diabetes mellitus

2. ARISHA IBRAHIM
ROLL NO. 105
2nd YEAR MBBS

3. “DIABETES MELLITUS”

4. LAY OUT
 Definition
 Types
 Etiology
 Sign/symptoms
 Complications
 Ketoacidosis
 Diagnosis
 Treatment
 References
 Acknowledgements

5. DEFINITION
“It is a metabolic syndrome of
impaired Carbohydrate,Lipid &
protein metabolism characterized
by “Hyperglycemia” either due to
insufficient insulin or defective
insulin receptors leading to
Polyuria, Polydipsia &
Polyphagia.”

7. TYPES OF DM
1) Type 1 DM
2) Type 2 DM
 Type 2 is further classified as:
• Non-Obese Type 2 DM
• Obese Type 2 DM

8. TYPE 1 DM
Due to Insulin
deficiency also
called :
Insulin Dependent
DM (IDDM)
Juvenile onset DM

9. TYPE 2 DM
Due to combined insulin
resistance & decrease
insulin secretions also
known as :
Noninsulin Dependent
DM (NIDDM)
Adult onset DM

10. SUB TYPES OF NIDDM
NON-OBESE TYPE
2 DM
Do not show the
early phase of
insulin release in
response to raised
Plasma glucose but
B cells do respond
to other
Insulinogenic
stimuli.
OBESE TYPE 2 DM
Insulin Resistance
cause Hyperplasia of
B cells
.Hyperinsulinemia
cause Down
Regulation of insulin
receptors. Obesity is
of Abdominal type
(Apple Like ).

12. ETIOLOGY
OF

13. TYPE 1DM TYPE2 DM
• Autoimmune
Diseases
• Idiopathic
• Environmental
Factors
Mumps
Rubella
Viruses
• Nutrients
Cow milk
• Mutation of
insulin receptor
Gene (19)
• Auto antibodies
to insulin
receptor
• Obesity
• Hemo-chromatosis

15. FACTORS CAUSING INSULIN RESISTANCE
 Obesity
 Excess Glucocorticoids
 Excess Growth Hormone
 Lipodystrophy
 Ploycystic Ovary Disease
 Mutation in Insulin Receptor
 Contraceptive agents
 B cell Adenoma
 Other causes

16. 16

17. 17

18. SIGN/SYMPTOMS
o Glucosuria
o Polyuria
o Poydipsia
o Polyphagia
o Weight Loss
o Hyperlipedemia

20. COMPLICATIONS OF DM
 EARLY
Ketoacidosis
Coma
Late Complications
Macrovascular
Microvascular

21. A. MACROVASCULAR
• Atherosclerosis of
Coronary Vessels
• Cerebral Accidents
(stroke)

22. B. MICROVASCULAR
 Diabetic Retinopathy

23.  Diabetic Cataract

24.  Diabetic Nephropathy
Proteinuria + Hypertension + Edema
( KIMMELSTEL-WILSON SYNDROME)

25.  Diabetic Neuropathy

26.  Diabetic Gangrene

27. EARLY Complications
• Diabetic
Ketoacidosis
DKA
• Common
in Type 1
• Hyperosmolar
Hyperglycemic
Nonketotic
syndrome
HHNS
• Common
in Type 2

28. DKA
Insulin + Glucagon
Hormone Sensitive Lipase
Lipolysis + Fatty acid
oxidation
KETONE BODIES
(8-15mmol/l)
Ketonemia
Ketonuria
Ketoacdisis
Coma
HHNS
Blood
glucose+Cellular
dehydration
Hyperosmolarity
(340mOsm/l)
Brain cells shrinkage
Coma

29. SIGN/SYMPTOMS
DKA
1. Hyperglycemia
2. Nausea
3. Air Hunger
4. Fruity Breath
Odor
5. Hypotension
6. Tachycardia
7. Abdominal Pain
8. Fatigue
HHNS
1. Altered
Consciousness
2. Hyperthermia
3. Motor & sensory
impairment
4. Seizures
5. Dry skin & Mucous
Mem.
6. Hypotension
7. Extreme thirst
8. Hperglycemia

30. CLINICAL FEATURES OF DKA

31. DIAGNOSIS
DKA
• Metabolic
Acidosis
• Blood Glucose
is relatively
low 350mg/dl
• Ketone bodies
in Urine
• Low
Bicarbonate &
Blood ph
HHNS
• No acidosis
• Blood glucose
level is up to
800-1000
mg/dl
• Altered Level of
Consciousness
• No fruity smell
of Breath

32. MANAGEMENT
DKA
 Intravenous Fluids
 Administration of
Potassium
 Administration of
Sodium Bicarbonate
 Insulin
 Mannitol /Hypertonic
saline 3% to treat
Cerebral Edema
HHNS
 Intravenous
Fluids to treat
Dehydration
 Electrolyte
Replacement
specially K+
 Insulin to lower
blood Glucose
level

33. INSULIN SHOCK & HYPOGLYCEMIA
 Type 1 DM
 Insulin therapy/Missing meals/ Excersise
Sign/symptoms
• Blood Glu (50-70mg/100ml) CNS excites
• Hallucinations
• Trembling/sweating
• Blood Glu (20-50mg/100ml)
• Clonic Seizures/Unconsciousnes
• Coma

34. DIAGNOSIS
• low blood Glucose level
• No rapid deep breathing
TREATMENT
• Iv Glucose
• Glucagon
• Epinephrine

35. DIAGNOSTIC TEST FOR DM
o GLUCOSURIA
To detect Glucose in Urine
by a Paper Strip Method
o FASTING BLOOD GLUCOSE
LEVEL
Normal : 60-110 mg/dl
Impaired: 110-126 mg/dl
Abnormal: >126 mg/dl

36. o RANDOM BLOOD GLUCOSE LEVEL
Normal : 110-140 mg/dl
Impaired : 140-200 mg/dl
Abnormal: >200 mg/dl

37. o GLUCOSE TOLERANCE TEST (GTT)
• Indicate Milder or Early DM
 Standard Oral GTT
 Intravenous GTT
FASTING
2Hrs
Normal
mg/dl
100
<140
Impaired
mg/dl
100-125
140-199
Diabetes
mg/dl
>126
>200

38. o GLYCOSYLATED HAEMOGLOBIN HbA1c
• Normally it contains 4-6% of
total Hb
• In case of DM its is >7%

39. TREATMENT OF DM
Non
pharmacological
Therapy
Pharmacological
Therapy

40.  NON PHRAMACOLOGICAL THERAPY
DIET
1. TYPE 1 DM :
Fat + Cholesterol+ Carbohydrate
2. TYPE 2 DM : (Cont’d)
“Caloric” Restriction

41. ( Cont’d)
• ARTIFICIAL
SWEETNERS
Aspartate
Saccharin
Acesulfame
• NUTRITIVE SWEETNERS
Fructose
Sorbitol

42. ACTIVITY
Exercise should start slowly in
patients to enhance Insulin
sensitivity

43. PHARMACOLOGICAL THERAPY
o INSULIN both for DM Type 1 & 2
o Drugs Inc. Insulin sensitivity :
Thiazolidinedione
Metformin
Troglitazone
o Drugs Inc. Insulin Release :
Sulfonylureas
(Glyburide & Tolbutamide)
o α- Glucosidase Inhibitors

44. REFERENCES
o Harrison’s Principles Of Internal
Medicine (17th Edition)
o William’s Book Of Endocrinology
(11th Edition)
o Guyton & Hall Physiology
(12th Edition)
o Medical Biochemistry By Mushtaq
Ahmad (7th Edition)
o Textbook Of Medical Biochemistry By
MN.Chatterjea (8th Edition)
o Wikipedia

45. ACKNOWLEDGEMENTS
• ALLAH ALMIGHTY
• Prophet (SAW)
• My Parents
• HOD of Biochemistry
“Dr. Khawaja Muhammad Fayyaz”
• My Sister
Dr. Sidra Zafar
• My Friends