicted to
rise to 454 million (8.0%) by 2030 and 548 million (8.6%) by 2045.
• An estimated 1.1 million children and adolescents (aged under 20 years) have type
1 diabetes. It is currently not possible to estimate the number of children and
adolescents with type 2 diabetes.
• The number of deaths resulting from diabetes and its complications in 2019 is
estimated to be 4.2 million.
• An estimated 15.8% (20.4 million) of live births are affected by hyperglycaemia in
pregnancy in 2019.
• Annual global health expenditure on diabetes is
• estimated to be USD 760 billion. It is projected that expenditure will reach USD 825
billion by 2030 and USD 845 billion by 2045. INTERNATIONAL DIABETES FEDERATION ATLAS 2019
10. Problem statement
WHO GLOBAL REPORT ON DIABETES
WHO Region
Prevalence (%) Number (millions)
1980 2014 1980 2014
African Region 3.1% 7.1% 4 25
Region of the Americas 5% 8.3% 18 62
Eastern Mediterranean
Region
5.9% 13.7% 6 43
European Region 5.3% 7.3% 33 64
South-East Asia Region 4.1% 8.6% 17 96
Western Pacific Region 4.4% 8.4% 29 131
Total 4.7% 8.5% 108 422
13. Problem statement – India
According to the World Health Organization (WHO):
There are estimated 72.96 million cases of diabetes in adult population of India.
The prevalence in urban areas ranges between 10.9%-14.2% and prevalence in
rural India is at 3.0-7.8% ,among population aged 20 years and above with a
much higher prevalence among individuals aged over 50 years.
According to National Diabetes and Diabetic Retinopathy Survey report (2015-19):
Prevalence of diabetes in India has been recorded at 11.8% in the last four years,
prevalence of known diabetes cases was 8% and new diabetes cases at 3.8%.
The prevalence of diabetes among males was 12%, whereas among females it
was 11.7%.
Highest prevalence of diabetes (13.2%) was observed in the 70-79 years’ age
group.
14. Risk factors for diabetes
1. If he/she is overweight (BMI is more than 23kg/m2)
2. If he/she is physically inactive, that is, he or she exercises less than 3 times
a week
3. If he/she has high blood pressure
4. If he/she has impaired fasting glucose or impaired glucose tolerance
5. If his/her triglyceride and/or cholesterol levels are higher than normal
6. If his/her parents/siblings or grandparents have or had diabetes
7. If she delivered a baby whose birth weight was 4 kgs or more
8. If she has had diabetes or even mild elevation of blood sugars during
pregnancy
15. When to suspect diabetes
1. Symptoms of uncontrolled hyperglycemia: excess thirst, excess
urination, excess hunger with loss of weight
2. Frequent infections
3. Non-healing wounds
4. Unexplained lassitude
5. Fatigue
6. Impotence in men
16. Criteria for diagnosis of T2DM using venous blood samples
Fasting Glucose (mg/dl) 2-hour Post-Glucose Load
(mg/dl)
Diabetes Mellitus >=126 or >=200
Impaired Glucose Tolerance < 126 and >140 to <200
Impaired Fasting Glucose >=110 to <126
*WHO Definition 1999 Capillary blood glucose value is also sufficient. Where capillary
blood glucose measured by glucometer is used in the fed state (i.e., post food/post
glucose/post meal), the >200 mg/dl cut off may be revised to >220 mg/dl.
17. Modified diagnostic criteria for diabetes
Fasting is defined as no caloric
intake for at least 8 hours.
The 2-hour postprandial
glucose test should be
performed using a glucose
load containing the equivalent
of 75g anhydrous glucose
dissolved in water.
The American Diabetes
Association (ADA)2
recommends diagnosing
‘prediabetes’ with HbA1c
values between 39 and 47
mmol/mol (5.7–6.4%) and
impaired fasting glucose when
the fasting plasma glucose is
between 5.6 and 6.9mmol/L
(100–125mg/dL).INTERNATIONAL DIABETES FEDERATION ATLAS 2019
18. Impaired glucose tolerance and impaired fasting glucose
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are
conditions of raised blood glucose levels above the normal range and
below the recommended diabetes diagnostic threshold.
The terms ‘prediabetes’, ‘non-diabetic hyperglycaemia’, ‘intermediate
hyperglycaemia’ are in use as alternatives.
Glycosylated Haemoglobin (HbA1C)
A fraction of hemoglobin in the RBCs is found to be in a glycosylated form i.e. has
glucose attached to it.
The HbA1c level is proportional to average blood glucose concentration over the
previous two to three months and therefore is an excellent indicator of how well
the patient has managed his/her diabetes over the last four weeks to three
months.
American Diabetes Association (ADA) recommends an HbA1c goal of less than 7%
for people with diabetes in general
19. Initial assessment of diabetic patients
History (Ask for) Physical Examination (Look for)
Duration since onset of symptoms Body Mass Index
Precipitating factors such as recent infections,
stress, change in dietary habits or physical
activity levels
Waist circumference, Waist-hip ratio
Acanthosis nigricans * Acanthosis nigricans *
Hypertension, pre-existing cardiovascular
Diseases
Blood pressure
Drug history Peripheral pulses
Diet
Feet: calluses, ulcers, prominent veins, edema,
injuries
Physical Activity: type, frequency Fundus examination
Family History Cardiovascular system
-Diabetes and complications -Age at onset -
Cardiovascular disease, if any
Peripheral nervous system Thyroid*Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin,
usually present in the posterior and lateral folds of neck, axilla, groin, umbilicus, and other areas.
This occur due to insulin spill over (from excessive production due to obesity or insulin resistance)
into the skin which results in its abnormal growth, and the stimulation of colour producing cells.
20. Initial management
Pharmacotherapy for the management of hyperglycemia and any other
co-morbid conditions e.g. high blood pressure, dyslipidemia etc.;
Therapeutic lifestyle management, and
Diabetes patient Education and counselling
21. Principles of management
The basic principles in the management of type-2 diabetes are:
Modify Lifestyle: diet and physical activity.
Reduce Insulin resistance through reduction in weight, specifically
reduction of fat mass.
Pharmacological treatment (if inadequate control): Metformin/
Sulfonylureas.
Treatment for high blood pressure: ACE Inhibitors, Calcium channel
blockers such as amlodipine and diuretics such as hydrochlorothiazide (For
details refer the ppt on hypertension).
22. Ideal targets of control in the management of diabetes
Fasting Blood Glucose 115 mg/dl
Post Meal Blood Glucose <160 mg/dl
HbA1C <7%
Total Cholesterol <180 mg/dl
LDL-cholesterol <100 mg/dl
HDL cholesterol <45 mg/dl
Blood pressure <130/80 mg/dl
Serum TG <150mg/dl
Source: ICMR 2005 guidelines
Note: The targets for diabetic population are lower than the non-diabetes
23. Non-pharmacological management of diabetes
*Source: ICMR 2005 GUIDELINES
Lifestyle Goals in Diabetes:
To improve health through optimum nutrition
To provide energy for reasonable body weight , normal growth and development
To maintain glycemic control
To achieve optimum blood lipid levels
To individualise the diet according to complications and co-morbidities
Achieve optimal physical activity
Advise other behavioural changes for: smoking, other tobacco products and
alcohol
Advocate stress management
24. Non-pharmacological management of diabetes
Medical Nutrition Therapy (MNT) for diabetes mellitus requires application of
nutritional and behavioural sciences along with physical activity. We need a
four-pronged approach:
i. Nutritional assessment which includes metabolic, nutritional and life style
parameters.
ii. Setting goals – practical, achievable and acceptable to the patient -
individualised
iii. Nutritional Intervention, including nutrition education – individualized
meal plans according to family eating patterns
iv. Evaluation – to assess if the goals have been achieved and to make*Source: ICMR 2005 GUIDELINES
25. Non-pharmacological management of diabetes
Dietary Recommendations:
a) Energy:
i. Ideal Body Weight (IBW) = (Height in cm – 100) * 0.9.
ii. Approximately, 25 kcals/kg ideal body weight/day can be given to a
moderately active patient with diabetes.
b) Energy or Calorie Distribution:
i. Carbohydrates: 55-60 % of energy from carbohydrates is an ideal
recommendation
ii. Fibre recommendation for general population is 40 g/day (2000
Kcals)
iii. Proteins should provide 12-15 % of the total energy intake for people
with diabetes
iv. Fats should provide 20-30 % of total energy intake for people with
diabetes.
*Source: ICMR 2005 GUIDELINES
26. Non-pharmacological management of diabetes
c) Fat quality
i. Saturated fats (SFA) ≤10% energy and 7% in those with raised blood lipid levels
ii. Polyunsaturated fats (PUFA) 10 % energy, n6: 3-7% energy, n3: >1% energy, n6/n3
ratio 5-10
iii.Monounsaturated Fatty Acids (MUFA) 10-15% energy + any calories left from the
carbohydrate portion
iv. Trans fats < 1% energy – preferably totally avoided
d) Salt:
i. Added (iodized) salt should be less than 5 g/day
ii. For persons with hypertension and diabetes, the intake should be reduced to less
than 3 g/ day
e) Alcohol:
i. best to avoid, however if used, should be taken in moderation
ii. it should not be counted as part of the meal plan.
iii.alcohol does provide calories (7 kcal/ g), which are considered as “empty calories”
iv. In the fasting state, alcohol may produce hypoglycaemia *Source: ICMR 2005 GUIDELINES
27. Non-pharmacological management of diabetes
f) Sweeteners:
i. Nutritive Sweeteners: These include fructose, honey, corn syrup,
molasses, fruit juice or fruit juice concentrates dextrose, maltose,
mannitol, sorbitol and xylitol. All these are best avoided.
ii.Non-nutritive Sweeteners: Aspartame, acesulfame K, stevia, sucralose
and saccharin are currently approved for use. However, they should be
used in moderation and are best avoided in pregnancy.
*Source: ICMR 2005 GUIDELINES
28. Non-pharmacological management of diabetes
Physical Benefits of exercise:
Improves insulin sensitivity, reduces the risk of heart disease, high blood
pressure, bone diseases, and unhealthy weight gain
Keeps one flexible and agile
Helps relieve stress, anxiety and prevents depression
Increases strength and stamina
Promotes sound sleep
Increases metabolic rate and digestion
Delays the process of aging
Activity and Exercise:
Recommendation is about 150 minutes of aerobic activity or its equivalent
/week along with some resistance training at least twice a week and flexibility
exercises.
Extra quick acting carbohydrate snack before the exercise and during the
exercise, if the exercise period extends the daily-recommended routine.
*Source: ICMR 2005 GUIDELINES
29. Healthy diet and physical activity
WHO recommendations on physical activity are provided for different age
groups
It is recommended that children and youth aged 5–17 years should do at
least 60 minutes of moderate- to vigorous-intensity physical activity daily.
It is recommended that adults aged 18–64 years should do at least 150
minutes of moderate - intensity aerobic physical activity (for example brisk
walking, jogging, gardening) spread throughout the week, or at least 75
minutes of vigorous-intensity aerobic physical activity throughout the week,
or an equivalent combination of moderate- and vigorous-intensity activity.
For older adults the same amount of physical activity is recommended, but
should also include balance and muscle strengthening activity tailored to
their ability and circumstances.
32. Insulin therapy
Indications:
Person with diabetes with significant symptomatic hyperglycaemia, loss of
weight and polyuria, polydipsia, polyphagia
Fasting plasma glucose > 270 mg/dl or HbA1c >9%
Severe infections
Presence of ketosis
Other situations:
Patients not responding to optimal doses of OHA alone or in combination.
Acute hyperglycaemia, diabetic ketoacidosis/hyperglycemic-hyperosmolar
state/lactic acidosis.
Stressful situations such as acute myocardial infarction, stroke, acute infections,
tuberculosis, trauma and other conditions requiring hospitalisation
Pregnancy and lactation
Peri-operative state
Intolerant/contraindications to OHA
Hepatic and renal failure
Renal transplantation
33. Insulin therapy
Types of insulin preparations:
i. Human insulin
a) Short acting – human soluble insulin (regular)
b) Intermediate acting – neutral protamine Hagedorn (NPH)
c) Premixed- mixtures of regular and NPH insulin in 25/75, 30/70,
50/50 proportion
ii. Insulin Analogues:
a) Rapid acting (e.g. Lispro, Aspart, Glulisine)
b) Long acting (Glargine, Degludec, Detemir)
c) Premixed Insulin analogue (Lispro/ lispro protamine, aspart/ aspart
protamine)
d) Co-formulations (Degludec + Aspart insulin)
35. Complications of diabetes
Acute complications:
Hypoglycaemia
Hyperglycaemic emergencies (Diabetic Ketoacidosis- DKA or
Hyperosmolar Hyperglycaemic State - HHS)
Chronic Complications:
Serious organ damage involving eyes, heart, kidney, nerves and limbs,
which ultimately can lead to blindness, heart attack, kidney failure and
limb amputation respectively
Coronary Artery Disease
Diabetic Nephropathy
Diabetic Retinopathy:
Diabetic Neuropathy
Diabetic Foot
36. When to refer to higher facility (CHC/SDH/DH)
Uncontrolled infections
Co-morbid conditions, e.g., Hypertension, CAD, COPD, CKD etc.
Severe cellulitis
Unresponsive UTI or other deep seated infections including bad
diabetic foot needing intravenous antibiotics
Recurrent UTI not responding to oral antibiotics
Presence of ketones in urine
37. Foot care advice to the patients
DO DO NOT
✅ Inspect feet daily using mirror ❌ Walk barefoot
✅ Wash feet daily in lukewarm water, also
in between toes
❌ Do not Smoke/alcohol abuse
✅ Apply moisturizing lotion to feet after
drying
❌ Expose to extreme temperature
✅ Have your feet checked at each clinic visit ❌ Use hot fomentation
✅ Inspect footwear daily for defects/foreign
bodies
❌ Use chemicals agents (e.g. corn plaster),
corn caps or blades to treat corns or
calluses
✅ Change footwear regularly
❌ Wear new footwear for more than few
hours
✅ Buy footwear preferably in the evening ❌ Neglect any minor foot lesions
38. WHO Voluntary Global Targets for Prevention and Control of Non-Communicable
Diseases to be Attained by 2025
39. KEY MESSAGES
• Diabetes is a serious, long-term condition that occurs when the body cannot
produce any or enough insulin or cannot effectively use the insulin it produces. The
main categories of diabetes are type 1, type 2 and gestational diabetes mellitus.
• Type 1 diabetes is the major cause of diabetes in childhood but can occur at any
age. At present, it cannot be prevented. People with type 1 diabetes can live
healthy and fulfilling lives but only with the provision of an uninterrupted supply of
insulin, education, support and blood glucose testing equipment.
• Type 2 diabetes accounts for the vast majority (around 90%) of diabetes worldwide.
It can be effectively managed through education, support and adoption of healthy
lifestyles, combined with medication as required. Evidence exists that type 2
diabetes can be prevented and there is accumulating evidence that remission of
40. KEY MESSAGES
• ‘Prediabetes’ is a term increasingly used for people with impaired glucose
tolerance and/ or impaired fasting glucose. It signifies a risk of the future
development of type 2 diabetes and diabetes-related complications.
• Pregnant women with gestational diabetes mellitus can have babies that are
large for gestational age, increasing the risk of pregnancy and birth
complications both for the mother and baby.
41. Diabetes control programme in India
NATIONAL PROGRAMME FOR PREVENTION AND
CONTROL OF CANCER, DIABETES,
CARDIOVASCULAR DISEASES AND STROKE*
*For details, refer to PPT on hypertension