Diabetes is a metabolic disorder where the body has too much glucose in the blood due to either not producing enough insulin or cells not responding to insulin. There are four main types of diabetes: Type 1 is characterized by insulin deficiency due to loss of beta cells in the pancreas and accounts for 10% of cases. Type 2 is characterized by insulin resistance and accounts for 90% of cases. Type 3 covers specific genetic defects affecting insulin action. Gestational diabetes occurs in 2-5% of pregnancies and may improve after delivery but increases risk of later Type 2 diabetes. Diabetes increases risks of heart disease, stroke, nerve damage, foot ulcers, blindness, and kidney failure. Treatment focuses on blood glucose control through lifestyle changes

1. Diabetes Mellitus
By: Roshan Nepal
CDBt, Tribhuvan University
Kirtipur, Kathmandu, Nepal
Universal blue circle : symbol for diabetes

2. Introduction
 medical term for what we generally call Sugar,
Diabetes, चिनी रोग
 medically defined as ‘metabolic disorder affecting
multi-organ systems, characterized by hyperglycemia’
- which in simple term means, a person has too
much Glucose (sugar) in his/her blood, either
because the pancreas does not produce
enough insulin, or because cells do not respond
to the insulin that is produced.
 General symptoms: 3 P’s viz. Polyuria, Polydipsia and
Polyphagia.

3. Classification
Diabetes mellitus is classified into FOUR broad categories:
1. Type 1 diabetes
2. Type 2 diabetes
3. Type 3 ‘Specific wide range’ of diabetes
4. Type 4 ‘Gestational diabetes’
Source: as proposed by WHO, 1998

4. Type 1 diabetes:
 Characterized by loss of insulin-producing -
cells of Islets of Langerhans in pancreas, leading to
insulin deficiency.
 Accounts for approximately 10% of diabetes mellitus
cases.
 -cells loss is a T-cell mediated autoimmune attack.

5. Type 1 diabetes:
SYMPTOMS:
 Polyuria
 Polydipsia
 Polyphagia
 Nausea /
Vomitting
 Weight loss
 Fatigue

6. Type 1 diabetes:
TREATMENT:
 Type 1 diabetes is treated with insulin, exercise and a
diabetic diet.
 Insulin lowers blood sugar by allowing it to leave the
blood-stream and enter cells.
 Everyone with type 1 diabetes must take insulin every
day.
 Pancreas transplant may be an option but has low
success rate until now!

7. Type 2 diabetes:
 Characterized by insulin resistance, which may be
combined with relatively reduced insulin secretion.
 Most common, accounts for  90% of diabetes mellitus
cases.
 Etiology – Unknown, however often associated with
obesity, inactivity, hypertension, elevated cholesterol
(combined hyperlipidemia).

8. SYMPYOMS:
• Apart from 3 P’s they also have
1. Blurred
vision
2. Slow healing
of wound
Type 2 diabetes:

9. Type 2 diabetes:
TREATMENT:
 First treated with weight reduction, a diabetic diet, and an
exercise.
 When these measures fail to control the elevated blood
sugars, oral medications are used.
 If oral medications are still insufficient, treatment with
insulin is considered.

10. Comparison betn Type 1 and
Type 2 Diabetes mellitus
Feature Type 1 Type 2
Onset Sudden Gradual
Age at onset Mostly children Mostly adults
Body habitus Thin or normal Often obese
Ketoacidosis Common Rare
Autoantibody Usually present Absent
Endogenous insulin Low or absent Normal, decreased or
increased
Concordance in identical twins 50% 90%
Prevalence ~10% ~90%

11. Type 3 diabetes:
 This covers a wide range of specific types of diabetes including
various genetic defects in insulin action, and diseases of the
exocrine pancreas.
 Many individual cases are reported which differ from each
other.
 Some examples:
• Prediabetes
• Latent autoimmune diabetes of adults (LADA)
• Some cases are caused by body's tissue receptors not responding
to insulin (even when insulin levels are normal, which is what
separates it from type 2 diabetes); this form is very uncommon.
• Genetic mutations (autosomal or mitochondrial) can lead to defects
in beta cell function.

12. Type 4 ‘Gestational’
 GDM resembles type 2 diabetes in several respects,
involving a combination of relatively inadequate insulin
secretion and responsiveness.
 Occurs in about 2%–5% of all pregnancies and may
improve or disappear after delivery. (www.wikipedia.org)
 Gestational diabetes is fully treatable, but requires
careful medical supervision throughout the pregnancy.
 About 20%–50% of affected women develop type 2
diabetes later in life. (www.wikipedia.org)

13. Type 4 ‘Gestational’
 Though transient, untreated GDM can damage the health
of the fetus or mother.
 Risks to the baby include macrosomia (high birth weight),
congenital cardiac and central nervous system anomalies,
and skeletal muscle malformations.
 Increased fetal insulin may inhibit
fetal surfactant production and cause respiratory distress
syndrome.
 Hyperbilirubinemia may result from red blood cell
destruction.
 In severe cases, perinatal death may occur, most
commonly as a result of poor placental perfusion due to
vascular impairment

14. Common consequencesof diabetes...
 Over time, diabetes can damage heart, blood vessels,
eyes, kidneys, and nerves.
 Diabetes increases the risk of heart disease and stroke.
50% of people with diabetes die of cardiovascular disease
(primarily heart disease and stroke).
 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. 1%
of global blindness can be attributed to diabetes.
 Diabetes is among the leading causes of kidney failure.
 The overall risk of dying among people with diabetes is at
least double the risk of their peers without diabetes.

15. Prevention:
Simple lifestyle measures have been shown to be
effective in preventing or delaying the onset of type 2
diabetes. To help prevent type 2 diabetes and its
complications, people should:
 achieve and maintain healthy body weight;
 be physically active – at least 30 minutes of regular,
moderate-intensity activity on most days. More activity
is required for weight control;
 eat a healthy diet of between three and five servings of
fruit and vegetables a day and reduce sugar and
saturated fats intake;
 avoid tobacco use – smoking increases the risk of
cardiovascular diseases.

16. Diagnosis and Treatment:
 Early diagnosis can be accomplished through
relatively inexpensive blood testing.
 Treatment of diabetes involves lowering blood
glucose and the levels of other known risk factors that
damage blood vessels. Tobacco use cessation is also
important to avoid complications.
 moderate blood glucose control. People with type 1
diabetes require insulin; people with type 2 diabetes
can be treated with oral medication, but may also
require insulin;
 blood pressure control;
 foot care.

17. Diagnosis and Treatment:
Other cost saving interventions include:
 screening and treatment for retinopathy (which
causes blindness);
 blood lipid control (to regulate cholesterol levels);
 screening for early signs of diabetes-related kidney
disease.
 These measures should be supported by a healthy
diet, regular physical activity, maintaining a normal
body weight and avoiding tobacco use.

18. References:
1. http://en.wikipedia.org/wiki/Diabetes_mellitus
2. http://www.diabetescare.net/
3. http://www.medicinenet.com/diabetes_mellitus/
4. http://diabetes.webmd.com
5. http://www.mayoclinic.com/print/type-1-diabetes
6. http://diabetes.niddk.nih.gov
7. http://www.who.int/topics/diabetes_mellitus/en/
8. http://www.patient.co.uk/doctor/diabetes-mellitus
9. http://www.news-medical.net/health/Diabetes-Mellitus-Type-2-
Pathophysiology.aspx
10. http://www.health.am/db
11. http://diabetes.webmd.com
12. http://en.wikipedia.org/wiki/Insulin

19. Thank you