This document provides an overview of diabetes mellitus (DM). It defines DM as a chronic condition characterized by high blood glucose levels. The document then covers the etiology, epidemiology, pathophysiology, classification, signs and symptoms, complications, risk factors, diagnosis, differential diagnosis, and management of DM. It discusses the main types of DM - type 1, type 2, and gestational diabetes mellitus. The management section outlines the medical, surgical, and physical therapy approaches to treatment and control of the disease.

1. DIABETES MELLITUS
PRESENTED BY :-
DR. N. D. DWIVEDI
BPTH (IU)
LUCKNOW
@nikhildwivedi317

2.  CONTENT
 INTRODUCTION
 ETIOLOGY
 EPIDEMIOLOGY
 PATHOPHYSIOLOGY
 CLASSIFICATION
 SIGNS & SYMPTOMS
 COMPLICATIONS
 RISK FACTORS
 DIAGNOSIS
 DIFFERENTIAL DIAGNOSIS
 MANAGEMENT

3.  INTRODUCTION
 DIABETES MELLITUS (DM) is a chronic condition that is characterized by raised blood glucose levels.
 It is a group of metabolic diseases characterized by increased levels of glucose in blood resulting from
defects in insulin secretion , insulin action or both .
 Diabetes Mellitus occurs throughout the world but it is more common (especially type 2) in the more
developed countries .
 It occurs due to insufficient production of insulin or insufficient sensitivity of cells to the action of
insulin.

4.  ETIOLOGY
1) Family history
2) Age (risk increases with age)
3) Being overweight
4) Physical stress
5) Injury to pancreas (such as infection , tumours , surgery )
6) Autoimmune diseases
7) High blood pressure
8) Abnormal blood cholesterol

5.  EPIDEMIOLOGY
 Diabetes mellitus currently affects more than 62 M Indians , which is more than 7.2% of the adult
population .
 Among young and middle aged adults the prevalence of diabetes is 6.7% and prediabetes is 5.6%
according to NATIONAL FAMILY HEALTH SURVEY .
 According to studies , In India alone diabetes is expected to increase from 40.6 million in 2006 to 79.4
million by 2030.
 WHO estimates that diabetes was the seventh leading cause of death in 2016.

6.  PATHOPHYSIOLOGY
IMPAIRED INSULIN
SECRETION IN
PANCREAS
INCREASED GLUCOSE
PRODUCTION IN LIVER
INCREASED
GLUCOSE
LEADS TO RECEPTOR AND
POST RECEPTOR DEFECTS
INSULIN RESISTANCE
IN PERIPHERAL
TISSUES
DIABETES
MELLITUS

7.  CLASSIFICATION
The classification of diabetes mellitus includes Type 1, Type 2, and gestational diabetes
mellitus .
1-) TYPE 1 DM :- Type 1 diabetes is characterized by insufficient insulin secretion.
Type 1 diabetes usually results from autoimmune destruction of the beta cells in the
pancreas. People with type 1 diabetes represent only 5% to 10% of all people with
diabetes .
Type 1 diabetes is also called “insulin-dependent diabetes”.

8. 2-) TYPE 2 DM :- Type 2 diabetes is the most common form of diabetes,
and is characterized by insulin resistance, or sluggish response of insulin after
food consumption. Type 2 diabetes represents 90% of all people with diabetes.
Type 2 diabetes is also called “adult-onset diabetes” because the disease develops
slowly and typically appears in older adults .
3-) GESTATIONAL DIABETES MELLITUS :- Gestational diabetes
mellitus (GDM) is diabetes that develops during pregnancy. It is seen during
specially 2nd or 3rd trimester of pregnancy because of hormonal disbalance . GDM
can be controlled through eating healthy food and regular exercises .

9.  SIGN & SYMPTOMS
1) HYPERGLYCEMIA
2) POLYDIPSIA
3) POLYURIA
4) POLYPHAGIA
5) Weight loss
6) Increased fatigue
7) Slow healing wound or sores

10.  COMPLICATIONS
 Diabetic ketoacidosis
 Hypoglycaemia
 Diabetic nonketotic hyperomolar coma
A-) Microvascular
Retinopathy – At first Diabetic retinopathy only have mild vision problems .
Nephropathy - People who have Diabetes for long time may develop nephropathy .
Diabetic foot - It is a long term complication of DM .
B-) Macrovascular
Cerebrovascular Disease - STROKE
Cardiovascular - HYPERTENSION
Peripheral vascular disease

11.  RISK FACTORS
 Obesity
 Physical inactivity
 Poor diet
 Hyperglycaemia
 Stress
 Chronic inflammation

12.  DIAGNOSIS
1) Medical History
2) Physical examination
3) CBC (COMPLETE BLOOD COUNT)
4) Blood glucose test
5) URINE TEST – Urinalysis for albumin
6) KIDNEY FUNCTION TEST
7) LIVER FUNCTION TEST

13.  DIFFERENTIAL DIAGNOSIS
1) Type 2 Diabetes Mellitus
2) MODY (Maturity-onset diabetes of the young)
3) Psychogenic polydipsia
4) Nephrogenic diabetes insipidus
5) Transient hyperglycaemia with illness / stress
6) Factitious illness

14.  MANAGEMENT
 MEDICAL MANAGEMENT :-
 GOAL :–
Euglycemia and prevention of complication .
Individual treatment plan through diet therapy
a) Drug Therapy
b) Execise and physical therapy
c) Self monitoring of blood glucose . (SMBG)

15.  SURGICAL MANAGEMENT :-
1. PANCREAS TRANSPLANT (Not usually done)
2. ISLET CELL TRANSPLANT
 PHYSICAL THERAPY MANAGEMENT :-
 GOALS :-
a) Improve or maintain ROM .
b) Reduce insulin requirement.
c) Increase muscular power , endurance and stress .
d) Lowering blood glucose level .
 EXERCISES :-
a) AEROBIC EXERCISES
b) STRENGTHENING EXERCISES
c) STRETCHING
d) ROM EXERCISES

16. THANK YOU