This PPT will be help for the nursing students who learn Adult Health Nursing.

1. Diabetes Mellitus
By
Prof. Anandh Sam Perera

2.  Chronic medical disorder.
 A syndrome of impaired
Carbohydrate, fat and protein
metabolism caused by either lack of
insulin secretion or decreased
sensitivity of the tissues to insulin.
What is diabetes mellitus?

3. History
 Arguably, SUSHRUTA is the person who
discovered diabetes in 400BC. In 600 BC,
he included exercise in his prescriptions to
prevent and treat diabetes.
 Diabetes was regarded by sushruta as as
disease of the urinary tract (prameha). He
noticed the sweet nature of urine and termed
the condition Madhu meha.

4. Insulin
 Hormone secreted by β cells of pancreas.
 This promotes glucose transport into the
cells & turns sugar into energy for the
body to use.
 It effects CHO, lipid and protein
metabolisms.

5. What happens without insulin?
Lack of insulin

Build up of glucose in the
blood (hyperglycemia)

Symptoms of Diabetes
Mellitus

6. Type 1 Diabetes Mellitus –
lack of insulin production by beta cells of
the pancreas

7. Injury to beta cells of pancreas or
diseases that impair insulin production can
lead to type I diabetes.
Reason for injury:
 Viral infection
 Autoimmune disorders
 Hereditary tendency for beta cell
degeneration.

8. Type 2 Diabetes Mellitus
 Far more common than type I.
 NIDDM
 Accounts for ≈ 90% of all cases of
diabetes mellitus.

9. Risk factors for type 2 diabetes
•Obesity
•Age > 45
•Physically inactive.
•Positive family history
•High Cholesterol levels
•High BP
•GDM or given birth to a baby of > 3.5kg

10. Symptoms of Diabetes
 Slower onset
 Increased thirst
 Increased urination
 Increased appetite
 Fatigue
 Blurred vision
 Slow-healing infections
 Impotence in men
• Increased thirst
• Increased urination
• Weight loss in spite of increased
appetite
• Fatigue
• Nausea
• Vomiting
• Coma
• Patients with type 1 diabetes usually
develop symptoms over a short
period of time, and the condition is
often diagnosed in an emergency
setting.
Type 2
Type 1

11. Insulin Resistance
“Diminished sensitivity of target
tissues to the metabolic effects of
insulin.”

12. When cell becomes resistance to insulin
Less glucose uptake by cells
plasma glucose
Type II Diabetes

13. Hyperglycemia Can Cause
Serious Long-Term Problems

14. Diagnosis
 Fasting blood glucose level/ PPG
 HBA1C
 Insulin C peptide
 Glucose tolerance test
 Urinary Glucose

15. Criteria for the Diagnosis of Diabetes
FPG 2-h postload glucose
Normal <100 mg/dl <140 mg/dl
IFG 100–125 mg/ dl -
IGT - 140–199 mg/dl
Diabetes ≥126 mg/dl ≥200 mg/dl

16. HbA1c: the blood test with a memory
What is HbA1c?
Hemoglobin is a protein that makes
your red blood cells red-colored.
When hemoglobin picks up glucose
from your bloodstream, the hemoglobin
becomes glycosylated.
Glycosylated hemoglobin is HbA1c.
The HbA1c test measures the
percentage of HbA1c in your blood—
a number that corresponds to your
average blood glucose for the previous
3 months.
HbA1c in your bloodstream.

17.  LIFE STYLE IS THE WAY WE LIVE
 Studies included people with IGT
and other high-risk characteristics
for developing diabetes.
 Lifestyle interventions included diet and moderate-
intensity physical activity (such as walking for 2 1/2
hours each week).
 In the Diabetes Prevention Program, a large
prevention study of people at high risk for diabetes,
the development of diabetes was reduced 58% over 3
years.
Prevention or delay of diabetes:
Life style modification

18.  In the Diabetes Prevention Program, people
treated with the drug Metformin reduced their risk
of developing diabetes by 31% over 3 years.
 Similarly, in the STOP-NIDDM Trial, treatment of
people with IGT with the drug Acarbose reduced
the risk of developing diabetes by 25% over 3
years.
 Other medication studies are ongoing. In addition
to preventing progression from IGT to diabetes,
both lifestyle changes and medication have also
been shown to increase the probability of reverting
from IGT to normal glucose tolerance.
Prevention or delay of diabetes: Medications

19. Management of
Diabetes Mellitus

20.  The major components of the treatment of diabetes are:
Management of DM
• Diet and Exercise
A
• Oral hypoglycaemic
therapy
B
• Insulin Therapy
C

21. Diet is a basic part of management in
every case. Treatment cannot be
effective unless adequate attention is
given to ensuring appropriate nutrition.
AIM:
◦ weight control
◦ Adequate nutritional requirements
◦ good glycaemic control
◦ Correcting associated blood cholesterol
levels.
A. Diet

22. TLC DIET
 Carbohydrates 45-60% of calories
 Avoid Raw sugar – High GI
 Avoid nutritive sweetness
 Rice, Wheat, Rahi same nutritive value.
 Refined sugar raises Glucose quickly.
 Use complex carbohydrates- whole grains
 Reduce rice & add vegetables, greens.

23. Sugar sweetened beverages (SSB)
 Cardio diabetes risk increased.
 Weight gain, increased insulin demand
 Dyslipidemia and chronic inflammation.
Dietary changes in India/Asia
 Shift from Green to polished rice & refined wheat High GI and GL India/China
 Reduced cereals
 High energy intake
 Increased meat, edible oil, animal fat and fast foods
 Decreased fiber
DIET AND DIABETIC RISK
Nutrition transition has increased DM

24. Recommended dietary guidelines :
Dietary fat 25-35% of total intake
Protein intake between 10-15% total energy
Excessive salt intake is to be avoided.
A. Diet (cont.)

25. Good News About Physical Activity

26. TLC EXERCISE
USDA Recommendation:
30minutes of moderate intensity physical activity
for most days of the week & reduce sedentary
activities.
Aerobic Exercise:
Brisk walking, jogging, running, swimming, Cycling.
Anaerobic Exercise: Strength training
-Increases muscles mass
&
-Bone / muscle strength
Indoor Exercise:
Evaluate clinically & start
Caution: Cardiac Ischemia, Retinopathy
BRISK WALKING BEST

27. Introduction to self-management
Key pieces of diabetes self-management:
Monitoring
blood glucose
Taking
medication
Following a
meal plan
Getting regular
exercise

28. Conclusions…
 Prevention of Diabetes at the Prediabetes Stage is
the main aim of controlling diabetes.
 Prevention of diabetes is a possibility with Lifestyle
modification.
 Education to promote healthy lifestyle, increased
exercise opportunities and changes in the Food
industry (low fat and high fiber foods)
Decrease the prevalence of diabetes
 Type 2 Diabetes is preventable.